Background: The natural evolution of euthyroid Hashimoto thyroiditis (HT) varies among children and treatment in children with HT and normal/mild elevated serum TSH is controversial.
Objective and hypotheses: The aim was to study the natural course of HT in children and evaluate predictive factors of thyroid function
Method: We evaluated data from 87 children retrospectively (63 girls, 24 boys), mean age 10.6±3.2yrs, with HT [antibody titers (anti-Tg and anti-TPO) at least double the upper limit of normal]. All children had FT4 within normal ranges at diagnosis, 64 had also normal TSH<5 U/L (group 1), whereas 23 of them had subclinical hypothyroidism 5<TSH<10 U/L (group 2). Serum levels of FT4 and TSH were recorded at 6, 12 and 24 months after their diagnosis and thyroid ultrasound was performed at 12 and 24 months.
Results: During follow up, 45 (70.3%) patients of group 1 remained euthyroid (TSH<5 U/L), 11 (17.2%) presented mild elevation of TSH<10 U/L and in 8 (12.5%) TSH rose>10 U/L, among whom 4 developed overt hypothyroidism. In group 2, 8 (34.8%) presented normalization of TSH, 5 (21.7%) remained stable with mild elevation of TSH<10 U/L, while 10 (43.5%) developed significant rise of TSH>10 U/L and/or overt hypothyroidism. Children with deterioration of thyroid function (33.3%) during follow up had higher anti-TPO (660.2±680 vs 329.7±392 U/ml, P=0.04) and anti-Tg levels (1288.6±1037 vs 608.3±536 U/ml, P=0.04) at baseline and significantly higher increase of anti-Tg levels during follow-up (115.2±78 vs 28.2±25 U/ml, P=0.05), compared to children who remained or reversed to normal.
Conclusion: A significant percentage of children (66.7%) with HT remained or became euthyroid during a 2 year follow-up period. Antibody titers at diagnosis and their progressive increase may constitute predictive factors of future deterioration of thyroid function in children with HT.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology