Pro-inflammatory Cytokine Levels and Cancer-related Fatigue in Breast Cancer Survivors: Effects of an Exercise Adherence Program / 한국유방암학회지

Purpose@#This study aimed to determine the effect of an exercise intervention on subjective cancer-related fatigue (CRF) and pro-inflammatory cytokine levels in breast cancer survivors (BCS). @*Methods@#BCS with greater than moderate CRF (≥ 4) were recruited and randomly assigned to experimental or control groups. The experimental group participated in a 12-week exercise adherence program (Better Life after Cancer - Energy, Strength, and Support; BLESS). Interleukin (IL)-6 and tumor necrosis factor-α (TNF-α) levels were determined at 3 time points (M1: baseline, M2: post-intervention, and M4: 6 months after intervention). Subjective fatigue was measured using the Korean version of the revised Piper Fatigue Scale. @*Results@#In this analysis of participants with physiological fatigue measures available (19 experimental, 21 control), there were no statistically significant differences in IL-6 (F = 1.157, p = 0.341), TNF-α levels (F = 0.878, p = 0.436), and level of fatigue (F = 2.067, p = 0.118) between the 2 groups at baseline. Fatigue in the experimental group showed statistically significant improvement compared to the control only at M2 (p = 0.022). There was no significant relationship between subjective and physiological fatigue at the 3 measurement points. @*Conclusion@#The BLESS intervention improved CRF in BCS immediately at post-intervention, and this study presents clinical feasibility for the management of CRF in BCS in the early survivorship phase who are already experiencing fatigue.

The adiposity rebound in the 21st century children: meaning for what? / 소아과

With the increase in the prevalence of overweight and obesity worldwide, early adiposity rebound, which is known to have a strong association with obesity, has recently been a focus of research. Early adiposity rebound is conventionally known to have a close relationship with non-communicable diseases. However, novel insights into early adiposity rebound have implied an acceleration of growth and puberty, which is directly reflected in the trends in the timing of adiposity rebound, in the 21st century compared with in the past. Furthermore, the observation that lean mass changes rather than fat mass changes show a more similar pattern to body mass index trajectories is interesting. In this article, the later outcomes and risk factors of early adiposity rebound are briefly summarized, and the current trends in the timing of adiposity rebound and novel insights into its relationship with body composition are reviewed.

Prevalence of Lower Bone Mineral Density and Its Associated Factors in Korean Children and Adolescents with Juvenile Idiopathic Arthritis

OBJECTIVE: This study examined the prevalence of low-bone mineral density (BMD) and its associated factors in Korean children and adolescents with juvenile idiopathic arthritis (JIA). METHODS: Thirty-nine patients with JIA were included in this cross-sectional study. The patients were examined for their bone age (BA) and bone mineral density (BMD). The BMD was measured using dual-energy X-ray absorptiometry on the lumbar spine. Each BMD value was converted to a Z-score by comparing the reference values of the healthy control group in terms of the age and sex of each patient, which was measured using the same device. A Z-score of less than −2.0 was defined as a low BMD. Laboratory tests were performed to detect the serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D levels. RESULTS: The mean age at the time of the examination was 12.2±3.6 years, and the study comprised a total of 39 patients (16 males, 23 females). Patients with systemic JIA had a lower BMD, which was calculated based on the CA, BA, and HA, than those with non-systemic JIA (P=0.020, P=0.049, and P=0.024, respectively); the corticosteroid user group also showed a lower BMD, which had been calculated based on the CA, BA, and HA, than the corticosteroid non-user group (p=0.002, p=0.022, and p=0.188, respectively). CONCLUSION: This study suggests that JIA patients have a lower BMD than control subjects. Therefore, treatment, and education are warranted while treating patients with JIA, particularly those requiring oral corticosteroids or those with systemic JIA and appropriate laboratory tests.

Novel genetic cause of idiopathic short stature

Traditionally, the growth hormone – insulin-like growth factor I (GH – IGF-I) axis is the most important signaling pathway in linear growth, and defects in this axis present as growth hormone deficiencies or IGF-I deficiencies. However, subtle changes in serum levels of GH or IGF-I, caused by gene mutations involved in the GH – IGF-I axis, can present as idiopathic short stature (ISS). This paper briefly discusses GHR and IGFALS. In addition, recent studies have shown that many factors, including paracrine signals, extracellular matrix, and intracellular mechanisms of chondrocytes, regulate the growth plate independent of the GH – IGF-I system. Rapid development of diagnostic technologies has enabled discovery of many genetic causes of ISS. This paper discusses 5 genes, SHOX, NPR2, NPPC, FGFR3, and ACAN, that may lead to better understanding of ISS.

