Natural history of thyroid abnormalities: prevalence, incidence, and regression of thyroid diseases in adolescents and young adults

Estradiol modulates TGF-β1 expression and its signaling pathway in thyroid stromal cells

The higher prevalence of thyroid disease in women suggests that estrogen (E2) might be involved in the pathophysiology of thyroid dysfunction. To approach the question of the effect of stromal cells in the modulation of thyroid epithelial cells activity, we established and characterized a homogeneous stromal cell population (TS7 cells) of rat thyroid gland. These fibroblastic cells synthesize the cytoskeleton proteins α-smooth muscle actin and vimentin, produce basement membrane components and express the cytokine transforming growth factor beta 1 (TGF-β1). Here, we hypothesized that the effects of E2 on follicular thyroid cells are mediated by TGF-β1 synthesis and secretion by stromal cells (paracrine action). Thus we investigated the effect of E2 on TGF-β1 synthesis and its signaling pathway in TS7 cells. In addition, we analyzed the role of TGF-β1 signaling pathway as mediator of TS7-PC CL3 thyroid epithelial cells interactions. We report that TS7 stromal cells expressed α and β estrogen receptors (ERα and ERβ). Further, both isoforms of TGF-β1 receptors, TGFRI and TGFRII, were also identified in TS7 cells, suggesting that these cells might be a target for this cytokine in vitro. Treatment of TS7 cells with E2 induced both synthesis and secretion of TGF-β1. This event was followed by phosphorylation of the transcription factor Smad2, a hallmark of TGF-β1 pathway activation. Co-culture of PC CL3 cells onto TS7 cells monolayers yielded round aggregates of PC CL3 cells surrounded by TS7 cells. TS7 cells induced a decrease in iodide uptake by PC CL3 cells, probably by a mechanism involving TGF-β1. Moreover, E2 affected synthesis and organization of the extracellular matrix (ECM) components, tenascin C and chondroitin sulfate, in these co-culture cells. Our results point to the TGF-β1/Smad-2 signaling pathway as a putative target of estrogen actions on thyroid stromal cells and contribute to understanding the interplay between stromal and follicular cells in thyroid physiology.

Fine-needle aspiration biopsy in the diagnosis and follow-up of thyroid nodules in childhood

OBJECTIVE

To assess the role of fine-needle aspiration biopsy (FNAB) in the management of pediatric thyroid nodules.

METHODS

Results of 30 FNABs performed in our clinic were retrospectively reviewed. Clinical and surgical follow-up data were obtained from the patient files, and clinical correlation and accuracy of FNAB were evaluated.

RESULTS

The results of 30 FNABs were reported as benign in 24 (80%), insufficient in 4 (13.3%) patients, malignant in 1 (3.3%), and suspicious in 1 (3.3%) patient. One patient with a FNAB result of malignancy underwent surgery and the histological diagnosis was papillary carcinoma. FNAB was repeated in two of the insufficient biopsies, and reported as benign; in one of these patients, the thyroid nodule disappeared and in one, remained stable at clinical follow-up. Four of the patients with benign FNAB results underwent surgery at clinical follow-up because of an increase in the size of the nodules and one patient was found to have papillary carcinoma. The remaining patients were clinically followed. In this study, the malignancy prevalence was 6.6% in patients with thyroid nodules. There was only one false-negative case.

CONCLUSION

FNAB is a reliable diagnostic tool in the management of pediatric thyroid nodules.

Autoimmune thyroiditis in antinuclear antibody positive children without rheumatologic disease

BACKGROUND

Children are commonly referred to a pediatric rheumatology center for the laboratory finding of an Anti-nuclear antibody (ANA) of undetermined significance. Previous studies regarding adult rheumatology patients have supported an association between ANA and anti-thyroid antibodies, with the prevalence of thyroid antibodies being significantly higher in patients referred to a rheumatology center for an ANA without evidence of connective tissue disease compared to the general population. The purpose of the present study was to determine the frequency of thyroid antibodies in children referred to a pediatric rheumatology center for a positive ANA without evidence of a connective tissue disease.

METHODS

A retrospective chart review was performed on children who were referred to our pediatric rheumatology center between August 2003 and March 2007 for positive ANA with concurrent thyroid antibody and thyroid function tests performed who did not fulfill criteria for a specific connective tissue disease. Laboratory and clinical features were recorded and analyzed. Mean and standard deviation were used to describe continuous data. Chi-square or Fisher's exact tests were used to compare proportions between variables.

RESULTS

One-hundred and four ANA-positive patients with concurrent thyroid studies were evaluated (88% female, 93% Caucasian, mean age 11.9 +/- 4.0 years). Half of patients had an ANA titer >/= 1:320. The ANA pattern was speckled in 60% of the patients. Thyroid antibodies were detected in 30% of the patients. Anti-Thyroglobulin (ATG) was detected in 29% and Anti-thyroid peroxidase (ATPO) in 21% of the patients; of these children, 14% had hypothyroidism. ANA pattern and titer were not associated with anti-thyroid antibody positivity.

CONCLUSION

Thyroid antibodies associated with chronic lymphocytic thyroiditis, ATG and ATPO, were detected significantly higher in ANA-positive children without a rheumatologic condition (30%) as compared to the general pediatric population (1.3 - 3.4%). ANA titer and pattern did not help predict the presence or absence of thyroid antibodies. Given the high frequency of thyroid antibodies and increased risk of developing hypothyroidism over time, routine evaluation of ATG and ATPO with thyroid function tests in ANA-positive children is recommended.

Thyroid follicular neoplasms: can sonography distinguish between adenomas and carcinomas?

PURPOSE

The purpose of this study was to determine whether sonography (US) can usefully differentiate thyroid follicular adenoma (FA) and follicular carcinoma (FC).

METHODS

This retrospective study included 60 pathologically proven FAs and 66 FCs in 123 consecutive patients (17 males and 106 females) with a mean age of 47 +/- 13 years, (17-73 years) who underwent thyroid surgery. We analyzed US features of each nodule, including maximum diameter, echogenicity, composition, presence of calcification, margins, and presence of halo. The frequencies of each US feature were compared by using the chi(2) test or Fisher's exact test between FAs and FCs. The relative risk of malignancy was evaluated by logistic regression analysis.

