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.
19 Sep 2019 - 21 Sep 2019