Comparison of Cervical-lymph-node-first Presentation of Kawasaki Disease and Typical Kawasaki Disease

PURPOSE: The diagnosis of Kawasaki disease depends on clinical symptoms, which makes it difficult to diagnose early in patients with only cervical lymphadenopathy. The purpose of this study is to understand the clinical characteristics of cervical-lymph-node-first presentation of Kawasaki disease and compare them with those of typical Kawasaki disease. METHODS: We surveyed 283 patients who were admitted to Hallym Sacred Heart Hospital and were diagnosed with Kawasaki disease from January 2012 to December 2014. The patients were divided into two groups: cervical-lymph-node-first presentation of Kawasaki disease (LKD, N=24) and typical Kawasaki disease (KD, N=259). The medical records were retrospectively reviewed. RESULTS: The mean age of the LKD group was higher than that of the KD group (P=0.04). At admission, the LKD patients had on average 1.62 out of 5 symptoms, whereas the KD patients had 3.47. The time from fever to diagnosis and administration of IV immunoglobulin was longer in the LKD group than in the KD group (P<0.001). The mean C-reactive protein of the LKD group was higher than that of the KD group (P=0.01). There were no statistical differences in the presence of coronary artery complications between the two groups at two weeks or at two months after diagnosis (P=0.52, P=0.08). CONCLUSIONS: The Kawasaki disease patients with fever and cervical lymphadenopathy usually do not present obvious clinical symptoms, which makes it hard to diagnose in the early phase of disease. Clinician must pay attention when examining these patients.

Accidental ingestion of E-cigarette liquid nicotine in a 15-month-old child: an infant mortality case of nicotine intoxication / 소아과

Electronic cigarettes are novel tobacco products that are frequently used these days. The cartridge contains liquid nicotine and accidental poisoning, even with a small oral dose, endangers children. We present here a mortality case of a 15-month-old child who ingested liquid nicotine mistaking it for cold medicine. When the emergency medical technicians arrived, she was found to have pulseless electrical activity. Spontaneous circulation was restored after approximately 40 minutes of cardiopulmonary resuscitation. The cotinine level in her urine was 1,716 ng/mL. Despite intensive supportive care, severe anoxic brain injury was found on computed tomography and the child ultimately died. This fatality highlights the need for public health efforts to minimize such accidents.

Prevalence and Risk Factors for Undercorrected Refractive Errors among South Korean: KNHANES 2008-2012

PURPOSE: To assess the prevalence and risk factors of undercorrected refractive error in South Korea. METHODS: We analyzed 36,162 participants for estimating prevalence using the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2012). Undercorrected refractive error was defined as an improvement of at least 2 lines in best corrected visual acuity compared with the presenting visual acuity in the right eye. Proportion of undercorrected refractive error by occupation was presented, and associated sociodemographic factors were evaluated by multivariable logistic regression. RESULTS: The prevalence of undercorrected refractive error among all participants and among adults was 8.5% (n/N, 6,954/36,162) and 18.8% (n/N, 3,980/19,884), respectively. The proportion of undercorrected refractive error was higher among those with did not wear spectacles or contact lenses (23.1%) than among spectacle or contact lens wearers (8.1%). The proportion of participants who gained more than four or more lines of best corrected visual acuity was 7.2% (n = 2,606) for the all age group. In terms of occupation, farming, fishing, and forestry occupations (22.8%, 570/2,499) and laborer (20.2%, 497/2,457) were more likely to have undercorrected refractive error. Age groups of 10s, 70s, or 80s (30s as a reference group), female sex, lower income, lower education level, and living without a spouse were associated with undercorrected refractive error. CONCLUSIONS: People of older age, female sex, and lower socioeconomic status were more likely to have undercorrected refractive error. This suggests that a public-health approach is needed for preventing visual impairment via proper vision correction.