RESULTS

Isohypoechoic echogenicity, predominantly solid or mixed echotexture, and presence of microcalcifications or rim calcifications were associated with FC (p < 0.05). Logistic regression analysis demonstrated that predominantly solid or mixed echotexture and microcalcifications or rim calcifications were associated with significant increases in relative risk for FC (odds ratio 8.1 and odds ratio 13.5, respectively, p < 0.01).

CONCLUSIONS

The US features of isohypoechoic echogenicity, predominantly solid or mixed echotexture, and microcalcifications or rim calcifications are more common in FC than in FA.

Pediatric thyroid fine-needle aspiration cytology: a meta-analysis

BACKGROUND

There is conflicting evidence in the current literature regarding the use of fine-needle aspiration (FNA) biopsy in the diagnosis of a thyroid nodule in the pediatric population. There are numerous studies that look at the sensitivity and specificity of this test with varying results. A meta-analysis will provide further insight into this topic.

PURPOSE

Our objective was to investigate the diagnostic parameters of FNA biopsy in the diagnosis of a thyroid nodule in the pediatric population, specifically, to determine the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the test in differentiating malignant vs benign tumors.

MATERIAL AND METHODS

We performed a literature search of Medline, Embase, and evidence based medicine (EBM) reviews for English studies that looked at FNA biopsy in thyroid nodules in the pediatric population, in which diagnostic values were present or could be calculated and where FNA results were compared to an acceptable reference standard. Two reviewers independently selected all abstracts, and from these, studies to review. Two reviewers also independently checked diagnostic values in the studies or calculated them from data available. A meta-analysis was performed, and pooled diagnostic test values were calculated using a random-effects, bivariate meta-regression model. Studies were also assessed for quality using the quality assessment for diagnostic accuracy studies tool.

RESULTS

Twelve studies were included for review. The quality of the studies in general was good. The pooled estimate of sensitivity and specificity were 94% (95% confidence interval [CI], 86%-100%) and 81% (95% CI, 72%-91%), respectively. Assuming 20% of nodules are malignant, the accuracy, PPV, and NPV were 83.6%, 55.3%, and 98.2%, respectively.

CONCLUSION

This meta-analysis provides good evidence that FNA biopsy of thyroid nodules is a sensitive test in the pediatric population and may be a useful tool for excluding malignancy in young patients. Future prospective studies are needed to evaluate this further.

Assessment of thyroid function during the long course of Hashimoto's thyroiditis in children and adolescents

CONTEXT

The prognosis of Hashimoto's thyroiditis (HT) in children and adolescents is not well known and studies reporting long-term outcome of the disease are scarce.

OBJECTIVE

To assess the thyroid hormone status during long-term follow-up and to establish the prognosis of children and adolescents with HT.

PATIENTS

One hundred and twenty-nine patients with HT were re-evaluated for thyroid hormone status after a mean follow-up period of 50 months.

RESULTS

Seventy-seven per cent of the euthyroid patients were still euthyroid, while 21.1% of these patients became hypothyroid at the time of re-evaluation. However, 69.5% of hypothyroid patients remained hypothyroid (overt or subclinical) and 30.5% recovered.

CONCLUSION

HT is a dynamic process. Thyroid functions can show variation during follow-up. Therefore, thyroid function tests should be repeated periodically to detect progression to hypothyroidism in initially euthyroid patients as well as reversibility of hypothyroidism.

Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review

CONTEXT

There has not been a comprehensive compilation of data regarding the epidemiology of all endocrine and metabolic disorders in the United States.

EVIDENCE ACQUISITION

We included 54 disorders with clinical and public health significance. We identified population-based studies that provided U.S. prevalence and/or incidence data by searching PubMed in December 2007 for English-language reports, hand-searching reference lists of six textbooks of endocrinology, obtaining additional resources from identified experts in each subspecialty, and searching epidemiological databases and web sites of relevant organizations. When available, we selected articles with data from 1998 or later. Otherwise, we selected the article with the most recent data, broadest geographical coverage, and most stratifications by sex, ethnicity, and/or age. Ultimately, we abstracted data from 70 articles and 40 cohorts.

EVIDENCE SYNTHESIS

Endocrine disorders with U.S. prevalence estimates of at least 5% in adults included diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, obesity, metabolic syndrome, osteoporosis, osteopenia, mild-moderate hypovitaminosis D, erectile dysfunction, dyslipidemia, and thyroiditis. Erectile dysfunction and osteopenia/osteoporosis had the highest incidence in males and females, respectively. The least prevalent conditions, affecting less than 1% of the U.S. population, were diabetes mellitus in children and pituitary adenoma. Conditions with the lowest incidence were adrenocortical carcinoma, pheochromocytoma, and pituitary adenomas. Certain disorders, such as hyperparathyroidism and thyroid disorders, were more common in females. As expected, the prevalence of diabetes mellitus was highest among ethnic minorities. Sparse data were available on pituitary, adrenal, and gonadal disorders.

CONCLUSIONS

The current review shows high prevalence and incidence of common endocrine and metabolic disorders. Defining the epidemiology of these conditions will provide clues to risk factors and identify areas to allocate public health and research resources.

Clinical evolution of autoimmune thyroiditis in children and adolescents

BACKGROUND

Few studies have addressed the clinical evolution of autoimmune thyroiditis (AIT) occurring in childhood and scant data are available on the role of thyroid ultrasonography. We aimed to evaluate the natural history of AIT diagnosed in children and adolescents and to assess the possible prognostic role of ultrasonography.

METHODS

Retrospective case series prospectively followed up for a further 3-year period.

RESULTS

A series of 23 patients with AIT, diagnosed before 18 years of age from 1994 to 2004, was further followed up from 2005 to 2007 with clinical, laboratory, and ultrasound evaluation. Hypothyroid patients were treated with levothyroxine (LT(4)), while euthyroid patients were left untreated. Patients with subclinical hypothyroidism were also evaluated 40 days after LT(4) withdrawal. At diagnosis seven patients were euthyroid, 14 with subclinical hypothyroidism, and two with overt hypothyroidism. Median follow-up was 4.7 years. At last follow-up visit, none of the seven euthyroid patients had developed hypothyroidism. Three of the 14 patients with subclinical hypothyroidism recovered a normal thyroid function while only one patient showed an increase in TSH level. By serological screening we identified three patients with other autoimmune disorders.

