Prepubertal ve Pubertal Hastalarda Hashimoto Tiroiditi’nin Dağılımı, Klinik Özellikleri ve Laboratuvar Bulguları

Year 2023, Volume: 33 Issue: 6, 683 - 688, 31.12.2023

Aylin Kılınç Uğurlu , Abdurrahman Bitkay

https://doi.org/10.54005/geneltip.1253549

Abstract

Giriş: Hashimoto tiroiditi (HT) çocukluk çağında edinsel hipotiroidizmin en sık nedenidir. Otoimmün temelde gelişen bu hastalık sıklıkla ergenlik döneminde ortaya çıkmaktadır. Ancak son yıllarda prepubertal ve infant dönemde bu hastalık tanısı alan olgular bildirilmektedir. Bu durumun endokrin sistemi bozan ve otoimmüniteyi tetikleyen çevresel faktörlere erken dönemde maruz kalınmasından kaynaklandığı düşünülmektedir. Kliniğimizde prepubertal ve pubertal dönemde Hashimoto tiroiditi tanısı alan hastalarımızın dağılımını, klinik özelliklerini ve laboratuvar bulgularını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmada Ağustos 2019-Mayıs 2022 tarihleri arasında Hashimoto Tiroiditi tanısı alan olgular prepubertal (Tanner evre 1) ve pubertal (Tanner evre 2-3-4-5) olarak iki gruba ayrıldı. İki grup klinik, laboratuvar ve ultrason bulguları açısından retrospektif olarak karşılaştırıldı.
Bulgular: HT tanısı konulan hastaların (n=134) ortalama yaşı 12.4±3.4 yıldı. Olguların %25’i (n= 33) prepubertal iken, %75’i (n=101) pubertaldi. Olguların kız/erkek oranı (K/E) 4,1/1, prepubertal dönemde K/E=2,3/1 ve pubertal dönemde K/E= 5,3/1 idi. Tanı anında yapılan tiroid fonksiyon testlerine göre, tüm olgularda en sık ötiroidizm saptandı. Prepubertal grupta, ötiroidizm ve subklinik hipotiroidizm oranları benzerdi ve en yüksek oranlara sahipti. Buna karşılık, pubertal grupta en sık ötiroidizm gözlendi. Prepubertal ve pubertal grupları karşılaştırdığımızda, prepubertal grupta subklinikhipotiroidi (%36.4), hipotiroidi (%21), pubertal gruba (%22.8 ve %10.9) göre daha sık saptandı. Bununla birlikte, subklinik hipertiroidizm ve hipertiroidizm pubertal grupta daha sık görüldü (p= 0.17).
Sonuç: Çalışmamızda, HT prepubertal evredeki erkek çocuklarda pubertal evredekilere göre daha yaygındır.Prepubertal dönemdeki hastalar hipotiroidi evresinde başvururken, pubertal grubun başvurularında hipertiroidi olması dikkat çekiciydi.

Keywords

Hashimoto Tiroiditi, prepubertal, pubertal, ötiroid faz, kız/erkek oranı

Distribution, Clinical Features and Laboratory Findings of Hashimoto’s Thyroiditis in Prepubertal and Pubertal Patients

Abstract

Aims:Hashimoto's thyroiditis (HT) is the most common cause of acquired hypothyroidism in childhood. This disease, which develops on an autoimmune basis, often appears in adolescence. However, in recent years, However, in recent years, cases diagnosed with this disease in prepubertal and infant period have been reported. This is considered to regarding early exposure to environmental factors that disrupt the endocrine system and trigger autoimmunity. We aimed to evaluate the distribution, clinical features, and laboratory findings of our patients diagnosed with Hashimoto's thyroiditis in our clinic in prepubertal and pubertal periods.
Material and Method:In the study, the cases diagnosed with Hashimoto's Thyroiditis in Ankara City Hospital Pediatric Endocrinology 5th outpatient clinic between August 2019 and May 2022 were divided into two groups prepubertal (Tanner stage 1) and pubertal (Tanner stage 2-3-4-5). The two groups were compared retrospectively in terms of clinical, laboratory, and ultrasound findings.
Results: The mean±SDS of 134 patients diagnosed with HT was 12.4±3.4 years. While 25% (n:33) of the cases were prepubertal, 75% (n:101) were pubertal. The cases' female/male ratio (F/M) was 4.1/1, F/M: 2.3/1 in the prepubertal period, and F/M: 5.3/1 in the pubertal period.
The euthyroid phase was detected most frequently in all cases at diagnosis. While the rate of euthyroid and subclinical hypothyroidism was the same in the prepubertal group, it was most detected in these two phases. In the pubertal group, it was mostly detected in the euthyroid phase. When we compared the prepubertal and pubertal groups, it was seen that subclinical hypothyroidism and hypothyroidism were most common in the prepubertal group. In contrast, subclinical hyperthyroidism and hyperthyroidism were more common in the pubertal group.
Conclusion:In our study, HT is more prevalent in boys at the prepubertal stage than in the pubertal stage.
While the patients in the prepubertal period applied in the hypothyroid phase, it was remarkable that the pubertal group had hyperthyroidism in their admissions.

