Hashimoto Thyroiditis and Dyslipidemia in Childhood: A Review

Rade Vukovic,Aleksandra Zeljkovic,Biljana Bufan,Tatjana Milenkovic,Jelena Vekic,Vesna Spasojevic-Kalimanovska

doi:10.3389/fendo.2019.00868

Rade Vukovic, Aleksandra Zeljkovic + Show 4 more

Open Access

https://doi.org/10.3389/fendo.2019.00868

Copy DOI

Abstract

Hashimoto autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in the pediatric population. Development of AIT is mediated mainly by cellular immune response directed toward thyroid autoantigens, leading to inflammation and impaired function of thyroid gland. Both thyroid dysfunction and inflammation affect the metabolism of plasma lipoproteins. The alterations in lipid profile worsen with the advancement of hypothyroidism, ranging from discrete changes in euthyroid AIT patients, to atherogenic dyslipidemia in the overt hypothyroidism. In this review, characteristics of dyslipidemia in pediatric AIT patients, and the consequences in respect to the risk for cardiovascular disease (CVD) development are discussed. Additionally, benefit of L-thyroxine treatment on serum lipid profile in pediatric AIT patients is addressed. Finally, potential usefulness of novel lipid biomarkers, such as proprotein convertase subtilisin/kexin type 9 (PCSK9), non-cholesterol sterols, low-density lipoprotein particle size and number, and high-density lipoprotein structure and functionality in AIT patients is also covered. Further longitudinal studies are needed in order to elucidate the long-term cardiovascular outcomes of dyslipidemia in pediatric patients with Hashimoto AIT.

Highlights

Hashimoto autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in childhood and adolescence
It could be regarded as convenient that the efficacy of L-thyroxine (LT4) treatment in the normalization of lipid status is directly proportionate to the degree of thyroid dysfunction, being highest in the overt hypothyroidism [5, 7, 11, 12]
The levels of high-density lipoprotein cholesterol (HDL-C) increased during the overt hypothyroid state, with impairment of function, and these changes persisted despite restoration of thyroid hormone levels

Summary

Introduction

Hashimoto autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in childhood and adolescence. The study evaluating children, adolescents and adults with subclinical hypothyroidism suggested that abnormalities in lipid profile are more pronounced in adult patients, as well as in those with severe form of the disease [62]. A recent study has shown that both cholesterol efflux and activity of HDL-associated enzyme paraoxonase 1 (PON1) are decreased in patients with overt hypothyroidism [75], implicating diminishing of HDL functionality.

Results

Conclusion