CONCLUSIONS

In young patients with normal or mildly increased TSH levels and minimal echographic changes, AIT may remain stationary for years. In fact, patients with subclinical hypothyroidism recover a normal thyroid function in approximately 20% of cases. In patients with subclinical hypothyroidism and goiter, LT(4) therapy may induce thyroid size reduction. Screening for other autoimmune disorders is useful to identify patients that need further diagnostic assessment.

The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report

OBJECTIVE

To review all available data and recommend a definition for polycystic ovary syndrome (PCOS) based on published peer-reviewed data, whether already in use or not, to guide clinical diagnosis and future research.

DESIGN

Literature review and expert consensus.

SETTING

Professional society.

PATIENTS

None.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

A systematic review of the published peer-reviewed medical literature, by querying MEDLINE databases, to identify studies evaluating the epidemiology or phenotypic aspects of PCOS.

RESULT(S)

The Task Force drafted the initial report, following a consensus process via electronic communication, which was then reviewed and critiqued by the Androgen Excess and PCOS (AE-PCOS) Society AE-PCOS Board of Directors. No section was finalized until all members were satisfied with the contents, and minority opinions noted. Statements were not included that were not supported by peer-reviewed evidence.

CONCLUSION(S)

Based on the available data, it is the view of the AE-PCOS Society Task Force that PCOS should be defined by the presence of hyperandrogenism (clinical and/or biochemical), ovarian dysfunction (oligo-anovulation and/or polycystic ovaries), and the exclusion of related disorders. However, a minority considered the possibility that there may be forms of PCOS without overt evidence of hyperandrogenism, but recognized that more data are required before validating this supposition. Finally, the Task Force recognized and fully expects that the definition of this syndrome will evolve over time to incorporate new research findings.

Herpes virus antibodies seroprevalence in children with autoimmune thyroid disease

BACKGROUND

Elevated titers of antibodies against different herpes virus antigens have been reported in some immunodeficient and systemic autoimmune disorders.

OBJECTIVE

To examine if Herpes Simplex Virus (HSV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) IgG and IgM antibodies are detected more frequently in children with autoimmune thyroid disease (AITD) compared to controls.

SUBJECTS AND METHODS

Thirty-four children with AITD, aged 9.62 +/- 2.35 years, and 31 matched controls, aged 9.24 +/- 2.98 years, were studied.

RESULTS

The percentage of EBV IgG+ children with AITD was statistically higher than the percentage of EBV IgG+ controls (82.35% versus 51.61%, P = 0.008). The percentage of EBV IgG+ children with AITD and hypothyroidism was statistically higher than the percentage of EBV IgG+ children with AITD, without hypothyroidism (100% versus 70%, P = 0.024). No other statistically significant differences were observed in HSV-1+2, and CMV IgG or IgM antibodies between the subgroups of children studied.

CONCLUSIONS

EBV seroprevalence is higher in children with AITD compared to controls and the underlying pathology remains to be elucidated.

Juvenile autoimmune thyroiditis

Autoimmune thyroiditis is a frequent cause of goiter in children and studies point to the increasing prevalence of juvenile autoimmune thyroiditis (JAT) in children and adolescents. Clinically, JAT can manifest, depending on the presence or absence of goiter, as either a goitrous form or atrophic form. Both are characterized by the presence of thyroid antibodies in serum, with the goitrous form being more common in children. Recent evidence suggests that thyroid autoimmunity originates from an interaction of genetic, endogenous and environmental factors which end up activating thyroid-specific autoreactive T-cells in susceptible children. In addition to underlying genetic/HLA predisposition, factors including sex hormones, glucocorticoids, low birth weight, radiation and drugs may play a role in thyroid autoimmunity. Patients with JAT can present due to thyroid enlargement or symptoms arising due to hypothyroidism. Asymptomatic enlargement of the thyroid gland is a common presenting complaint, especially in older children and adolescents. Thyroid function can vary from euthyroidism to subclinical or overt forms of hypothyroidism and less commonly hyperthyroidism. Accordingly, patients can be symptomatic. There is considerable debate regarding the management of patients with euthyroidism or subclinical hypothyroidism. Available evidence indicates the presence of residual goiter in endemic form and a high prevalence of JAT in children. It is suggested that children should be screened for goiter as part of school health examinations, and goitrous children should be monitored for thyroid function.

Subclinical hypothyroidism in infertile women: the importance of continuous monitoring and the role of the thyrotropin-releasing hormone stimulation test

The aim of our study was to assess the prevalence of subclinical hypothyroidism (SH) after administering a thyrotropin-releasing hormone (TRH) stimulation test among women with normal serum thyroid-stimulating hormone (TSH) levels and various causes of infertility. Eighty-seven infertile women (39 with ovulation disorders and 48 with other causes of infertility) had a TRH stimulation test on day 3 - 7 of their cycle. Exaggerated TSH response (>30 mIU/l at 20, 40 or 60 min) following intravenous injection of 400 microg TRH was defined as SH. The TRH test was performed 2 - 4 months after the first visit to the clinic. We found that the prevalence of SH was significantly higher among women with ovulation disorders (20.5%) than among women with normal ovulation (8.3%). In addition, we found that although basal TSH levels were normal at recruitment, 2 - 4 months later these levels were abnormally high in 8% of the women. All these women had an abnormal TRH test. We recommend performing TRH stimulation testing in women suffering from ovulation disorders who have normal basal TSH levels, followed by repeat assessments of thyroid function to enable treatment with thyroxine in cases with abnormal results.