The impact of obesity on hyperandrogenemia in Korean girls

PURPOSE: As metabolic complication and polycystic ovarian syndrome due to childhood obesity is rising, the role of hyperandrogenemia (HA) and hyperinsulinism is receiving attention. The aims of this study were to investigate the presence of obvious HA according to pubertal status and to find potential etiologic determinants of HA in Korean obese (OB) girls. METHODS: We analyzed 91 girls aged 6–17 years (prepuberty, n=54; puberty, n=37). Each girl was classified as being either normal weight (NW) or OB. Anthropometric measurements were obtained and blood test was performed early in the morning after at least 8 hours of fasting to measure glucose, insulin, total testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular-stimulating hormone, estradiol, and progesterone. RESULTS: The plasma levels of free testosterone (FT) and DHEAS were markedly higher in OB girls compared to NW girls in puberty (FT, P=0.009; DHEAS, P=0.046) but not in prepuberty (FT, P=0.183; DHEAS, P=0.052). Hyperinsulinemia and high homeostasis model assessment of insulin resistance (HOMA-IR) values were found regardless of pubertal status in OB girls. The significant related factor to HA in puberty was the body mass index Z-score (P=0.003). But HOMA-IR, LH, and progesterone levels were not relevant to HA in pubertal girls. CONCLUSION: OB prepubertal girls did not show HA in the present study but they should be regularly monitored because they already had hyperinsulinemia. OB pubertal girls had significant HA and hyperinsulinemia, and obesity per se was the most important factor for HA.

The impact of obesity on hyperandrogenemia in Korean girls

PURPOSE: As metabolic complication and polycystic ovarian syndrome due to childhood obesity is rising, the role of hyperandrogenemia (HA) and hyperinsulinism is receiving attention. The aims of this study were to investigate the presence of obvious HA according to pubertal status and to find potential etiologic determinants of HA in Korean obese (OB) girls. METHODS: We analyzed 91 girls aged 6–17 years (prepuberty, n=54; puberty, n=37). Each girl was classified as being either normal weight (NW) or OB. Anthropometric measurements were obtained and blood test was performed early in the morning after at least 8 hours of fasting to measure glucose, insulin, total testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular-stimulating hormone, estradiol, and progesterone. RESULTS: The plasma levels of free testosterone (FT) and DHEAS were markedly higher in OB girls compared to NW girls in puberty (FT, P=0.009; DHEAS, P=0.046) but not in prepuberty (FT, P=0.183; DHEAS, P=0.052). Hyperinsulinemia and high homeostasis model assessment of insulin resistance (HOMA-IR) values were found regardless of pubertal status in OB girls. The significant related factor to HA in puberty was the body mass index Z-score (P=0.003). But HOMA-IR, LH, and progesterone levels were not relevant to HA in pubertal girls. CONCLUSION: OB prepubertal girls did not show HA in the present study but they should be regularly monitored because they already had hyperinsulinemia. OB pubertal girls had significant HA and hyperinsulinemia, and obesity per se was the most important factor for HA.

Visual Acuity and Falls in South Korea: Korean National Health and Nutrition Examination Survey 2008-2012

PURPOSE: To assess the influence of visual acuity (VA) and ocular condition on falls. METHODS: We analyzed 28,899 Korean adults using cross-sectional data from the Korean National Health and Nutrition Examination Survey (2008-2012). Associations between best corrected VA based on better or worse seeing eye and ocular condition and falls were identified using multivariable logistic regression. We included sociodemographic factors and comorbidities including hypertension, diabetes, arthritis, acute myocardial infarction/angina, and stroke as independent variables. VA was divided into 1.0, 0.8, 0.5-0.63, and <0.5. RESULTS: Among 28,899 subjects, falls occurred in 511. In multivariable logistic regression analysis, low VA based on the better seeing eye was significantly associated with falls (VA 1.0 as a reference group; adjusted odds ratio [aOR] = 1.31, 95% confidence interval [CI], 1.00-1.72 in VA of 0.8; aOR = 1.86, 95% CI, 1.07-3.24 in VA of 0.5-0.63; and aOR = 1.21, 95% CI, 0.58-2.54 in VA of <0.5; p = 0.025 for trend). There was no association between VA based on the worse seeing eye and falls. Early age-related macular degeneration was associated with falls in univariable analysis (OR = 2.24) and age- and sex-adjusted analysis (aOR = 1.52), but not in multivariable analysis. In terms of age subgroups, subjects with VA of 0.5-0.63 were more likely to have experienced falls compared with subjects with VA of 1.0 (aOR = 5.83, 95% CI, 1.58-21.54) among subjects 50 years of age or younger. An increasing trend of falls with decreasing VA among subjects between 50 and 70 years of age was observed (p = 0.033 for trend). However, no such association was observed in elderly subjects ≥70 years of age. CONCLUSIONS: VA should be considered for preventing falls because lower VA is associated with increased risk of falls.

