ESPE2015 Poster Category 3 Thyroid (64 abstracts)
Goitre in Childhood and Adolescence; Clinical Course and Associated Factors for Thyroid Autoimmunity or Isolated Nonautoimmune Hyperthyrotropinemia
So Youn Kim a , Hae Woon Jung a , Kyung A Jeong a , Keun Hee Choi a , Gyung Min Lee b , Hwa Young Kim c , Young Ah Lee a , Choong Ho Shin a & Sei Won Yang a
aSeoul National University Children’s Hospital, Seoul, Republic of Korea; bKonyang University Hospital, Daejeon, Republic of Korea; cKangwon National University Hospital, Chuncheon, Republic of Korea
Background: Simple goitre (SG) and autoimmune thyroid disease (AITD) are the two most common causes of goiter in children.
Objective and hypotheses: The prevalence of thyroid dysfunction, AITD, and SG at the time of goiter diagnosis was investigated. The natural course of SG was studied and factors related to the development of AITD and/or thyroid dysfunction were analysed.
Method: A retrospective review of 1,225 patients (1071 females, 5.0–17.9 years) initially diagnosed with goiter was performed. Anthropometrics, pubertal status, goitre grade, and family history of thyroid disease were investigated. SG was defined as a euthyroid goitre without pathologic cause after exclusion of AITD or isolated nonautoimmune hyperthyrotropinemia (iso-NAHT).
Results: At initial diagnosis, 29% of children showed thyroid dysfunction and/or AITD (euthyroid AITD (8.1%), hyper or hypothyroid AITD (14.2%), and iso-NAHT (6.7%)). Despite being initially euthyroid, the AITD group had a higher risk of subsequent medication when compared to the SG group (19.2% vs 0.8%, P<0.001). Hashimoto’s thyroiditis (HT) and iso-NAHT developed in 18.5% and 13.7% of those initially diagnosed with SG after 1.8±1.1 and 1.5±1.2 and years respectively. Compared to the persistent SG group, the HT group showed proportionally greater family history (50.0% vs 28.0%, P=0.005) and increasing size of goiter (15.2% vs 5.4%, P=0.024). The iso-NAHT group had higher baseline thyrotropin levels (2.9±0.9 vs 2.0±0.8, P<0.001), greater proportion of patients with increasing goitre size (18.2% vs 5.4%, P=0.01) and overweight or obese (35.3% vs 18.1%, P=0.026) patients.
Conclusion: Thyroid dysfunction and/or AITD were detected in one-third of children at initial diagnosis of goiter. Judging from higher risk of subsequent medication in euthyroid AITD patients, thyroid autoimmunity should be checked at diagnosis and during follow-up. During follow-up of SG, thyroid dysfunction or AITD can develop in one-third of patients, especially in those with family history of thyroid disease or increasing goitre size.
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