[Evidences for subclinic chronic autoimmune thyroid disease in girls with Turner Syndrome]

Patients with Turner syndrome (TS) frequently exhibit transient, recurrent and asymptomatic variations of TSH and/or thyroid hormones (TH). This work was carried out to evaluate thyroid function and structure in patients with TS who had had such variations in hormone concentrations. Our sample comprised 24 patients, 17 less than 20-years old. Evaluation included serum levels of TSH, free T4, total T3, TPO and Tg autoantibodies, thyroid ultrasound (US) and scintigraphy with 99mTc-pertechnetate. Thirteen patients had abnormal TSH and/or TH levels; 23 exhibited US features compatible with chronic thyroid disorder, particularly thyromegaly (established according to volume expected for stature) and heterogeneous echogenicity. Uptake was normal in 21 cases and tracer distribution was homogeneous in 22. The finding of abnormal hormone concentrations was independent of age, length of time since the first similar finding, thyroid autoantibodies, number of abnormalities at US and abnormal scintigraphic findings. Patients aged more than 20 years had higher frequency of thyroid antibodies and heterogeneous echogenicity, and thyroid volume was significantly correlated to length of time since detection of the first hormone variation, indicating progressive thyroid disease. These results suggest that subclinical thyroid dysfunction in TS is due to chronic autoimmune thyroid disease.

The natural history of euthyroid Hashimoto's thyroiditis in children

OBJECTIVE

To study the natural history of Hashimoto's thyroiditis (HT) in children and identify factors predictive of thyroid dysfunction.

STUDY DESIGN

We evaluated 160 children (43 males and 117 females, mean age 9.10 +/- 3.6 years, with HT and normal (group 0; 105 patients) or slightly elevated (group 1; 55 patients) serum thyroid-stimulating hormone (TSH) concentrations. The patients were assessed at presentation and then followed for at least 5 years if they remained euthyroid or if their TSH did not rise twofold over the upper normal limit.

RESULTS

At baseline, age, sex, thyroid volume, free thyroxine, free triiodothyronine, thyroid peroxidase antibody (TPOab), and thyroglobulin antibody (TGab) serum concentrations were similar in the 2 groups. During follow-up, 68 patients of group 0 remained euthyroid, and 10 patients moved from group 0 to group 1. In 27 patients, TSH rose twofold above the upper normal limit (group 2), and 9 of these patients developed overt hypothyroidism. Sixteen patients of group 1 ended up in group 0, 16 remained in group 1, and 23 moved to group 2. A comparison of the data of the patients who maintained or improved their thyroid status with those of the patients whose thyroid function deteriorated revealed significantly increased TGab levels and thyroid volume at presentation in the latter group. However, none of these parameters alone or in combination were of any help in predicting the course of the disease in a single patient.

CONCLUSIONS

The presence of goiter and elevated TGab at presentation, together with progressive increase in both TPOab and TSH, may be predictive factors for the future development of hypothyroidism. At 5 years of follow-up, more than 50% of the patients remained or became euthyroid.

Long-term outcome of hormonal status in Taiwanese children with Hashimoto's thyroiditis

The objective of this prospective study was to evaluate both thyroid function in children with Hashimoto's thyroiditis and the necessity of lifetime thyroxine replacement therapy. A total of 47 patients with goiter and positive thyroid auto-antibodies participated in the study. Serum thyroxine and thyrotropin levels and titers of thyroid auto-antibodies were checked regularly throughout the follow-up period. At the beginning of the study, 25 patients were diagnosed as euthyroid, but at the end of the study, 22 patients initially diagnosed with euthyroidism remained euthyroid, while eight patients with subclinical hypothyroidism and three patients with overt hypothyroidism had become euthyroid. Thus, of the 22 patients with thyroid dysfunction at diagnosis, subclinical or overt, 11 became euthyroid during the follow-up period. The effect of thyroxine treatment on thyroid auto-antibody titers was not significant.

CONCLUSION

Our data shows that Hashimoto's thyroiditis in children has a benign course and that thyroid function in one half of the patients with thyroid dysfunction at diagnosis reverts to normal. Careful follow-up of thyroid function is important in order to determine the necessity and timing of thyroxine replacement therapy.

Thyroid and parathyroid disease in children

Although diseases of the thyroid and parathyroid glands are relatively uncommon in children, the implications of missed diagnoses can be severe. This review describes the embryology, anatomy, and physiology of the thyroid and parathyroid glands, and focuses on significant benign and malignant pathologies of these glands.

The thyroid and urticaria

PURPOSE OF REVIEW

Although it is generally accepted that thyroid autoimmunity is more prevalent in patients with chronic urticaria than in the general population, the importance of this finding is unclear. In addition, there are reports that chronic urticaria remits in some but not all patients who have evidence of thyroid autoimmunity and are treated with l-thyroxine. This review will summarize the history of this controversy and suggest a possible role for thyroid autoimmunity in the pathophysiology of chronic urticaria.

RECENT FINDINGS

Important subsets of patients with chronic urticaria have autoantibodies to the high-affinity receptor for IgE (FcepsilonRI), anti-IgE, and antithyroid antibodies. Patients with chronic urticaria and biochemical evidence of thyroid autoimmunity may have active thyroid disease or may be clinically euthyroid. These patients are often poorly responsive to conventional therapy of urticaria and may have more chronic disease. New findings on the pathogenic effects of anti-FcepsilonRI auto-antibodies and of antithyroid antibodies have revealed a role for complement activation.

SUMMARY

Currently, there are no compelling arguments to decide whether or not thyroid autoimmunity plays a significant role in the pathogenesis of chronic urticaria. New developments concerning a role for complement activation in the pathogenesis of chronic urticaria may, however, lead to better understanding of this phenomenon in the future.

Ultrasound of thyroid cancer

The management of thyroid nodules is multi-disciplinary and involves head and neck surgeons, pathologists and radiologists. Ultrasound is easy to perform, widely available, does not involve ionizing radiation and is readily combined with fine needle aspiration cytology (FNAC). It is therefore an ideal investigation of choice for evaluating thyroid nodules. It evaluates specific features that help in identifying the nature of the nodule and FNAC helps in diagnostic accuracy. In addition, following treatment for thyroid cancer ultrasound provides a safe tool for disease surveillance. This paper discusses the role of ultrasound in the management of patients with thyroid cancer.

