Abstract #1403921: Characteristics of Children and Adolescents with Hashimoto’s Thyroiditis in a Multiethnic Community Hospital

Abstract

Hashimoto's thyroiditis (HT), an autoimmune thyroid disorder, is the most common cause of acquired hypothyroidism in children and adolescents. HT is familial with female predominance. It has peak incidence in school-aged children and adolescents. It is most common in Whites and Asians and in those with other autoimmune conditions. In addition to goiter, poor linear growth and disruption of pubertal development are common. The diagnosis is made by presence of thyroid autoantibodies (Abs) and can be confirmed by heterogeneous echogenicity on sonogram. There is increased risk for papillary thyroid carcinoma (PTC) in HT. The aim of this study was to explore the characteristics of pediatric patients with HT in a multiethnic community hospital where the majority of patients are Hispanic and Asian. A retrospective review was conducted. Patients 0-21 years with HT seen in Pediatric Endocrine Clinic at Flushing Hospital Medical Center between 2013 and 2021were included. Data extracted from EHR included demographics, clinical findings, comorbidities, thyroid function tests, thyroid autoantibodies, sonogram findings, fine needle aspiration (FNA) results and treatment. The sample was characterized using descriptive statistics. Of 114 patients identified with HT, 80 (70%) were female. The mean age at time of diagnosis was 12.6+4.2 years. Of 66 patients with documented ethnicity, 59% were Hispanic. Family history of thyroid dysfunction was present in 35%. The most common presenting complaint was goiter (47%). Elevated thyrotropin was present in 86%. Comorbidities included diabetes (5%), celiac disease (2%) and vitiligo (2%). Both anti-thyroglobulin antibodies (anti-Tg Abs) and anti-peroxidase (anti-TPO) Abs were present in 60%, anti-TPO Abs only in 22% and anti-Tg Abs only in 9%. All patients had thyroid sonogram: 64% revealed heterogeneous echogenicity, 4% homogeneous echogenicity and 32% normal. Both nodules and cysts were reported in 12%, nodules only in 24%, and cysts only in 9%. No patient met criteria for FNA. All patients with overt hypothyroidism or nodules/cysts were prescribed levothyroxine. Our patients were mostly of Hispanic ethnicity, an underrepresented population in previous studies. Female to male ratio was almost 4:1 with mean age of 12.6 years, concurring with known epidemiology. Hypothyroidism and goiter were common. Having both anti-TPO Abs and anti-Tg Abs was more common than having only one Abs. Thyroid sonogram was confirmatory in two-thirds. Nodules and cysts were common but did not lead to FNA. Future research exploring associations with development of PTC will require extended follow up.