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Hashimoto Tiroidili Çocuk ve Adolesanların Tanı Anındaki ve İzlemdeki Klinik ve Laboratuvar Özellikleri

Yıl 2019, Cilt: 72 Sayı: 3, 314 - 319, 23.01.2020

Özlem Kara

Öz

Amaç: Hashimoto tiroiditi (HT) tanısı ile izlenen çocuk ve adolesanların tanı anındaki ve izlemdeki klinik ve laboratuvar bulgularının değerlendirilmesi
amaçlandı.

Gereç ve Yöntem: Çocuk endokrinoloji kliniğinde Ocak 2015-Ocak 2019 tarihleri arasında HT tanısı ile takip edilen, yaşları 4-18 yıl arasında değişen
toplam 181 hasta çalışmaya alındı. Tüm hastaların tanı anında ve izlemdeki oksolojik, klinik, laboratuvar ve radyolojik verileri dosya kayıtlarından
değerlendirildi.

Bulgular: Tüm hastaların %85’i kızdı. Hastaların yaş ortalaması 13,4±3,2 yıldı ve %77’si pubertaldi. Hastaların takip süreleri 22,5±10,3 ay (4-54 ay)
idi. Tanı sırasında tiroid fonksiyonuna göre %35’inde ötiroidi, %29’unda subklinik hipotiroidi, %22’sinde hipotiroidi, %4’ünde subklinik hipertiroidi
ve %10’unda hipertiroidi saptandı. Hastaların en sık başvuru şikayetleri arasında halsizlik (%44), saç dökülmesi (%25), kabızlık (%23) ve boyunda
şişlik (%21) geliyordu. Hastaların başvurudaki USG görüntülemede %13’ünde nodül saptandı. Ötiroidili hastalarda nodül sıklığı fazlayken, boyut
artışı hipertiroidili olgularda daha fazla saptandı. İzlemde hastaların %6’sında izlemde nodül gelişimi gözlendi. Subklinik hipertiroidili hastaların
hepsi izlemde ötiroid oldu. Ötiroidili hastaların ise %13’ünde hipotiroidi geliştiği gözlendi. En sık eşlik eden hastalıklar polikistik over sendromu ve
vitiligo idi.

Sonuç: HT’li hastaların geliş şekilleri oldukça değişken olup, izlemde de klinik değişiklikler devam etmektedir. Bu nedenle bu hastaların tanıdan
itibaren yakın takip edilmesi ve ilişkili diğer hastalıklar açısından dikkat edilmesi önemlidir.

Anahtar Kelimeler

Hashimoto Tiroidi Ötiroidi Subklinik Hipertiroidi Tiroid Fonksiyonu Uzun Dönem Prognoz

Etik Beyan

Etik Kurul Onayı: Çalışma protokolü Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi Etik Kurul Komitesi tarafından Helsinki beyannamesi esaslarına uygun olarak onaylandı (Etik kurul protokol kodu: 2011-KAEK-25 2019/03-02). Hasta Onayı: Çalışma retrospektif olduğundan hasta onayı alınmamıştır. Hakem Değerlendirmesi: Editörler kurulunun dışında olan kişiler tarafından değerlendirilmiştir. Finansal Destek: Yazar tarafından finansal destek almadıkları bildirilmiştir.