Development of Job Standards for Clinical Nutrition Therapy for Dyslipidemia Patients

Dyslipidemia has significantly contributed to the increase of death and morbidity rates related to cardiovascular diseases. Clinical nutrition service provided by dietitians has been reported to have a positive effect on relief of medical symptoms or reducing the further medical costs. However, there is a lack of researches to identify key competencies and job standard for clinical dietitians to care patients with dyslipidemia. Therefore, the purpose of this study was to analyze the job components of clinical dietitian and develop the standard for professional practice to provide effective nutrition management for dyslipidemia patients. The current status of clinical nutrition therapy for dyslipidemia patients in hospitals with 300 or more beds was studied. After duty tasks and task elements of nutrition care process for dyslipidemia clinical dietitians were developed by developing a curriculum (DACUM) analysis method. The developed job standards were pretested in order to evaluate job performance, difficulty, and job standards. As a result, the job standard included four jobs, 18 tasks, and 53 task elements, and specific job description includes 73 basic services and 26 recommended services. When clinical dietitians managing dyslipidemia patients performed their practice according to this job standard for 30 patients the job performance rate was 68.3%. Therefore, the job standards of clinical dietitians for clinical nutrition service for dyslipidemia patients proposed in this study can be effectively used by hospitals.

Comparison of the Medication Effects between Milnacipran and Pregabalin in Fibromyalgia Syndrome Using a Functional MRI: a Follow-up Study

PURPOSE: In this study, the medication effects of Milnacipran and Pregabalin, as well known as fibromyalgia treatment medicine, in fibromyalgia syndrome patients were compared through the change of BOLD signal in pain related functional MRI. MATERIALS AND METHODS: Twenty fibromyalgia syndrome patients were enrolled in this study and they were separated into two groups according to the treatment medicine: 10 Milnacipran (MLN) treatment group and 7 Pregabalin (PGB) treatment group. For accurate diagnosis, all patients underwent several clinical tests. Pre-treated and post-treated fMRI image with block-designed pressure-pain stimulation for each group were obtained to conduct the statistical analysis of paired t-test and two sample t-test. All statistical significant level was less than 0.05. RESULTS: In clinical tests, the clinical scores of the two groups were not significantly different at pre-treatment stage. But, PGB treatment group had lower Widespread Pain Index (WPI) and Brief Fatigue Inventory (BFI) score than those of MLN treatment group at post-treatment stage. In functional image analysis, BOLD signal of PGB treatment group was higher BOLD signal at several regions including anterior cingulate and insula than MLN treatment group at post-treatment stage. Also, paired t-test values of the BOLD signal in MLN group decreased in several regions including insula and thalamus as known as 'pain network'. In contrast, size and number of regions in which the BOLD signal decreased in PGB treatment group were smaller than those of MLN treatment group. CONCLUSION: This study showed that MLN group and PGB group have different medication effects. It is not surprising that MLN and PGB have not the same therapeutic effects since these two drugs have different medicinal mechanisms such as antidepressants and anti-seizure medication, respectively, and different detailed target of fibromyalgia syndrome treatment. Therefore, it is difficult to say which medicine will work better in this study.

Prepubertal unilateral gynecomastia in the absence of endocrine abnormalities

Gynecomastia is defined as the excessive development of breast tissue in males, which can occur as unilateral or bilateral. Although the overall prevalence of gynecomastia is 40%-65%, the prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is unusual, with only a few case reports in literature. Idiopathic gynecomastia in prepuberty is benign but a diagnosis of exclusion. We here report two cases of healthy prepubertal boys aged 8.8 and 9.6 years old, respectively, presented with painful palpable mass in their unilateral breast. Breast tissue with glandular proliferation was confirmed on ultrasonography. Serum levels of estradiol, testosterone, and other laboratory findings were within normal range. They seem to have the prepubertal idiopathic gynecomastia but further follow-up to see their progression is needed.

