Abstract
Autoimmune thyroid diseases (AITDs), including Hashimoto's thyroiditis (HT) and Graves' disease (GD), tend to aggregate with other non-thyroidal autoimmune diseases (NTADs). Aim of this Mini-review is to report the most recent insights concerning the clustering of NTADs in pediatric patients with either HT or GD, the pathophysiology of AITDs and the metamorphic thyroid autoimmunity. A systematic literature research of the last 15 years, according to EQUATOR statement, was carried out through MEDLINE via PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) Embase, CINAHL, Cochrane Library, based on the following keywords: (autoimmune thyroid disease OR Hashimoto thyroiditis OR Grave's disease) AND (autoimmune comorbidities OR extra-thyroidal autoimmune disorders) AND (children OR adolescents OR pediatrics) AND (celiac disease OR type 1 diabetes mellitus OR arthropathies OR cutaneous diseases) AND (Turner syndrome OR Down syndrome). One-hundred and twenty-eight manuscripts were extrapolated but only seventeen were eligible. On the basis of the available reports it may be inferred that clustering of NTADs can be significantly modified by both patients' age at AITDs presentation and association with Down's syndrome (DS). Particularly, the association of AITDs with celiac disease and type 1 diabetes was most commonly reported in children than in adults. A sequential shifting from HT to GD has been described in children with AITDs, and it seems to be more frequent in children with DS than in those without DS. Coexistence of autoimmune diseases might be the result of a complex interaction among genetics, environment and epigenetic modifications that are able to affect gene expression, immune system response and, finally, the pathogenesis of autoimmune diseases.
Highlights
Autoimmune diseases (ADs) represent a heterogeneous group of chronic disorders, which afflict specific target organs or multiple organ systems and are initiated by the loss of immunological tolerance to self-antigens
Recent reports have evidenced that the clustering of different non-thyroidal autoimmune diseases (NTADs) in patients with Autoimmune thyroid diseases (AITDs) may be conditioned by other intrinsic factors, such as age [6] and association with specific chromosomopathies [7,8,9], apart from genetic predisposition
Seventeen manuscripts satisfying the following eligibility criteria have been selected: articles written in English belonging to the categories of clinical trial, observational study, Meta-Analysis, multicenter Study, randomized controlled trial, review, concerning the association between AITDs and NTADs in children and adolescents with Hashimoto’s thyroiditis (HT) or Graves’ disease (GD) (Tables 1, 2), the pathophysiology of AITDs and the metamorphic thyroid autoimmunity
Summary
Autoimmune diseases (ADs) represent a heterogeneous group of chronic disorders, which afflict specific target organs or multiple organ systems and are initiated by the loss of immunological tolerance to self-antigens. Two peculiar aspects of these disorders are that more ADs tend to aggregate in the same patient (polyautoimmunity) and that affected individuals tend to cluster in the same nuclear family (familial autoimmunity). Such shared characteristics suggest that the development of ADs is affected by similar genetic, epigenetic and environmental factors [1]. Recent reports have evidenced that the clustering of different non-thyroidal autoimmune diseases (NTADs) in patients with AITDs may be conditioned by other intrinsic factors, such as age [6] and association with specific chromosomopathies [7,8,9], apart from genetic predisposition
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