Destekleyen Kurum

-

Proje Numarası

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Teşekkür

-

Kaynakça

  • 1. Rallison ML, Dobyns BM, Keating FR, et al. Occurrence and natural history of chronic lymphocytic thyroiditis in chidhood. J Pediatr. 1975;86:675-682.
  • 2. Setian NS. Hypothroidisim in children: diagnosis and treatment. J Pediatr. 2007;83:209-216.
  • 3. Matsuoka N, Unger P, Ben-Nun A, et al. Thyroglobulin-induced murine thyoiditis assessed by intrathyroidal T cell receptor sequencing. J Immunol. 1994;152:2562-2568.
  • 4. Kotani T, Umeki K, Hirai K, et al. Experimental murine thyroiditis induced by porcine thyroid peroxidase and its transfer by the antigen-specific T cell line. Clin Exp Immunol. 1990;80:11-18.
  • 5. Davies TF. Pathogenesis of Hashimoto’s thyroiditis (chronic autoimmune thyroiditis). www.uptodate.com 2019.
  • 6. Huber G, Staub JJ, Meier C, et al. Prospective study of the spontaneous course of subclinical hypothyroidism:prognostic value of thyrotropin, thyroid reserve and thyroid antibodies. J Clin Endocrinol Metab. 2002;87:3221- 3226.
  • 7. World Health Organization. Indicators for assessing iodine deficiency disorders and their control programmes: report of a joint WHO/UNICEF/ ICCIDD consultation; 1993. https://www.who.int/nutrition/publications/ micronutrients/iodine_deficiency/WHO_NUT_93.1/en/
  • 8. de Vries L, Bulvik S, Phillip M. Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up. Arch Dis Child. 2009;94:33-37.
  • 9. Lorini R, Gastaldi R, Traggiai C, et al. Hashimoto’s thyroiditis. Pediatr Endocrinol Rev. 2003;1 Suppl 2:205-11; discussion 211.
  • 10. Markovic S, Kostic G, Igrutinovic Z, et al. Hashimoto’s thyroiditis in children and adolescents. Srp Arh Celok Lek. 2008;136:262-266.
  • 11. Ozcelik T, Uz E, Akyerli CB, et al. Evidence from autoimmune thyroiditis of skewed Xchromosome inactivation in female predisposition to autoimmunity. Eur J Hum Genet. 2006;14:791-797.
  • 12. Ansar Ahmed S, Young PR, Penhale WJ. The effect of female sex-steroids on the development of autoimmune throiditis in thymectomized and irradiated rats. Clin Exp Immunol. 1983;54:351-358.
  • 13. Foley TP Jr, Abbassi V, Copeland KC, et al. Brief report: hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. N Engl J Med. 1994;330:466-468.
  • 14. Dündar B, Boyacı A, Sangün Ö, ve ark. Çocuk ve ergenlerde Hashimoto tiroiditi: klinik ve laboratuvar bulgularının değerlendirilmesi. Türk Ped Arş. 2011;46:318-322.
  • 15. Fava A, Oliverio R, Giuliano S, et al. Clinical Evolution of Autoimmune Thyroiditis in Children and Adolescents. Thyroid. 2009;19:361-367.
  • 16. Demirbilek H, Kandemir N, Gonc EN, at al. Hashimoto’s thyroiditis in children and adolescents: a retrospective study on clinical, epidemiological and laboratory properties of the disease. J Pediatr Endocrinol Metab. 2007;20:1199-1205.
  • 17. Gopalakrishnan S, Chugh PK, Chhillar M, et al. Goitrous Autoimmune Thyroiditis in a Pediatric Population: A Longitudinal Study. Pediatrics. 2008;122:e670-674.
  • 18. Sklar CA, Qazi R, David R. Juvenile autoimmune thyroiditis. Hormonal status at presentation and after long-term follow-up. Am J Dis Child. 1986;140:877-880.
  • 19. Desai MP, Karandikar S. Autoimmune thyroid disease in childhood: a study of children and their families. Indian Pediatr. 1999;36:659-666.
  • 20. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. 1996;335:99-107.
  • 21. Zak T, Noczynska A, Wasikowa R, et al. Chronic autoimmune thyroid disease in children and adolescents in the years 1999 2004 in Lower Silesia, Poland. Hormones (Athens). 2005;4:45-48.
  • 22. Skarpa V, Kappaousta E, Tertipi A, et al. Epidemiological characteristics of children with autoimmune thyroid disease. Hormones. 2011;10:207-214.
  • 23. De Luca F, Santucci S, Corica D, et al. Hashimoto’s thyroiditis in childhood: presentation modes and evolution over time. Ital J Pediatr. 2013;39:8.
  • 24. Radetti G, Gottardi E, Bona G, et al. Study group for thyroid diseases of the Italian society for pediatric endocrinology and diabetes (SIEDP/ISPED): the natural history of euthyroid Hashimoto’s thyroiditis in children. J Pediatr. 2006;149:827-832.
  • 25. Wasniewska M, Salerno M, Cassio A, et al. Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence. Eur J Endocrinol. 2009; 160:417-421.
  • 26. Wasniewska M, Corrias A, Aversa T, et al. Comparative evaluation of therapy with L-thyroxine versus no treatment in children with idiopathic and mild subclinical hypothyroidism. Horm Res Paediatr. 2012;77:376-381.
  • 27. Takasu N, Komiya I, Asawa T, et al. Test for recovery from hypothyroidism during thyroxine. Lancet. 1990;336:1084-1086.
  • 28. Radetti G. Clinical Aspects of Hashimoto’s Thyroiditis. Endocr Dev. 2014;26:158-70
  • 29. Weetman AP. Graves’ disease. N Engl J Med. 2000;343:1236-1248.
  • 30. Wasniewska M, Corrias A, Salerno M, et al. Outcomes of children with hashitoxicosis. Horm Res Paediatr. 2012;77:36-40.
  • 31. Vlachopapadopoulou E, Thomas D, Karachaliou F, et al. Evolution of sonographic appearance of the thyroid gland in children withHashimoto’sthyroiditis. J Pediatr Endocrinol Metab. 2009;22:339-344.
  • 32. Aversa T, Lombardo F, Valenzise M, et al. Peculiarities of autoimmune thyroid diseases in children with Turner or Down syndrome: an overview. Ital J Pediatr. 2015;41:39.
  • 33. Husebye ES, Anderson MS, Kämpe O. Autoimmune Polyendocrine Syndromes. N Engl J Med. 2018;378:1132-1141.
  • 34. Arduc A, Dogan BA, Bilmez S, et al. High prevalence of Hashimoto’s thyroiditis in patients with polycystic ovary syndrome: does the imbalance between estradiol and progesterone play a role? Endocr Res. 2015;40:204- 210.
  • 35. Ganie MA, Marwaha RK, Aggarwal R, et al. High prevalence of polycystic ovary syndrome characteristics in girls with euthyroid chronic lymphocytic thyroiditis: a case–control study. Eur J Endocrinol. 2010;162:1117-1122.

Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up

Yıl 2019, Cilt: 72 Sayı: 3, 314 - 319, 23.01.2020

Özlem Kara

Öz

Objectives: The aim of this study was to evaluate the clinical and laboratory findings of children and adolescents with Hashimoto thyroiditis (HT) at diagnosis and during follow-up.

Materials and Methods: Between January 2015 and January 2019, a total of 181 patients aged between 4 and 18 years who were followed in the pediatric endocrinology department were evaluated. All patients were evaluated at the time of diagnosis and during follow-up with the clinical, laboratory and radiological data.

Results: Female patients constituted 85% of all patients. Mean age at diagnosis was 13.4±3.2 years and 77% of patients were pubertal. The followup period was 22.5±10.3 months (4-54 months). At the time of diagnosis 35% of patients were euthyroid, 29% had subclinical hypothyroidism, 22% had overt hypothyroidism, 4% had subclinical hyperthyroidism and 10% had overt hyperthyroidism. The common complaints of the patients were fatigue (44%), hair loss (25%), constipation (23%) and goitre (21%). In the ultrasonographic imaging of the patients, nodule was detected in 13% of the patients. The frequency of nodules was higher in patients with euthyroidism. Increased size of the thyroid gland was common in patients with hyperthyroidism. In follow-up, nodule development was observed in 6% of patients. All patients with subclinical hyperthyroidism became euthyroid during follow-up. Hypothyroidism developed in 13% of euthyroid patients during follow-up. The most common concomitant diseases were polycystic ovary syndrome and vitiligo.

Conclusion: The admission of patients with HT is highly variable and clinical changes have continued during follow-up. Therefore these patients
should be followed closely from the diagnosis and attention should be paid to other related diseases.

Key Words: Hashimoto Thyroiditis, Euthyroidism, Subclinical Hyperthyroidism, Thyroid Function, Long-term Prognosis

Anahtar Kelimeler

Hashimoto Thyroiditis Euthyroidism Subclinical Hyperthyroidism Thyroid Function Long-term Prognosis