Clinical and Epidemiological Study of 1,165 Hospitalized Cases of Rotaviral Gastroenteritis Before and After the Introduction of Rotavirus Vaccine, 2006-2013 / 소아감염

PURPOSE: This study was performed to assess the clinical and epidemiological changes after the introduction of the rotavirus vaccine in Korea, as well as to determine the efficacy of the rotavirus vaccine among hospitalized rotaviral gastroenteritis patients over the past two years. METHODS: We analyzed yearly and seasonal patterns of 1,165 inpatients who were hospitalized for rotaviral gastroenteritis under the age of 5 years between 2006 and 2013. We also conducted a survey among 460 gastroenteritis patients who were hospitalized between 2012 and 2013 regarding the rotavirus vaccination and the symptoms of gastroenteritis. Among those individuals surveyed, clinical indices were analyzed for 124 patients who were tested positive for the rotavirus antigen. RESULTS: The incidence of Rotaviral gastroenteritis have decreased significantly by year 2010. After the introduction and widespread dissemination of the rotavirus vaccine, the onset of the disease and the seasonal peak have been delayed. Overall, the vaccinated group showed a lower rate of positivity than the unvaccinated group. Among the hospitalized rotaviral gastroenteritis patients, the vaccinated group had a shorter hospitalization period, less severe clinical symptoms of gastroenteritis, and better laboratory test results. CONCLUSIONS: After introduction of the rotavirus vaccine in Korea, there were two main trends observed: 1) the overall level of disease incidence was reduced; 2) the severity of rotaviral gastroenteritis cases also decreased. Based on this data, more children should receive vaccination in order to prevent the rotavirus infection and decrease the severity of rotaviral gastroenteritis.

Bone mineral density deficits in childhood cancer survivors: Pathophysiology, prevalence, screening, and management / 소아과

As chemotherapy and other sophisticated treatment strategies evolve and the number of survivors of long-term childhood cancer grows, the long-term complications of treatment and the cancer itself are becoming ever more important. One of the most important but often neglected complications is osteoporosis and increased risk of fracture during and after cancer treatment. Acquisition of optimal peak bone mass and strength during childhood and adolescence is critical to preventing osteoporosis later in life. However, most childhood cancer patients have multiple risk factors for bone mineral loss. Cancer itself, malnutrition, decreased physical activity during treatment, chemotherapeutic agents such as steroids, and radiotherapy cause bone mineral deficit. Furthermore, complications such as growth hormone deficiency and musculoskeletal deformity have negative effects on bone metabolism. Low bone mineral density is associated with fractures, skeletal deformity, pain, and substantial financial burden not only for childhood cancer survivors but also for public health care systems. Thus, it is important to monitor bone health in these patients and minimize their risk of developing osteoporosis and fragility fractures later in life.

Growth after Hematopoietic Stem Cell Transplantation in Children with Acute Myeloid Leukemia

Previous studies have shown that hematopoietic stem cell transplantation (HSCT) may result in growth impairment. The purpose of this study was to evaluate the growth during 5 yr after HSCT and to determine factors that influence final adult height (FAH). We retrospectively reviewed the medical records of acute myeloid leukemia (AML) patients who received HSCT. Among a total of 37 eligible patients, we selected 24 patients who began puberty at 5 yr after HSCT (Group 1) and 19 patients who reached FAH without relapse (Group 2). In Group 1, with younger age at HSCT, sex, steroid treatment, hypogonadism and hypothyroidism were not significantly associated with growth impairment 5 yr after HSCT. History of radiotherapy (RT) significantly impaired the 5 yr growth after HSCT. Chronic graft-versus-host disease (cGVHD) only temporarily impaired growth after HSCT. In Group 2, with younger age at HSCT, steroid treatment and hypogonadism did not significantly reduce FAH. History of RT significantly reduced FAH. Growth impairment after HSCT may occur in AML patients, but in patients without a history of RT, growth impairment seemed to be temporary and was mitigated by catch-up growth.

Influence of Body Mass Index on the Growth Hormone Response to Provocative Testing in Short Children without Growth Hormone Deficiency

Obesity and its related factors are known to suppress the secretion of growth hormone (GH). We aimed to evaluate the influence of body mass index (BMI) on the peak GH response to provocative testing in short children without GH deficiency. We conducted a retrospective review of medical records of 88 children (2-15 yr old) whose height was less than 3 percentile for one's age and sex, with normal results (peak GH level > 10 ng/mL) of GH provocative testing with clonidine and dopamine. Peak stimulated GH level, height, weight, pubertal status and serum IGF-1 level were measured. Univariate analysis showed that the BMI standard deviation score (SDS) correlated negatively with the natural log (ln) of the peak stimulated GH level (ln peak GH). BMI SDS did not correlate significantly with sex, age, pubertal status, or ln IGF-1 level. BMI SDS correlated negatively with ln peak GH level induced by clonidine but not by dopamine. In stepwise multivariate regression analysis, BMI SDS was the only significant predictor of ln peak GH level in the combination of tests and the clonidine test, but not in the dopamine test. In children without GH deficiency, BMI SDS correlates negatively with the peak GH level. BMI SDS should be included in the analysis of the results of GH provocation tests, especially tests with clonidine.