Keywords

Hashimoto, prepubertal, pubertal, euthyroid phase, boys

References

• Peters C. and Schoenmakers N. The Thyroid Gland,In: Dattani MT BC eds. B 7th edition. OS 2019: 310.
• Hansen PS, Brix TH, Iachine I, Kyvik KO, Hegedüs L. The relative importance of genetic and environmental effects for the early stages of thyroid autoimmunity: a study of healthy Danish twins. European Journal of Endocrinology. 2006;154 (1):29–38.
• Tomer Y, Huber A. The etiology of autoimmune thyroid disease: a story of genes and environment. Journal of Autoimmunity. 2009;32 (3–4):231–9.
• Burek CL, Talor M V. Environmental triggers of autoimmune thyroiditis. Journal of Autoimmunity. 2009;33 (3–4):183–9.
• Tanda ML, Piantanida E, Lai A, Lombardi V, Dalle Mule I, Liparulo L, et al. Thyroid autoimmunity and environment. Hormone and Metabolic Research. 2009;41 (06):436–42.
• Strieder TGA, Tijssen JGP, Wenzel BE, Endert E, Wiersinga WM. Prediction of progression to overt hypothyroidism or hyperthyroidism in female relatives of patients with autoimmune thyroid disease using the Thyroid Events Amsterdam (THEA) score. Archives of Internal Medicine. 2008;168 (15):1657–63.
• Brent GA. Environmental exposures and autoimmune thyroid disease. Thyroid : official journal of the American Thyroid Association. 2010 Jul;20 (7):755–61.
• Tang S, Yang M, Zhang D, Tong YJ, Xin Y. Clinical Characteristics and Follow-Up of 19 Children With Hashimoto’s Thyroiditis Aged Below 3 Years: A Single-Center Retrospective Analysis. Frontiers in Endocrinology. 2021;12 (September):1–8.
• Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmunity Reviews. 2014;13 (4–5):391–7.
• Aversa T, Valenzise M, Corrias A, Salerno M, Mussa A, Capalbo D, et al. Subclinical hyperthyroidism when presenting as initial manifestation of juvenile Hashimoto’s thyroiditis: first report on its natural history. Journal of Endocrinological Investigation. 2014;37 (3):303–8.
• Marshall W TJ. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;291:291.
• World Health Organization, International Council for Control of Iodine Deficiency Disorders.Indicators for assessing iodine deficiency disorders and their control through salt iodization. World Health Organization; 1994; 66 p. https://iris.who.int/handle/10665/70715
• Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, et al. Reference values for weight, height, head circumference, and body mass index in Turkish children. Journal of clinical research in pediatric endocrinology. 2015;7 (4):280.
• Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC. Volumetric analysis of thyroid lobes by real-time ultrasound (author’s transl). Deutsche Medizinische Wochenschrift (1946). 1981;106 (41):1338–40.
• Aydıner Ö, Aydıner EK, Akpınar İ, Turan S, Bereket A. Normative data of thyroid volume-ultrasonographic evaluation of 422 subjects aged 0-55 years. JCRPE Journal of Clinical Research in Pediatric Endocrinology. 2015;7 (2):98–101.
• Brown RS. Autoimmune thyroiditis in childhood. Journal of clinical research in pediatric endocrinology. 2013;5 (Suppl 1):45.
• Cappa M, Bizzarri C, Crea F. Autoimmune Thyroid Diseases in Children. Francis GL, editor. Journal of Thyroid Research [Internet]. 2011;2011:675703. Available from: https://doi.org/10.4061/2011/675703
• Foley TP, Abbassi V, Copeland KC, Draznin MB. Hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. New England Journal of Medicine. 1994;330(7):466–8.
• Demirbilek H, Kandemir N, Gonc EN, Ozon A, Alikasifoglu A. Assessment of thyroid function during the long course of Hashimoto’s thyroiditis in children and adolescents. Clinical Endocrinology. 2009;71 (3):451–4.
