Long-Term Follow-Up and Outcomes of Autoimmune Thyroiditis in Childhood

• Published in: Frontiers in endocrinology (Lausanne) 2020-06, Vol.11, p.309-309
• Main Authors: Admoni, Osnat, Rath, Shoshana, Almagor, Tal, Elias-Assad, Ghadir, Tenenbaum-Rakover, Yardena
• Format: Article
• Language: English
• Subjects: autoimmune thyroiditis (AIT); Endocrinology; goiter; Hashimoto's thyroiditis; Hashitoxicosis; thyroid autoantibodies
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2020.00309

Background: Autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in children. The natural outcome of AIT in childhood has been reported previously however follow-up duration is generally short and results variable. Objectives: To characterize clinical and biochemical findings at presentation of AIT, evaluate long-term outcomes and assess which factors at presentation predict evolution over time. Study cohort: 201 children under 18 years of age at presentation (82% female) were enrolled. Subjects were divided into five subgroups according to thyroid stimulating hormone (TSH) level at referral. Results: Mean follow-up was 8.1 years (range 0–29 years). At presentation, 34% of patients had overt hypothyroidism, 32% subclinical hypothyroidism (SCH), 16% compensated hypothyroidism, 14% were euthyroid, and 3.7% had Hashitoxicosis. Children with overt hypothyroidism were younger (10.6 vs. 13.2 years) and had higher thyroid peroxidase antibody titers. At the time of the study, levothyroxine (LT 4 ) therapy was required in 26% of children who were euthyroid at presentation, 56% of SCH patients, 83–84% of those with TSH above 10 mIU/L, and 57% of those with Hashitoxicosis. Over the years, 16% of children presenting with overt hypothyroidism stopped therapy. Free T 4 at presentation was the only predictor of outcome over time. Conclusions: Our findings suggest that only 26% children who were euthyroid at presentation developed hypothyroidism, whereas over 50% of those with SCH went on to require treatment. Of those presenting with overt hypothyroidism, 16% recovered with time. The only predictive parameter for LT 4 therapy at the end of the study was free T 4 levels at presentation. Long-term follow-up is required to determine ongoing therapy needs and screen for additional autoimmune diseases.