Boys with precocious or early puberty: incidence of pathological brain magnetic resonance imaging findings and factors related to newly developed brain lesions

PURPOSE: Brain magnetic resonance imaging (MRI) findings and factors predictive of pathological brain lesions in boys with precocious puberty (PP) or early puberty (EP) were investigated. METHODS: Sixty-one boys with PP or EP who had brain MRI performed were included. PP was classified into the central or peripheral type. Brain MRI findings were categorized into group I (pathological brain lesion known to cause puberty; newly diagnosed [group Ia] or previously diagnosed [group Ib]); group II (brain lesion possibly related to puberty); and group III (incidental or normal findings). Medical history, height, weight, hormone test results, and bone age were reviewed. RESULTS: Brain lesions in groups I and II were detected in 17 of 23 boys (74%) with central PP, 9 of 30 boys (30%) with EP, and 7 of 8 boys (88%) with peripheral PP. All brain lesions in boys with peripheral PP were germ cell tumors (GCT), and 3 lesions developed later during follow-up. Group I showed earlier pubertal onset (P<0.01) and greater bone age advancement (P<0.05) than group III. Group III had lower birth weight and fewer neurological symptoms than "Ia and II" (all P<0.05). CONCLUSION: Earlier onset of puberty, greater bone age advancement, and/or neurological symptoms suggested a greater chance of pathological brain lesions in boys with central PP or EP. All boys with peripheral PP, even those with normal initial MRI findings, should be evaluated for the emergence of GCT during follow-up.

Reproducibility Analysis of Brain Volumetry Measured from Inter MR Scanner of Multi-Institute

PURPOSE: The aim of this study was to evaluate the variations of brain volumetry between the different MR scanners or the different institutes. MATERIALS AND METHODS: Ten normal subjects were scanned at four different MR scanners, two of them were the same models, to measure inter-MR scanner variations using intraclass correlation coefficient (ICC), coefficient of variation (CV) and percent volume difference (PVD) and to calculate minimal thresholds to detect the significant volumetric changes in gray matter and subcortical regions. RESULTS: Averaged statistical reliability (ICC = 0.837) and volumetric variation (CV = 4.310%) in all segmented regions were observed on overall MR scanners. Comparing the segmented volumes with PVD between two MR scanners, volumetric differences on same models were the lowest (PVD = 3.611%) and volume thresholds were calculated with 7.168%. PVD results and thresholds values on systemically different MR scanners were evaluated with 5.785% and 11.340% respectively. CONCLUSION: Authors conclude that the reliability of brain volumetry is not so high. Calibration studies of MRI system and image processing are essential to reduce the volumetric variability. Additionally, frameworks comprised of database and algorithms with high-speed image processing are also required for the efficient image data management.

Thyrotoxicosis Associated with Autoimmune Thyroiditis in Children and Adolescents

PURPOSE: The aims of this study are to estimate the frequency of thyrotoxicosis associated with autoimmune thyroiditis (TAIT) and to investigate the characteristics of TAIT in children and adolescents. METHODS: 220 subjects who had shown thyroid autoimmunity before the age of 18 were included. All the subjects were divided as autoimmune thyroiditis (AIT), Graves' disease and unspecified group. In addition, AIT was subdivided as TAIT and euthyroid or hypothyroid AIT. Clinical data were review and the variation of thyroid hormone status was investigated among the subjects with TAIT. RESULTS: Of 220 subjects who showed thyroid autoimmunity, 147 subjects were diagnosed as AIT and 47 were as Graves' disease. Among 147 subjects with AIT, 14 subjects (9.5%) had presented TAIT. Among 65 subjects who had initially presented with thyrotoxicosis, 8 subjects (12.3%) were compatible with TAIT. Whereas presenting symptoms of TAIT were similar to those of Graves' disease, Technetium-99m scan had showed thyroid with decreased uptake. The durations of thyrotoxicosis were several weeks. 6 of 14 TAIT subjects showed recurrent thyrotoxicosis, and 4 of 8 patients who had initially presented with thyrotoxicosis showed subclinical or overt hypothyroidism during follow-up. CONCLUSIONS: Possibility of TAIT should not be overlooked when a patient presents thyrotoxicosis, because this condition is not so rare in children and adolescents. Long term follow-up after resolution of thyrotoxicosis is necessary because of a diverse clinical course.