Clinical and Biochemical Profile of Children on Follow-up with Autoimmune Thyroiditis
Associate Professor, Department of Paediatrics, Government Medical College, Thrissur, Kerala, India.
Introduction: Hashimotos Thyroiditis (HT) is the most common autoimmune thyroid disease and the most common cause of acquired hypothyroidism in children. Understanding the clinical profile in children with Autoimmune Thyroiditis (AIT) helps in follow-up and appropriate management of the condition.
Aim: To assess the clinical, biochemical profile and the course of disease in children with AIT.
Materials and Methods: This was a hospital-based longitudinal study done at a Paediatric endocrinology clinic, from January 2018 to June 2019, at Southern India on all children with autoimmune thyroiditis on follow-up for atleast three years, age group between 5 to 18 years, attending the clinic. Clinical examination for thyroid swelling, anthropometry of the child, Tanner staging for pubertal status, Thyroid Stimulating Hormone (TSH), and free Thyroxine (T4) was done at enrollment and also at follow-up after one year.
Results: A total of 33 children were enrolled into the study. Of this, girls constituted 85%, with a female to male ratio of 5.6:1. Mean age at diagnosis was 9.76±1.69 years; 25 (75.8%) patients were hypothyroid and 8 (24.2%) were euthyroid at presentation; 21 (63.6%) had a positive family history of thyroid illness. The most common presentation was goitre (87.8%), 32 (97%) of them had positive thyroid antibodies either Antithyroid Peroxidase (TPO) or anti thyroglobulin (Tg) antibody. Of the 32 children with positive antibodies, 26 (81.2%) had raised anti TPO and 17 (53.1%) had positive anti Tg; 12 (37.5%) were positive for both anti TPO and anti Tg; 29 patients (78.7%) required treatment with thyroxine. All were noted to be pubertal but with no significant growth impairment. On follow-up after 1 year, the percentage of hypothyroid patients increased from 87.88% to 96.97%, and 1 (3.03%) became hyperthyroid. None of them had other autoimmune disorders during follow-up.
Conclusion: Children with AIT were mostly females and the majority had goitre. The prevalence of goitre was 88% and the majority were hypothyroid at presentation. A majority of children with autoimmune thyroiditis had a positive family history of thyroid disease. On follow-up after at 1 year, all the euthyroid patients had become hypothyroid. The thyroid status of children with autoimmune thyroiditis can change over time and needs regular clinical and biochemical follow-up.