Urticaria and angioedema

Urticaria and angioedema are commonly encountered complaints in children. Although the diagnosis is clear, establishing an etiology, especially with respect to chronic urticaria, can be challenging. A significant proportion of chronic urticarial cases are now considered to have an autoimmune etiology. This article reviews progress in the field of urticaria and angioedema including developments in pathogenesis, description of laboratory testing, and review of medications. Urticaria and angioedema can usually be controlled by avoidance of triggers, a variety of supportive medications, and reassurance.

Chronic mucocutaneous candidiasis and primary hypothyroidism in two families

We describe the clinical and immunological features of two families with chronic mucocutaneous candidiasis (CMC) and primary hypothyroidism. Family A includes three siblings with both candidiasis and hypothyroidism and four individuals with hypothyroidism only. Family B includes four members with candidiasis, of whom one (a male child) also had hypothyroidism. All individuals affected with CMC had suffered from oral candidiasis and onychomycosis since infancy. Facial seborrhoic dermatitis, general folliculitis and scaling blepharitis were main manifestations. Hypothyroidism became evident during childhood. No thyroid antibodies were present in the affected siblings in family A, while the male in family B with hypothyroidism had antibodies against thyroid peroxidase at diagnosis. Immunological evaluation revealed intra-individual variations in serum immunoglobulin levels, lymphocyte subsets and proliferative responses, but there were no consistent abnormalities. Vaccine responses were normal. AIRE gene region microsatellite markers did not segregate with disease nor were autoantibodies typical for autoimmune polyendocrine syndrome type 1 detected in the families.

CONCLUSION

The link between hypothyroidism and chronic mucocutaneous candidiasis remains to be identified.

Chronic urticaria: association with thyroid autoimmunity

BACKGROUND

Though autoimmune phenomena have been regularly associated with chronic urticaria in adults, data in children are sparse.

AIM

To describe our experience with children and adolescents with chronic urticaria and autoimmunity.

METHODS AND RESULTS

Of 187 patients referred for evaluation of chronic urticaria during a 7.5 year period, eight (4.3%), all females aged 7-17 years, had increased levels of antithyroid antibody, either antithyroid peroxidase antibody (n = 4, >75 IU/ml), antithyroglobulin antibody (n = 2, >150 IU/ml), or both (n = 2). The duration of urticaria was four months to seven years. Five patients were euthyroid, one of whom was found to have increased antithyroid antibody levels five years after onset of the urticaria. One patient was diagnosed with Hashimoto thyroiditis three years before the urticaria, and was receiving treatment with thyroxine. Two other hypothyroid patients were diagnosed during the initial work up for urticaria (thyroxine 9.2 pmol/l, thyroid stimulating hormone (TSH) 40.2 mIU/l) and five years after onset of the urticaria (thyroxine 14 pmol/l, TSH 10.3 mIU/l). Both were treated with thyroxine but neither had remission of the urticaria. Five patients had a low positive titre of antinuclear antibodies.

CONCLUSION

Children with chronic urticaria should be screened periodically for thyroxine, TSH, and antithyroid antibodies, as thyroid autoimmunity and hypothyroidism may appear several years after onset of the urticaria.

Evaluation and management of a solitary thyroid nodule in a child

Although an uncommon clinical entity, a pediatric patient with a solitary thyroid nodule requires a thorough assessment because of the increased incidence of thyroid carcinoma in this population. In the future, one may expect the widespread clinical use of genetic markers in identifying children, who are at risk for, or who have developed, thyroid carcinomas, with the hopes that these molecular markers will lead to the prevention, or earlier detection and cure, of these malignancies.

Management of simple nodular goiter: current status and future perspectives

The simple nodular goiter, the etiology of which is multifactorial, encompasses the spectrum from the incidental asymptomatic small solitary nodule to the large intrathoracic goiter, causing pressure symptoms as well as cosmetic complaints. Its management is still the cause of considerable controversy. The mainstay in the diagnostic evaluation is related to functional and morphological characterization with serum TSH and (some kind of) imaging. Because malignancy is just as common in patients with a multinodular goiter as patients with a solitary nodule, we support the increasing use of fine-needle aspiration biopsy (cytology). Most patients need no treatment after malignancy is ruled out. In case of cosmetic or pressure symptoms, the choice in multinodular goiter stands between surgery, which is still the first choice, and radioiodine if uptake is adequate. In addition to surgery, the solitary nodule, whether hot or cold, can be treated with percutaneous ethanol injection therapy. If hot, radioiodine is the therapy of choice. Randomized studies are scarce, and the side effects of nonsurgical therapy are coming into focus. Therefore, the use of the optimum option in the individual patient cannot at present be based on evidence. However, we are of the view that levothyroxine, although widely used, should no longer be recommended routinely for this condition. Within a few years, the introduction of recombinant human TSH and laser therapy may profoundly alter the nonsurgical treatment of simple nodular goiter.

Diagnosis and management of patients with thyroid nodules

Fewer than 5% of all adults will have a palpable thyroid nodule, but this is still a large number of individuals who require evaluation. Although most thyroid nodules are a result of a benign disease process (more than 95%), the possibility of thyroid cancer is always a consideration. Important aspects of history taking with a patient in whom a thyroid nodule has been noted include age, gender, family history of thyroid or endocrine disease, prior low dosage head and neck radiation, recent hoarseness, dysphagia, and symptoms of hypermetabolism. Key features of evaluation by physical examination are the size and location of the thyroid abnormality, the degree of firmness of the nodule, the presence of other nodules in the thyroid, palpable cervical lymph nodes, vocal cord paresis or paralysis, and tachycardia and/or tremor. The major categories of thyroid abnormality in such patients include cysts, adenomas, thyroiditis, and cancer. Although radionuclide scans, ultrasound examination and computer tomography have all been employed in the assessment of thyroid nodules, and thyroid stimulating hormone assay is useful for confirming a euthyroid state, fine needle aspiration biopsy (FNAB) has proved to be the most efficient diagnostic tool. The findings from FNAB allow avoidance of operative treatment for a large portion of these patients with palpable thyroid nodules, but a diagnosis of "follicular neoplasm" on FNAB usually requires operation, despite the fact that many such patients do ultimately prove to have a benign lesion. The extent of operation in patients undergoing surgery will depend on the diagnostic findings before operation, but unilateral thyroid lobectomy is the minimum procedure when surgery is required.

