ESPE Abstracts

Hashimoto's thyroiditis (HT) is most commonly caused by autoimmune thyroid disease and rarely in children. It is characterized clinically by gradual thyroid failure, with or without goiter formation, due to autoimmune-mediated destruction of the thyroid gland involving apoptosis of thyroid epithelial cells. In fact, thyroid function at presentation may significantly vary in the different pediatric reports, ranging from euthyroidism (52.1%) to overt hypothyroidism (41.4%) or, occasionally, hyperthyroidism (6.5%).

Objectives: To describe the clinical and laboratory features, as well as the management of patients with Hashimoto's disease at Vietnam National Children's Hospital (NCH).

Subjects and methods: this is case series study including clinical features, biochemical, image findings, and management of 3 children (2 girls and one boy) with HT.

Results: All three exhibited the typical symptoms and signs of enlarge forming a painless goiter. The first patient is a third child of the family who is 7 years old, with a history of normal motor mental development. She presented with diffuse goiter grade 3 and difficult swallowing; investigations showed low levels of plasma T3 (0.6 nmol/l) and FT4 (4.39 pmol/l), elevated level TSH (117.51 mIU/l), Anti-TG (1748 U/ml), Anti-TPO (339.6 U/ml); thyroid ultrasonography showed hypertrophy, uniform parenchyma and no focal nodule. The second patient is an 8-year-old girl. Her painless goiter was recognized from two weeks, investigations showed low levels of plasma T3 (0.89 nmol/l) and FT4 (4.19 pmol/l), elevated levels of TSH (129.7 mIU/l), Anti-TPO (>7260 U/ml), Anti-TG (2547 U/ml) and normal levels of TRab (< 0.3 U/l); echocardiography was normal but manifesting sinus arrhythmias on the electrocardiogram. The last patient was a 6-year-old boy, he presented with goiter grade IIa and normal function of thyroid during first year of his illness. The review data showed FT4 = 12.91 pmol/l, TSH 23.44 mIU/l, Anti-TG 2073 U/ml, hypertrophic thyroid on ultrasound. All three patients are treated with thyroid hormone replacement - levothyroxine.

Conclusions: three cases with HT were confirmed diagnosis in a week at refferal center, with the manifestations of goiter and hypothyroidism. This implies that whether or not all goiter patients are tested for autoimmune thyroid marker.