Clinical evaluation and follow up of autoimmune thyroiditis in children and adolescents [a retrospective study]

ABSTRACT

The objective of the present study was to assess the clinical manifestations of autoimmune thyroiditis [AlT] in children and adolescents, in addition to disease course and long-term outcome. A retrospective analysis of data obtained at pediatric endocrinology outpatients clinic, Saudi German Hospital, Jeddah, Saudi Arabia. Fifty three children, 11 boys and 42 girls, with diagnosis of autoimmune thyroiditis and with the age of 12.33 +/- 1.58 years at presentation were included in the study and followed-up in pediatric endocrinology clinic for two years. Clinical characteristics at presentation, reasons for referral, treatment and outcome; by thyroid and pubertal status were recorded. Noticeable goitre was found in 37.75%at time of presentation. Other reasons for referral were clinical symptoms of hypothyroidism [28.3%] and findings on work-up for an unrelated problem [20.7%] or for high-risk groups [13.2%]. Thirteen patients [24.5%] were euthyroid, 18 [34%] had sub-clinical hypothyroidism, and 22 [41.5%] had overt hypothyroidism. The concordance of anti-thyroid peroxidase [anti-TPO] high titers was found in 83%of subjects, while 75.4%of the cases had anti thyroglobulin [ATg] positive titer and both titers were positive in 71.6%. Treatment was initiated shortly after diagnosis in all 22 hypothyroid patients and in 12/18 compensated hypothyroid patients, and within 12 months in two euthyroid patients. Indications for treatment of euthyroid patients were further thyroid enlargement during follow-up, significant increase in TSH concentration, or development of one or more symptoms compatible with hypothyroidism. Ht-SDS at last follow-up was significantly lower than at diagnosis for the entire study group [-0.02 +/- 0.38 vs-0.14 +/- 0.30], p<0.01] but both were within normal Puberty was normal in the studied patients. Forty two [79.2%] had reached their final height by the last follow-up visit [mean Ht-SDS-0.13[0.31] and their final height was within the normal range. There was no significant difference in body mass index SDS at referral by thyroid status. In conclusion, although goitre is the main symptom leading to diagnosis of AlT, it is still often overlooked, underscoring the need for thorough thyroid evaluation on routine physical examination. Acquired hypothyroidism is not often associated with obesity, and ultrasound usually has no added diagnostic value. Adequate treatment in this age group leads to normal growth, puberty and final height