Thyrotoxicosis among Hanford, Washington, Downwinders: a community-based health survey

Sixty cases of thyrotoxicosis (including hyperthyroidism, Graves' disease, and toxic goiter), an unexpectedly large number compared with general population data, were reported in a voluntary health survey that included a period of approximately 50 yr, with 801 self-defined "Downwinders" who had lived near the Hanford, Washington, nuclear facility. In another self-selected group of medical patients (n = 423) who were examined over the same time period, only 2 cases of thyrotoxicosis were identified. Evidence is presented that suggests that the effects of bias from self-selection likely did not account for the magnitude of the apparent excess of thyrotoxicosis cases in the present study population. The findings are consistent with those of other studies, as well as with the hypothesis of an association of thyrotoxicosis with exposures to radioiodine.

Two tumors detected by thyroid assessment in two children

OBJECTIVE

To describe the early detection of two tumors in two children by recognition of unusual features in initial thyroid assessments.

METHODS

We present the clinical findings and results of laboratory studies in two children. In addition, we describe RET proto-oncogene studies in one of them.

RESULTS

A 14.5-year-old boy was referred for assessment because of short stature in conjunction with lack of physical growth and development. His physical examination was remarkable for height at the 50th percentile (height age, 11.5 years), weight at the 50th percentile (weight age, 13 years), and prepubertal male status. Pertinent laboratory findings were a normal thyroid-stimulating hormone (TSH) level but low free thyroxine (FT4) index. These findings prompted an immediate magnetic resonance imaging study of the head. A parasellar tumor was detected and removed; histopathologic examination revealed that it was a craniopharyngioma. The patient requires lifelong multihormonal therapy for his panhypopituitarism and has responded with physical growth. Our second patient, a 7.5-year-old girl, was referred because of a painless left thyroid nodule of 4 months' duration. Her physical examination was remarkable for (1) upper lip swelling, (2) intermittent rash, and (3) a goiter with painless mobile left and right nodules. Normal levels of TSH and FT4, serum calcitonin of 6,192 pg/mL, and a fine-needle biopsy specimen that stained strongly for calcitonin were obtained at her first clinic visit. A total thyroidectomy was performed and confirmed the presence of medullary thyroid carcinoma. Genetic studies showed that she was positive for the RET multiple endocrine neoplasia IIB mutation. After 4 years of follow-up, the patient had serum calcitonin levels that remained low (<2.2 pg/mL).

CONCLUSION

Attention to thyroid physical findings and laboratory studies can promptly lead to correct diagnoses and management of some rare and life-threatening tumors in children.

The Sardinian Autoimmunity Study: 3. Studies on circulating antithyroid antibodies in Sardinian schoolchildren: relationship to goiter prevalence and thyroid function

The relationship among iodine intake, goiter prevalence, and thyroid autoimmunity remains controversial. In the present article, we report the prevalence of antithyroid antibodies (ATA) in relation to iodine intake, frequency of goiter, and thyroid function in a large group of Sardinian schoolchildren living in areas with borderline iodine sufficiency, or mild to moderate iodine deficiency. A total of 8,040 schoolchildren (4,194 males, 3,846 females, ages 6-15 years) from 29 communities were examined between 1986-1994. Thyroid size was assessed by palpation, according to the Pan American Health Organization (PAHO) criteria. In all cases antimicrosomal (MAb) or antithyroid peroxidase antibodies (TPOAb) and thyrotropin (TSH) were assayed. Urinary iodine was determined in a subgroup of 820 children. ATA was detected in 235 (2.92%) sera (88 males, 2.12%; 147 females, 3.82%; chi2 = 20.41, p < 0.0001). ATA prevalence ranged between 0.0%-7.3% in the 29 communities without any geographical correlation with goiter prevalence and urinary iodine excretion. However, ATA was more frequently detected in goitrous children, especially in females. The presence of ATA was not age-dependent in males, whereas a significant increase of ATA was observed in females older than 11 years of age. Seventy-seven (0.96%) children showed borderline to slightly increased serum TSH (>5.2-32 mU/L). Increased serum TSH concentration was more frequently found in children with ATA, especially at higher titers. In summary, our study in Sardinian schoolchildren indicates: (1) ATA display geographical heterogeneity, which seems to be unrelated to goiter prevalence and/or to iodine supply; (2) ATA are more frequently detected in females older than 11 years of age, suggesting that puberty has a role in determining the predominance in females of thyroid autoimmunity; (3) although most goitrous children are ATA-negative, the prevalence of ATA is increased in children with enlarged glands; (4) ATA is associated with an increased prevalence of subclinical hypothyroidism.

Lymphocytic thyroiditis

Lymphocytic thyroiditis is a common canine condition that can lead to functional hypothyroidism. It is associated with more than 50% of cases of canine hypothyroidism. Evidence in human beings and experimental situations suggests that it is a disease of defective immunoregulation, but specific investigation of the molecular pathogenesis of the naturally occurring disease in dogs has not yet been carried out. The condition is heritable in those breeds that have been studied, and progression to hypothyroidism, if it occurs, can be slow. Factors that influence the progression from subclinical thyroiditis to hypothyroidism in dogs are still to be identified, but excessive iodine intake is an important factor in other species.

Cancer of the thyroid gland in infants and children

Carcinoma of the thyroid gland is unusual in children and represents only about 3% of pediatric malignancies. Surgical management is the principal method of treatment, but there is considerable controversy regarding exactly how much of the thyroid gland should be removed for adequate treatment. There also is controversy regarding the use of fine-needle aspiration (FNA) in the evaluation of potentially neoplastic thyroid lesions. In this report, the pertinent literature is reviewed regarding these issues. Moreover, this report will discuss recent discoveries that have elucidated some of the molecular biological events responsible for the development of thyroid cancer.

[Chronic autoimmune thyroiditis in the child]

OBJECTIVE

The aim of the study was to describe the clinical characteristics and long-term follow-up of a group of children with chronic autoimmune thyroiditis.

