Clinical Follow-Up of Children and Adolescents with Hashimoto Thyroiditis / 대한소아내분비학회지

PURPOSE: We aimed to study the clinical manifestations and clinical course of Hashimoto thyroiditis in children and adolescents. METHODS: We retrospectively analyzed the clinical manifestations and thyroid function in 59 children and adolescents with Hashimoto thyroiditis who were admitted at Kangnam St. Mary's Hospital between January 1999 and January 2009. RESULTS: We investigated thyroid function and clinical manifestations of thyroiditis in 50 female and 9 male patients. The mean age of the patients at the time of diagnosis was 10.6+/-2.7 years, and the mean duration of follow-up was 3.8+/-3.1 years. The most common complaints at the time of diagnosis were goiter (77.9%), fatigue (38.9%), weight gain, constipation, growth retardation, headache, nervousness, cold intolerance, and menstrual disturbances. Antithyroid peroxidase antibodies were detected in 52 patients (88.1%); antithyroglobulin antibodies, 45 patients (76.2%); and both antibodies, 42 patients (71.1%). The height, weight, and body mass index (BMI) standard deviation scores (SDS) of the patients at the time of diagnosis were not markedly different from the corresponding scores at the patients' last visit. At the time of the last follow-up, 19 patients were in remission and 40 were in non-remission state. At the first visit, there were no significant differences between the age, thyroid function test, positive rate of thyroid autoantibody, weight, and BMI SDS of patients in the remission group (RG) and non- remission group (N-RG). However, at the time of initial diagnosis, the height (Ht)-SDS of the patients in RG were greater than in N-RG (P=0.037). At the end of follow up, euthyroidism was achieved in 53 patients, 5 patients had compensated hypothyroidism, and 1 patient had overt hypothyroidism. CONCLUSION: The patients with thyroid dysfunction at diagnosis were 72.9% and 32.2% of patients were in remission. We could not find out significant predictive factor for remission at the time of diagnosis and further studies with a large number of subjects should be performed.

Serum IGF-I and IGFBP-3 Concentrations in Children with Cancer: Comparisons with Normal Children / 대한소아내분비학회지

PURPOSE: Since insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) are often used as markers for growth assessment, we compared the serum IGF-I and IGFBP-3 levels in children diagnosed with cancer with those in the healthy children. METHODS: Forty-nine children who were diagnosed with cancer and treated with radiotherapy or chemotherapy were enrolled in the study. Sixty-four healthy children without any medical problems were enrolled as controls. Height, weight, body mass index (BMI), height standard deviation score (HTSDS), serum IGF-I, serum IGFBP-3 and molar ratio of IGF-I/IGFBP-3 were compared between the two groups. RESULTS: The mean age of children in the control group was 9.3+/-2.9 years and that of children in the cancer group was 8.8+/-3.3 years. There were no significant differences in mean height, weight, BMI and HT SDS between in the two group. Serum IGF-I levels increased with age in both groups, and the mean level of the control group was significantly higher than that of the cancer group. The mean serum level of IGFBP-3 in the control group was higher than that of the cancer group. IGF-I/IGFBP-3 molar ratio also increased with age in both groups and the mean level of molar ratio of the control group was higher than that of the cancer group. IGF-I, IGFBP-3, and IGF-I/IGFBP-3 molar ratio in the leukemia group and the solid tumor group were not significantly different. Mean age, IGF-I and IGFBP-3 concentrations in the chemotherapy group were higher than those in the chemotherapy and radiation therapy group. CONCLUSION: The serum levels of IGF-I and IGFBP-3 in children diagnosed with cancer, treated with radiotherapy or chemotherapy, were lower than those of the control group. In conclusion, the serum levels of IGF-I and IGFBP-3 can possibly be used as early markers of growth assessment in children with cancer treatment.

A case of PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis) syndrome / 소아과

PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis) syndrome is one of the causes of periodic fever in pediatrics with unknown etiology. It is characterized by abrupt onset of fever, malaise, aphthous stomatitis, pharyngitis and cervical adenitis without long-term sequelae. Laboratory findings of this sporadic and nonhereditary syndrome are so non-specific that the diagnosis is based on clinical findings. Oral prednisolone is quite effective in controlling the symptoms. We report a case of a 6-year-old girl who was diagnosed as having PFAPA syndrome after 2 years of episodes, by excluding other disease entities with similar clinical features. The patient was treated with oral prednisolone and her symptoms improved dramatically.