ESPE Abstracts

Background: Atrophic thyroiditis is difficult to diagnose earlier due to asymptomatic or nonspecific symptoms, such as fatigue and headaches. Atrophic thyroiditis is frequently diagnosed in children with growth failure in school health examinations.

Case: The case is a 14-year-old female with wobbles. She visited hospital, and blood test was performed. Hypothyroidism occurred with TSH of 657 µIU/mL and FT4 of <0.1 ng/dL, anemia with Hb of 8.4 g/dL, elevated transaminase, hypercreatininemia, and dyslipidemia. Her height was 137.6 cm (-3.6 SD), her weight was 37.4 kg, and her BMI was 19.4 (-1.7 SD). Growth failure was started from 10 years of age. Low blood pressure, peripheral coldness, and pitting edema in the lower extremities was shown. Brain MRI showed pituitary enlargement. Thyroid ultrasound showed no thyroid enlargement. Blood tests showed TSBAb positive, resulting in a diagnosis of atrophic thyroiditis. She was administered in 25 µg of LT4, then she gradually improved thyroid function and clinical symptoms of atrophic thyroiditis. Her thyroid function with 62.5µg of LT4 is now within the normal range.

Discussion: Approximately 10% of atrophic thyroiditis patients show TSBAb positive, which decreases thyroid function with atrophic thyroid gland. Atrophic thyroiditis in pediatric patients with TSBAb is relatively rare, but this case showed TSBAb positive. In some regions of Japan, annual school health examinations have been performed to measure height and weight with growth charts for the assessment of growth since the year April 2016. Unfortunately, the patient lived in an area where school health examinations was not performed. The patient was not identified with atrophic thyroiditis with severe growth failure. There were large regional differences in school health examinations in the Kyushu region of Japan.

Conclusion: We report a case of atrophic thyroiditis over a 4-year period for diagnosis because the patient was identified a growth failure, despite growth failure in a marked manner. We warrant caution for the use of growth charts to detect growth failure in the early stage and school health examinations should be conducted in all regions of Japan.