Long-Term Follow-Up and Outcomes of Autoimmune Thyroiditis in Childhood.

Osnat Admoni,Shoshana Rath,Ghadir Elias-Assad,Tal Almagor,Yardena Tenenbaum-Rakover

doi:10.3389/fendo.2020.00309

Osnat Admoni, Shoshana Rath + Show 3 more

Open Access

https://doi.org/10.3389/fendo.2020.00309

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Abstract

Background: Autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in children. The natural outcome of AIT in childhood has been reported previously however follow-up duration is generally short and results variable.Objectives: To characterize clinical and biochemical findings at presentation of AIT, evaluate long-term outcomes and assess which factors at presentation predict evolution over time.Study cohort: 201 children under 18 years of age at presentation (82% female) were enrolled. Subjects were divided into five subgroups according to thyroid stimulating hormone (TSH) level at referral.Results: Mean follow-up was 8.1 years (range 0–29 years). At presentation, 34% of patients had overt hypothyroidism, 32% subclinical hypothyroidism (SCH), 16% compensated hypothyroidism, 14% were euthyroid, and 3.7% had Hashitoxicosis. Children with overt hypothyroidism were younger (10.6 vs. 13.2 years) and had higher thyroid peroxidase antibody titers. At the time of the study, levothyroxine (LT4) therapy was required in 26% of children who were euthyroid at presentation, 56% of SCH patients, 83–84% of those with TSH above 10 mIU/L, and 57% of those with Hashitoxicosis. Over the years, 16% of children presenting with overt hypothyroidism stopped therapy. Free T4 at presentation was the only predictor of outcome over time.Conclusions: Our findings suggest that only 26% children who were euthyroid at presentation developed hypothyroidism, whereas over 50% of those with SCH went on to require treatment. Of those presenting with overt hypothyroidism, 16% recovered with time. The only predictive parameter for LT4 therapy at the end of the study was free T4 levels at presentation. Long-term follow-up is required to determine ongoing therapy needs and screen for additional autoimmune diseases.

Highlights

Autoimmune thyroiditis (AIT), known as Hashimoto’s thyroiditis, is the most common cause of acquired hypothyroidism in childhood, with a prevalence of 1 to 3%, peaking during adolescence [1,2,3]
Reasons for referral were goiter or thyroid dysfunction and/or increased thyroid autoantibodies identified during a work-up performed for various other complaints
thyroid stimulating hormone (TSH) at presentation, was undetectable in 3.7% of subjects, within the normal range in 14%, slightly increased in 32%, and elevated (>10 mIU/L) in 50%

Summary

Introduction

Autoimmune thyroiditis (AIT), known as Hashimoto’s thyroiditis, is the most common cause of acquired hypothyroidism in childhood, with a prevalence of 1 to 3%, peaking during adolescence [1,2,3]. Children are commonly referred for endocrine evaluation due to thyroid enlargement or on the basis of abnormal thyroid function results discovered as part of a medical workup for variable complaints (often unrelated to thyroid dysfunction) or for positive family history of AIT. At the time of diagnosis, thyroid function in children may be variable ranging from euthyroidism (52.1%), to overt (22.2%) or subclinical hypothyroidism (SCH) (19.2%) or, more rarely to either subclinical or overt hyperthyroidism (6.5%) [4]. Autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in children. The natural outcome of AIT in childhood has been reported previously follow-up duration is generally short and results variable

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