The natural history of euthyroid Hashimoto’s thyroiditis in children

Radetti, Giorgio; Gottardi, Elena; Bona, Gianni; Corrias, Andrea; Salardi, Silvana; Loche, Sandro; Study Group for Thyroid Diseases of the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP/ISPED),

doi:10.1016/j.jpeds.2006.08.045

« Previous Next »The Journal of Pediatrics
Volume 149, Issue 6 , Pages 827-832, December 2006

The natural history of euthyroid Hashimoto’s thyroiditis in children

Giorgio Radetti, MD
- Reprint requests: Dr. Giorgio Radetti, Department of Pediatrics, Regional Hospital, Via L Boehler 5, 39100 Bolzano, Italy.
Elena Gottardi, MD
Gianni Bona, MD
Andrea Corrias, MD
Silvana Salardi, MD
Sandro Loche, MD
Study Group for Thyroid Diseases of the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP/ISPED)
- Members of the Study Group for Thyroid Diseases of the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP/ISPED) are Fabio Buzi (Brescia), Marco Cappa (Roma), Elena Faleschini (Trieste), Edoardo Farinelli (Perugia), Roberto Gastaldi (Genova), Nella Augusta Greggio (Padova), Lorenzo Iughetti (Modena), Daniela Larizza (Pavia), Silvana Lauriola (Verona), Costanzo Mastrangelo (Foggia), Mariacarolina Salerno (Napoli), and Alessandro Salvatoni (Varese)

From the Department of Pediatrics, Regional Hospital, Bolzano, Italy; Pediatric Clinic, University of Novara, Novara, Italy; Department of Pediatrics, Regina Margherita Hospital, Torino, Italy; Pediatric Clinic, University of Bologna, Bologna, Italy; and Pediatric Endocrine Unit, Regional Hospital for Microcitemie, Cagliari, Italy.

Received 13 December 2005; received in revised form 25 April 2006; accepted 19 August 2006.

Objective

To study the natural history of Hashimoto’s thyroiditis (HT) in children and identify factors predictive of thyroid dysfunction.

Study design

We evaluated 160 children (43 males and 117 females, mean age 9.10 ± 3.6 years, with HT and normal (group 0; 105 patients) or slightly elevated (group 1; 55 patients) serum thyroid-stimulating hormone (TSH) concentrations. The patients were assessed at presentation and then followed for at least 5 years if they remained euthyroid or if their TSH did not rise twofold over the upper normal limit.

Results

At baseline, age, sex, thyroid volume, free thyroxine, free triiodothyronine, thyroid peroxidase antibody (TPOab), and thyroglobulin antibody (TGab) serum concentrations were similar in the 2 groups. During follow-up, 68 patients of group 0 remained euthyroid, and 10 patients moved from group 0 to group 1. In 27 patients, TSH rose twofold above the upper normal limit (group 2), and 9 of these patients developed overt hypothyroidism. Sixteen patients of group 1 ended up in group 0, 16 remained in group 1, and 23 moved to group 2. A comparison of the data of the patients who maintained or improved their thyroid status with those of the patients whose thyroid function deteriorated revealed significantly increased TGab levels and thyroid volume at presentation in the latter group. However, none of these parameters alone or in combination were of any help in predicting the course of the disease in a single patient.

Conclusions

The presence of goiter and elevated TGab at presentation, together with progressive increase in both TPOab and TSH, may be predictive factors for the future development of hypothyroidism. At 5 years of follow-up, more than 50% of the patients remained or became euthyroid.

Abbreviations: CD, Celiac disease, DM, Diabetes mellitus, fT3, Free triiodothyronine, fT4, Free thyroxine, HT, Hashimoto’s thyroiditis, TGab, Thyroglobulin antibody, TPOab, Thyroid peroxidase antibody, TS, Turner’s syndrome, TSH, Thyroid-stimulating hormone