ESPE Abstracts

Background: Autoimmune thyroid disease (AITD) is the most common thyroid disorder in the paediatric age range. However, the development of thyroid dysfunction in biochemically euthyroid children with positive TPOAbs and associated risk factors is unclear.

Objective and hypotheses: To evaluate the evolution of children with positive TPOAbs and normal thyroid function and identify predictive factors for the development of thyroid dysfunction.

Method: A retrospective study analysing a database of 250 children with positive TPOAbs in 2010 and the development of thyroid dysfunction and levothyroxine treatment over 5 years. Clinical features and risk factors for hypothyroidism were recorded.

Results: In 2010, 250 patients had TPOAbs analysed with 46 (18.4%) positive, median age 11 years, 147 (58.8%) non-diabetic children. Of the positive children, 32 (69.5%) were associated with normal thyroid function. We excluded 12 children (ten: on levothyroxine treatment and two: no further bloods test done). Among those with normal thyroid function (18 (90%) females, 10 (50%) diabetics, and 4 (20%) goitre), four developed hypothyroidism within a median 2.45 years (1.96–3.68) from initial testing, with 80% remaining euthyroid over 5 years. The median follow-up time of the children who remain euthyroid was 4.19 years (1.13–4.67) and the median time for the hypothyroid ones was 4.09 years (3.94–4.29). No differences in age or gender were seen. Children who remain euthyroid are more like to have lower TPOAbs levels, with an absence of goitre.

Conclusion: Paediatric patients with increased TPOAbs need careful monitoring because no clear criteria exist to predict the development of thyroid dysfunction. Hypothyroidism developed in 20% of our children with positive antibodies within 4 years and it seems to be more prevalent in those with a higher level of antibodies together with the presence of goitre, but more studies are needed with greater subjects.