ESPE Abstracts

Introduction: Graves-Basedow disease (GD) is the most common cause of thyrotoxicosis in pediatric age. Multi-factorial pathogenesis stand on the basis of the autoimmune disorder activation, leading to lymphocyte imbalance that include increased CD4+ and CD8+ subtypes, increased CD4+/CD8+ ratio and B cells dysregulation. The aim of this study is to determine the potential prognostic value of lymphocyte population parameters in pediatric GD.

Methods: Thyroid hormone profile, TRAb titre, lymphocyte population and clinical data of all pediatric subjects (aged <18 y) with new diagnosis of GD were collected. All of them were referred to the Department of Pediatric Endocrinology of Regina Margherita Children’s Hospital in Turin in the period November 2017-April 2021.

Results: The data of 10 subjects (2 males, 8 females; age 11.7 ± 3.47 years old) with newly diagnosed GD in a follow-up period of 2.4 ± 0.8 years are represented in table 1. Pearson correlation coefficient among CD4+/CD8+ ratio and fT3 levels and thyroid volume at diagnosis was 0.72 (P = 0.04) and 0.81 (P = 0.004) respectively. Positive correlation coefficient was observed also among CD4+/CD8+ ratio and TRAb titre at diagnosis and after 6, 12 and 24 months (0.89, 0,89, 0.73 and 0.77; P = 0.02, P = 0.01, P = 0.03 and 0.04 respectively). The ATD dose correlation coefficient after 6 and 12 months with CD4+/CD8 ratio showed also a similar course (0.88 and 0.78, P = 0.001 and P = 0.02 respectively). After 2 years of follow-up, 2/10 patients underwent thyroidectomy, 2/10 had disease remission and 6/10 are still under ATD treatment.

Conclusion: Among lymphocyte population parameters, the CD4+/CD8+ ratio seems to be positively related to higher fT3 levels and goiter size at diagnosis, higher TRAB titre in the first two years and higher ATD dose in the first year after the diagnosis. These are preliminary data which need to be confirmed in longer follow-up period and larger cohorts.