PATIENTS AND METHODS

Sixty children (age: 11.9 +/- 2.7 years) were studied in a retrospective analysis.

RESULTS

At diagnosis, 34 of the children were hypothyroid (compensated hypothyroidism, n = 15; true hypothyroidism, n = 19) and 26 euthyroid. Thyroid ultrasonography showed characteristic features of heterogenicity and/or hypoechogenicity in all patients. Other autoimmune diseases were found in ten subjects (17%) and 23% had a family history of thyroid disease. At the end of the follow-up, nine of 45 children (20% of the cases) followed up for at least one year (mean follow-up 4.4 +/- 3.7 years), demonstrated a change in thyroid function. Hypothyroidism was detected in two initially euthyroid patients. Among initially hypothyroid patients, seven (28%) recovered normal thyroid function, allowing L-thyroxine withdrawal for four weeks, after 1.5 to 8.4 years. No factor was found to be predictive of the course of the disease. All subjects treated with L-thyroxine for hypothyroidism reached normal final height.

CONCLUSION

The natural course of chronic lymphocytic thyroiditis is variable and unpredictable. Recovery from hypothyroidism does occur and can be aided by the L-thyroxine withdrawal test. The disease requires lifelong thyroid surveillance, especially in women during pregnancy, in order to avoid a potential adverse effect on the future child.

Clinical aspects of early and late hypocalcaemia afterthyroid surgery

AIM

This study aimed to evaluate hypocalcaemia (time-course) and need for calcium administration after thyroid surgery in 135 consecutive cases (69 bilateral subtotal thyroidectomies, 50 unilateral lobectomies, 13 total thyroidectomies and three isthmectomies) for benign lesions and for differentiated carcinoma in 89% and 11% respectively.

RESULTS

In unilateral lobectomy, two parathyroid glands were identified and preserved in 72%, and one gland in 28% of the patients; calcaemia decreased by 10% on average in the early post-operative period (P<0.001). Calcium treatment (average: 2.3 days) was administered to 34% of the patients, these patients had lower nadir post-operative calcaemia than those who did not receive calcium: 2.03 vs 2.14 mmol/l (P<0.001). Their calcaemias reverted to normal within 1 week after surgery and remained normal thereafter without further calcium administration. In bilateral procedures, four parathyroid glands were preserved in 40%, three in 42%, two in 16%, and only one in 2% of the cases. Calcaemia decreased by 15% on average (P<0.001), and early hypocalcaemia was common and severe in some patients: nadir post-operative calcaemia <2.0 mmol/l in 61%, and <1.75 mmol/l in 6% of the cases. Post-operative hypocalcaemia was more pronounced after total than subtotal thyroidectomy (1.86+/-0.19 vs 1.98+/-0.14 mmol/l P=0.014), and also after lymph node dissection (1.83+/-0.11 mmol/l). Serum parathormone (PTH) decreased from 36 ng/l before surgery to 17 ng/l in the week thereafter (P=0.001). There was a linear relationship between the number of preserved parathyroid glands and early hypocalcaemia. The percentage of patients requiring calcium treatment was: 24 h (15%), 2-7 days (26%), 8-180 days (33%), >1 year (9%).

DISCUSSION

The number of parathyroid glands preserved in situ did not help predict the duration of post-surgical calcium treatment, nor the final outcome of hypocalcaemia. However, when total calcium levels were compared in patients having had one or two glands preserved vs three or four parathyroid glands, it was possible to show that despite prolonged calcium administration, late calcaemias remained significantly lower during the first 6 months in patients with a smaller number of parathyroid glands. Hypoparathyroidism, defined functionally on the basis of requirement of calcium supplementation 1 year after surgery, occurred in 8.6% of patients after bilateral lobectomy (despite measurable but inappropriately low-PTH concentration). This outcome could have been predicted earlier (after 3 to 6 months) and the patients perhaps given the benefit of definitive vitamin D treatment earlier, in order to avoid late and prolonged hypocalcaemia. Evaluation after 1 year showed that only one patient out of 82 bilateral lobectomies (1.2%) had permanent hypoparathyroidism and needed calcium whereas hypocalcaemia was persistent in one out of four patients who had undergone a staged procedure (i.e. heterolateral lobectomy years after a previous operation).

Prevalence and aetiology of hypothyroidism in the young

AIMS

To define the prevalence of hypothyroid disease in children and young people, and describe its aetiology.

METHODS

We identified all patients on the Medicines Monitoring Unit (MEMO) database in the Tayside region of Scotland who had received two or more prescriptions for thyroxine during the study period (January 1993 to December 1995). Using this as a surrogate marker of hypothyroidism, we calculated the prevalence of hypothyroidism in those aged less than 22 years. Main outcome measures were prevalence of thyroxine prescription, estimated prevalence of hypothyroidism, and aetiology of the hypothyroidism (determined from case records, and biochemistry and immunology databases).

RESULTS

Of 103,500 residents aged less than 22 years, 140 were identified as receiving thyroxine on prescription, giving a population prevalence of 0.135%. The ratio of male to female was 1:2.8. Acquired hypothyroidism was the commonest aetiology found in 73%, 66% of which had an autoimmune basis. The prevalence of congenital hypothyroidism was 0.027%. Seven had received treatment for malignancy (two primary thyroid). Fifteen per cent of patients had no record of secondary care follow up in Tayside.

CONCLUSIONS

The overall prevalence of hypothyroidism in young people less than 22 years of age is 0.135%, and in the group aged 11-18 years it is 0.113%; these values are at least twice those of previous estimates. This suggests an increase in autoimmune thyroid disease, similar to the rising prevalence of type 1 diabetes, possibly indicating a rising incidence of autoimmunity in young people.

Importance of thyroid abnormalities detected at US screening: a 5-year follow-up

PURPOSE

To clarify the natural history and frequency of thyroid echo abnormalities in a random adult population by performing a 5-year follow-up study of subjects of a previous thyroid ultrasonographic (US) screening study.

