Long-term Follow-up Outcome in Children and Adolescents with Hashimoto's Thyroiditis

Lee, Jung Hyun; Yoo, Han Wook

Abstract

PURPOSE
Hashimoto's thyroiditis is the most common cause of thyroid disease in children and adolescents. It shows a wide spectrum of thyroid functions, ranging from hypothyroidism to hyperthyroidism, with variable clinical course. This study was undertaken to investigate the clinical course and outcome of Hashimoto's thyroiditis with long-term follow-up in children and adolescents.
METHODS
We analyzed retrospectively clinical data in 85 girls diagnosed as Hashimoto's thyroiditis in the pediatric endocrinology clinic at Asan Medical Center from January 1996 to June 2006. Of 24 patients, who had been followed up for more than five years, we investigated age at diagnosis, family history, initial thyroid function, initial thyroid autoantibody titers, changes of thyroid function, and changes of positivity rate of thyroid autoantibody.
RESULTS
The mean age at diagnosis was 10.9+/-2.6 years. Goiter was found in about 95% of patients, whereas 5 patients presented with short stature. Positive family history of autoimmune thyroid disease was documented in 27 out of 85 patients (31.8%). At diagnosis, 34 of 85 patients (40.0%) were in euthyroidal status, 43 (50.7%) in overt or compensated hypothyroidism, and 8 (9.4%) in hyperthyroidism. Among the 24 patients followed up for more than five years, 7 patients were in euthyroidal status, 16 in overt or compensated hypothyroidism, and 1 in hyperthyroidism at initial presentation. Four patients initially diagnosed with euthyroidism remained in euthyroidal status, while 7 patients with hypothyroidism were shifted to euthyroidism. Overall, 15 out of 24 patients were in remission status at the last follow-up. Initial TSH level was significantly higher in non-remission group (P=0.016). Initial thyroid autoantibody titers were not correlated with remission rate.
CONCLUSION
The clinical course of children and adolescents with Hashimoto's thyroiditis varied widely. After more than five years follow-up, 62.5% of patients remained or became euthyroid. Initial TSH level can be a prognostic factor of Hashimoto's thyroiditis.