Etik Beyan

-

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1. Rallison ML, Dobyns BM, Keating FR, et al. Occurrence and natural history of chronic lymphocytic thyroiditis in chidhood. J Pediatr. 1975;86:675-682.
  • 2. Setian NS. Hypothroidisim in children: diagnosis and treatment. J Pediatr. 2007;83:209-216.
  • 3. Matsuoka N, Unger P, Ben-Nun A, et al. Thyroglobulin-induced murine thyoiditis assessed by intrathyroidal T cell receptor sequencing. J Immunol. 1994;152:2562-2568.
  • 4. Kotani T, Umeki K, Hirai K, et al. Experimental murine thyroiditis induced by porcine thyroid peroxidase and its transfer by the antigen-specific T cell line. Clin Exp Immunol. 1990;80:11-18.
  • 5. Davies TF. Pathogenesis of Hashimoto’s thyroiditis (chronic autoimmune thyroiditis). www.uptodate.com 2019.
  • 6. Huber G, Staub JJ, Meier C, et al. Prospective study of the spontaneous course of subclinical hypothyroidism:prognostic value of thyrotropin, thyroid reserve and thyroid antibodies. J Clin Endocrinol Metab. 2002;87:3221- 3226.
  • 7. World Health Organization. Indicators for assessing iodine deficiency disorders and their control programmes: report of a joint WHO/UNICEF/ ICCIDD consultation; 1993. https://www.who.int/nutrition/publications/ micronutrients/iodine_deficiency/WHO_NUT_93.1/en/
  • 8. de Vries L, Bulvik S, Phillip M. Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up. Arch Dis Child. 2009;94:33-37.
  • 9. Lorini R, Gastaldi R, Traggiai C, et al. Hashimoto’s thyroiditis. Pediatr Endocrinol Rev. 2003;1 Suppl 2:205-11; discussion 211.
  • 10. Markovic S, Kostic G, Igrutinovic Z, et al. Hashimoto’s thyroiditis in children and adolescents. Srp Arh Celok Lek. 2008;136:262-266.
  • 11. Ozcelik T, Uz E, Akyerli CB, et al. Evidence from autoimmune thyroiditis of skewed Xchromosome inactivation in female predisposition to autoimmunity. Eur J Hum Genet. 2006;14:791-797.
  • 12. Ansar Ahmed S, Young PR, Penhale WJ. The effect of female sex-steroids on the development of autoimmune throiditis in thymectomized and irradiated rats. Clin Exp Immunol. 1983;54:351-358.
  • 13. Foley TP Jr, Abbassi V, Copeland KC, et al. Brief report: hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. N Engl J Med. 1994;330:466-468.
  • 14. Dündar B, Boyacı A, Sangün Ö, ve ark. Çocuk ve ergenlerde Hashimoto tiroiditi: klinik ve laboratuvar bulgularının değerlendirilmesi. Türk Ped Arş. 2011;46:318-322.
  • 15. Fava A, Oliverio R, Giuliano S, et al. Clinical Evolution of Autoimmune Thyroiditis in Children and Adolescents. Thyroid. 2009;19:361-367.
  • 16. Demirbilek H, Kandemir N, Gonc EN, at al. Hashimoto’s thyroiditis in children and adolescents: a retrospective study on clinical, epidemiological and laboratory properties of the disease. J Pediatr Endocrinol Metab. 2007;20:1199-1205.
  • 17. Gopalakrishnan S, Chugh PK, Chhillar M, et al. Goitrous Autoimmune Thyroiditis in a Pediatric Population: A Longitudinal Study. Pediatrics. 2008;122:e670-674.
  • 18. Sklar CA, Qazi R, David R. Juvenile autoimmune thyroiditis. Hormonal status at presentation and after long-term follow-up. Am J Dis Child. 1986;140:877-880.
  • 19. Desai MP, Karandikar S. Autoimmune thyroid disease in childhood: a study of children and their families. Indian Pediatr. 1999;36:659-666.
  • 20. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. 1996;335:99-107.
  • 21. Zak T, Noczynska A, Wasikowa R, et al. Chronic autoimmune thyroid disease in children and adolescents in the years 1999 2004 in Lower Silesia, Poland. Hormones (Athens). 2005;4:45-48.
  • 22. Skarpa V, Kappaousta E, Tertipi A, et al. Epidemiological characteristics of children with autoimmune thyroid disease. Hormones. 2011;10:207-214.
  • 23. De Luca F, Santucci S, Corica D, et al. Hashimoto’s thyroiditis in childhood: presentation modes and evolution over time. Ital J Pediatr. 2013;39:8.
  • 24. Radetti G, Gottardi E, Bona G, et al. Study group for thyroid diseases of the Italian society for pediatric endocrinology and diabetes (SIEDP/ISPED): the natural history of euthyroid Hashimoto’s thyroiditis in children. J Pediatr. 2006;149:827-832.
  • 25. Wasniewska M, Salerno M, Cassio A, et al. Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence. Eur J Endocrinol. 2009; 160:417-421.
  • 26. Wasniewska M, Corrias A, Aversa T, et al. Comparative evaluation of therapy with L-thyroxine versus no treatment in children with idiopathic and mild subclinical hypothyroidism. Horm Res Paediatr. 2012;77:376-381.
  • 27. Takasu N, Komiya I, Asawa T, et al. Test for recovery from hypothyroidism during thyroxine. Lancet. 1990;336:1084-1086.
  • 28. Radetti G. Clinical Aspects of Hashimoto’s Thyroiditis. Endocr Dev. 2014;26:158-70
  • 29. Weetman AP. Graves’ disease. N Engl J Med. 2000;343:1236-1248.
  • 30. Wasniewska M, Corrias A, Salerno M, et al. Outcomes of children with hashitoxicosis. Horm Res Paediatr. 2012;77:36-40.
  • 31. Vlachopapadopoulou E, Thomas D, Karachaliou F, et al. Evolution of sonographic appearance of the thyroid gland in children withHashimoto’sthyroiditis. J Pediatr Endocrinol Metab. 2009;22:339-344.
  • 32. Aversa T, Lombardo F, Valenzise M, et al. Peculiarities of autoimmune thyroid diseases in children with Turner or Down syndrome: an overview. Ital J Pediatr. 2015;41:39.
  • 33. Husebye ES, Anderson MS, Kämpe O. Autoimmune Polyendocrine Syndromes. N Engl J Med. 2018;378:1132-1141.
  • 34. Arduc A, Dogan BA, Bilmez S, et al. High prevalence of Hashimoto’s thyroiditis in patients with polycystic ovary syndrome: does the imbalance between estradiol and progesterone play a role? Endocr Res. 2015;40:204- 210.
  • 35. Ganie MA, Marwaha RK, Aggarwal R, et al. High prevalence of polycystic ovary syndrome characteristics in girls with euthyroid chronic lymphocytic thyroiditis: a case–control study. Eur J Endocrinol. 2010;162:1117-1122.
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Çocuk Endokrinolojisi
Bölüm Makaleler
Yazarlar

