INVESTIGATION OF THE TRIGGERING ROLE OF INFECTIOUS AGENTS IN THE PATHOGENESIS OF AUTOIMMUNE THYROIDITIS IN CHILDREN AND ADOLESCENTS

Öz

Objective: Autoimmune thyroiditis (AIT) is a common endocrine disorder in paediatrics. Although genetic and environmental factors contribute to its development, infectious agents have also been considered as triggers. This study examined the potential role of Epstein–Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and toxoplasma gondii in paediatric AIT. Material and Methods: Forty nine patients (aged 1–18 years) who presented to the Paediatric Infectious Diseases and Paediatric Endocrinology outpatient clinics and were diagnosed with AIT within the previous six months were included in the study. Viral serology was routinely performed during the evaluation for lymphadenopathy in the Paediatric Infectious Diseases clinic. The diagnosis of AIT was based on positive thyroid autoantibodies (antiTG, anti TPO, and TSI), with or without thyroid dysfunction, and ultrasound f indings suggestive of thyroiditis. Clinical and laboratory data were retrospectively analysed using SPSS version 22. Results: The median age was 13.1 years (IQR: 4.6). Of the patients, 14.3% (n=7) were male and 85.7% (n=42) were female. Four patients had Graves’ disease, and the rest had Hashimoto’s thyroiditis. Treatment was required in 53.1% (n=26). Parvovirus IgM was positive in three patients, EBV VCA IgM in four, and both in one. No significant differences in antiTPO or antiTG levels were found between the seropositive and seronegative patients. No cases had HIV or HCV, and 97% tested negative for Toxoplasma gondii antibodies. Conclusion: Parvovirus B19 and EBV may contribute to AIT pathogenesis, but larger studies are needed to confirm these findings.

Anahtar Kelimeler

• Autoimmune thyroiditis
• Epstein–Barr virus
• parvovirus B19
• cytomegalovirus
• toxoplasma gondii
• children and adolescents

ÇOCUKLAR VE ERGENLERDE OTOİMMÜN TİROİDİTİN PATOGENEZİNDE ENFEKSİYÖZ ETKENLERİN TETİKLEYİCİ ROLÜNÜN ARAŞTIRILMASI

Öz

Amaç: Otoimmün tiroidit (AIT), pediatrik endokrinolojide yaygın görülen bir hastalıktır. Genetik ve çevresel faktörlerin yanı sıra enfeksiyöz ajanların da hastalığın gelişiminde rol oynayabileceği öne sürülmüştür. Bu çalışma, EpsteinBarr virüsü (EBV), sitomegalovirüs (CMV), Parvovirüs B19, HIV, HCV ve Toxoplasma gondii’nin pediatrik AIT’deki potansiyel rolünü incelemektedir. Gereç ve Yöntemler: Önceki altı ay içinde otoimmün tiroidit (AIT) tanısı almış, Çocuk Endokrinoloji ve Çocuk Enfeksiyon Hastalıkları polikliniklerine başvuran 1–18 yaş aralığındaki 49 hasta çalışmaya dahil edildi. Viral seroloji, Çocuk Enfeksiyon Hastalıkları polikliniğinde lenfadenopati değerlendirmesi sırasında rutin olarak yapılmıştı. AIT tanısı, tiroid fonksiyon bozukluğu olsun ya da olmasın, pozitif tiroid otoantikorları (antiTG, antiTPO ve/veya TSI) ve/veya tiroidite işaret eden ultrasonografi bulgularına (heterojenite veya psödonodüler görünüm) dayanılarak konuldu. Klinik ve laboratuvar verileri retrospektif olarak toplanarak SPSS sürüm 22 kullanılarak analiz edildi. Bulgular: Hastaların medyan yaşı 13,1 yıl (IQR: 4,6) idi. Hastaların %14,3’ü (n=7) erkek, %85,7’si (n=42) kızdı. Dört hastada Graves hastalığı, geri kalanında Hashimoto tiroiditi vardı. Hastaların %53,1’i (n=26) tedavi gerektirdi. Üç hastada Parvovirüs IgM, dört hastada EBV VCA IgM ve bir hastada her ikisi de pozitif bulundu. Seropozitif ve seronegatif hastalar arasında antiTPO veya anti TG seviyeleri açısından anlamlı fark saptanmadı. Hiçbir hastada HIV veya HCV saptanmazken, hastaların %97’si Toxoplasma gondii antikorları açısından negatifti. Sonuç: Parvovirüs B19 ve EBV, AIT patogenezine katkıda bulunabilir, ancak bu bulguların doğrulanması için daha geniş çaplı çalış malara ihtiyaç vardır.

Anahtar Kelimeler

• Otoimmun tiroidit
• EpsteinBarr virüs
• parvovirus B19
• sitomegalovirüs
• toxoplasma gondii
• çocuk ve adolesan

Kaynakça

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