Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up

Abstract

Objective: To investigate the clinical manifestations of autoimmune thyroiditis (AIT) leading to referral in children and adolescents, in addition to disease course and long-term outcome.

Design: Chart review.

Setting: Major tertiary hospital.

Patients: 114 children/adolescents (92 female, 22 male; mean (SD) age 11.8 (35) years) with AIT referred for evaluation/treatment.

Main outcome measures: Clinical characteristics at presentation, reasons for referral, treatment and long-term (mean 6 years) outcome; by thyroid and pubertal status.

Results: The male/female (1:4.2) ratio was lower than in adult AIT (1:10) and varied by age. Patients with noticeable goitre at presentation (39.5%) accounted for half the total number in whom goitre was eventually diagnosed. Other reasons for referral were clinical symptoms of hypothyroidism (28.9%) and findings on work-up for an unrelated problem (19.2%) or for high-risk groups (10.5%). There was no difference in management or outcome between patients who underwent ultrasound (n = 79) or not. Treatment was initiated shortly after diagnosis in all 42 hypothyroid patients and 44/48 compensated hypothyroid patients, and within 16 months in 19/24 euthyroid patients. There was no change in thyroid status in the nine untreated patients. Height standard deviation score (SDS) was normal at referral and last visit and correlated with parental height SDS. Puberty was normal. There was no significant difference in body mass index SDS at referral by pubertal or thyroid status. There was no difference from the general population in the prevalence of obesity.

Conclusions: Although goitre is the main symptom leading to diagnosis of AIT, it is still often overlooked, underscoring the need for thorough thyroid evaluation on routine physical examination. Acquired hypothyroidism is not often associated with obesity, and ultrasound usually has no added diagnostic value. Adequate treatment in this age group leads to normal growth, puberty and final height.