Özlem Kara 0000-0003-0915-5546

Proje Numarası -
Yayımlanma Tarihi 23 Ocak 2020
Yayımlandığı Sayı Yıl 2019 Cilt: 72 Sayı: 3

Kaynak Göster

APA Kara, Ö. (2020). Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 72(3), 314-319. https://doi.org/10.4274/atfm.galenos.2019.18480
AMA Kara Ö. Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ocak 2020;72(3):314-319. doi:10.4274/atfm.galenos.2019.18480
Chicago Kara, Özlem. “Clinical and Laboratory Characteristics of Children and Adolescents With Hashimoto Thyroiditis at Diagnosis and During Follow-up”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72, sy. 3 (Ocak 2020): 314-19. https://doi.org/10.4274/atfm.galenos.2019.18480.
EndNote Kara Ö (01 Ocak 2020) Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72 3 314–319.
IEEE Ö. Kara, “Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 3, ss. 314–319, 2020, doi: 10.4274/atfm.galenos.2019.18480.
ISNAD Kara, Özlem. “Clinical and Laboratory Characteristics of Children and Adolescents With Hashimoto Thyroiditis at Diagnosis and During Follow-up”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72/3 (Ocak 2020), 314-319. https://doi.org/10.4274/atfm.galenos.2019.18480.
JAMA Kara Ö. Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;72:314–319.
MLA Kara, Özlem. “Clinical and Laboratory Characteristics of Children and Adolescents With Hashimoto Thyroiditis at Diagnosis and During Follow-up”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 3, 2020, ss. 314-9, doi:10.4274/atfm.galenos.2019.18480.
Vancouver Kara Ö. Clinical and Laboratory Characteristics of Children and Adolescents with Hashimoto Thyroiditis at Diagnosis and During Follow-up. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;72(3):314-9.
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