• Özsu E, Mutlu RGY, Çizmeci F, Hatun Ş. Characteristics of our patients with hashimoto thyroiditis. Turk Pediatri Arsivi. 2011;46 (3):252–5.
• Lópeza EG, Nso-Roca AP, Ruiz MJ, Castell EC. Hashimoto’s disease in a cohort of 29 children and adolescents. Epidemiology, clinical course, and comorbidities in the short and long term. Archivos Argentinos de Pediatria. 2018;116 (1):56–9.
• Shapira Y, Agmon-Levin N, Shoenfeld Y. Defining and analyzing geoepidemiology and human autoimmunity. Journal of autoimmunity. 2010;34 (3):168–77.
• McGrogan A, Seaman HE, Wright JW, De Vries CS. The incidence of autoimmune thyroid disease: a systematic review of the literature. Clinical endocrinology. 2008;69 (5):687–96.
• Lerner A, Matthias T. Changes in intestinal tight junction permeability associated with industrial food additives explain the rising incidence of autoimmune disease. Autoimmunity reviews. 2015;14 (6):479–89.
• Wasniewska M, Corrias A, Salerno M, Mussa A, Capalbo D, Messina MF, et al. Thyroid function patterns at hashimoto’s thyroiditis presentation in childhood and adolescence are mainly conditioned by patients’ age. Hormone Research in Paediatrics. 2012;78 (4):232–6.
• Özen S, Berk Ö, Şimşek DG, Darcan Ş. Clinical course of Hashimoto’s thyroiditis and effects of levothyroxine therapy on the clinical course of the disease in children and adolescents. JCRPE Journal of Clinical Research in Pediatric Endocrinology. 2011;3 (4):192–7.
• Ruggeri RM, Trimarchi F, Giuffrida G, Certo R, Cama E, Campennì A, et al. Autoimmune comorbidities in Hashimoto’s thyroiditis: Different patterns of association in adulthood and childhood/adolescence. European Journal of Endocrinology. 2017;176 (2):133–41.
• Loviselli A, Velluzzi F, Mossa P, Cambosu MA, Secci G, Atzeni F, et al. The Sardinian Autoimmunity Study: 3. Studies on circulating antithyroid antibodies in Sardinian schoolchildren: relationship to goiter prevalence and thyroid function. Thyroid. 2001;11 (9):849–57.
• Kordonouri O, Klinghammer A, Lang EB, Grüters-Kieslich A, Grabert M, Holl RW, et al. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes care. 2002;25 (8):1346–50.
• Kordonouri O, Hartmann R, Deiss D, Wilms M, Grüters-Kieslich A. Natural course of autoimmune thyroiditis in type 1 diabetes: association with gender, age, diabetes duration, and puberty. Archives of disease in childhood. 2005;90 (4):411–4.
• Mariotti S, Prinzis A, Ghiani M, Cambuli VM, Pilia S, Marras V, et al. Puberty Is Associated with a Marked Increase of the Female Sex Predominance in Chronic Autoimmune Thyroiditis. Hormone Research. 2009;72 (1):52–6.
• Skarpa V, Kousta E, Tertipi A, Anyfandakis K, Vakaki M, Dolianiti M, et al. Epidemiological characteristics of children with autoimmune thyroid disease. Hormones. 2011;10 (3):207–14.
• Gopalakrishnan S, Chugh PK, Chhillar M, Ambardar VK, Sahoo M, Sankar R. Goitrous autoimmune thyroiditis in a pediatric population: a longitudinal study. Pediatrics. 2008;122 (3):e670–4.
• De Luca F, Santucci S, Corica D, Pitrolo E, Romeo M, Aversa T. Hashimoto’s thyroiditis in childhood: presentation modes and evolution over time. Italian journal of pediatrics [Internet]. 2013;39 (1):1. Available from: Italian Journal of Pediatrics
• Lazar L, Kalter-Leibovici O, Pertzelan A, Weintrob N, Josefsberg Z, Phillip M. Thyrotoxicosis in Prepubertal Children Compared with Pubertal and Postpubertal Patients. The Journal of Clinical Endocrinology & Metabolism [Internet]. 2000 Oct 1;85 (10):3678–82. Available from: https://doi.org/10.1210/jcem.85.10.6922
• Fort P, Moses N, Fasano M, Goldberg T, Lifshitz F. Breast and soy-formula feedings in early infancy and the prevalence of autoimmune thyroid disease in children. Journal of the American College of Nutrition. 1990;9 (2):164–7.