MATERIALS AND METHODS

In the original survey, 253 randomly selected adults were screened by means of thyroid US. US abnormalities were detected in 69 subjects (27%). In the follow-up study, 57 (83%) of those 69 subjects who had abnormalities were reexamined by means of thyroid US, fine-needle aspiration biopsy (FNAB), blood tests, and clinical examination.

RESULTS

Of 34 individual nodules, 12 (35%) had grown. Biopsy was performed in 10 of them. Nine were benign. One was equivocal, was excised, and proved to be an adenomatous nodule. Eight nodules (24%) had diminished or disappeared. Seven new focal lesions were found in seven subjects (12%). Biopsy was performed in five of these lesions, and they were benign. At 5-year follow-up, no thyroid malignancies were detected among subjects with echo abnormalities at the primary US screening.

CONCLUSION

Thyroid US abnormalities occurring in a random adult population are predominantly benign and clinically unimportant.

Turner's syndrome and thyroid disease: a transverse study of pediatric patients in Brazil

An increased prevalence of autoimmune thyroid disease (AITD) has been described in Turner's syndrome (TS), but the extent of this association is still controversial. Some studies also suggest that AITD is more frequent among patients with X-isochromosome. In order to determine the prevalence of AITD among girls with TS, and to look for an association with age and karyotype, we evaluated 71 patients with a mean age of 11.4 years (range 0-19.9). 15.5% (11/71) were hypothyroid, 17 (23.9%) were positive for thyroid peroxidase (TPO) and/or thyroglobulin (Tg) antibodies, and 24 (33.8%) had thyromegaly. No abnormality was observed before 4 years, and the highest frequencies were observed after 16 years. There were no significant differences concerning thyroid findings among patients with a 45,X karyotype, mosaics, and structural rearrangements. Half of the patients (35/71) exhibited one or more abnormalities, which demonstrates the importance of careful evaluation of thyroid function in all girls with TS.

Value of re-aspirations in benign nodular thyroid disease

Fine-needle aspiration cytology (FNAC) is the most useful procedure for the evaluation of thyroid nodules. The requirement for repeated aspirations in the follow-up of benign nodular thyroid disease, however, is controversial. To determine the value of re-aspirations in benign nodular thyroid disease, we studied 457 fine-needle reaspirations performed on 216 patients (197 female, 19 male) aged 42.9+/-12 years with uninodular (n = 65) and multinodular (n = 151) thyroid disease. Two hundred fifty-seven of these were second, 137 were third, 46 were fourth, and 17 were fifth re-aspirations of the same nodule, performed in a mean follow-up time of 43.9+/-31 (3-156) months. FNAC results were benign in 407 (89%), insufficient for diagnosis in 31 (6.8%), suspicious in 16 (3.5%), and papillary carcinoma (PC) in 3 (0.7%). An initial benign diagnosis did not change after multiple aspirations in 213 (98.61%) of the cases. Three patients with initial aspirations read as benign had a diagnosis of PC from their second biopsies, (diagnosis confirmed at surgery). Re-examination of the initial FNAC revealed atypical features in 1 of the 3 patients. These 3 patients likely represent a false-negative result of the initial FNAC rather than benign nodular disease transformed to a malignant one during the follow-up period. In conclusion, a second aspiration of clinically suspicious nodules may correct a few initial false-negative results, but routine additional re-aspirations are not useful for clinically stable disease.

[Late effects of ionizing radiations on the thyroid gland]

The thyroid is the purest endocrine gland in the body and is likely to produce clinically significant abnormalities after external radiotherapy. Functional clinical modifications after direct irradiation exceeding 30 Gy are essentially related to hypothyroidism which may be clinically overt or subclinical with normal serum free thyroxine levels and high thyrotropin concentrations; the risk of hyperthyroidism, silent thyroiditis and Hashimoto's disease is also increased. Secondary hypothyroidism related to irradiation of the hypothalamus and the pituitary gland may arise with doses over 40-50 Gy following treatment for brain and nasopharyngeal tumors--Morphological glandular modifications induced by radiotherapy are responsible for the appearance of benign adenomas, more rarely cystic degenerations and specially well differentiated papillary or follicular carcinomas among children and adults. After irradiation during childhood for benign or malignant tumors, thyroid cancers are more frequent, higher for younger children, and the relative excess risk is increased from 15.6-to 53-fold; tumors can belatedly occur, more than 35 years after initial therapy. Thereby, in order to limit excess morbidity, it is evident that long term supervision with careful clinical and biological evaluations is necessary for patients who previously received neck, upper mediastinum and pituitary radiation therapy.

Thyroid function in a population of children with attention deficit hyperactivity disorder

OBJECTIVE

To determine the prevalence of thyroid hormone abnormalities and generalized resistance to thyroid hormone in a population of children with attention deficit hyperactivity disorder (ADHD) as compared to reference ranges determined from a control population and hence to determine if routine thyroid hormone screening in children with non-familial ADHD is indicated.

METHOD

Children attending the State Child Development Centre in Perth, Western Australia with ADHD, as defined by the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) provided the study population. The control population consisted of 353 normal children with a history of allergy in whom radioallergosorbent (RAST) testing was being performed.

RESULTS

The prevalence of thyroid hormone abnormalities in the study population was 2.3% (95% CI 0.6%, 5.7%). There were no cases of generalized resistance to thyroid hormone. The prevalence of thyroid hormone abnormalities in the general population of children and adolescents has been reported to vary between 1 and 3.7%.

CONCLUSION

Routine thyroid hormone screening is not indicated in children with non-familial ADHD.

The epidemiology of thyroid disease and implications for screening

The burden of thyroid disease in the general population is enormous. As many as 50% of people in the community have microscopic nodules, 3.5% have occult papillary carcinoma, 15% have palpable goiters, 10% demonstrate an abnormal thyroid-stimulating hormone level, and 5% of women have overt hypothyroidism or hyperthyroidism. Despite this high prevalence of thyroid disease, screening for these disorders is not recommended by any major health agency. This article explores the epidemiologic issues surrounding this complex problem by analyzing prevalence, incidence, and mortality data from a worldwide variety of sources.

Hyperthyroidism in children: an Indian experience

During the period 1986-1993, 24 children with hyperthyroidism were referred to us for management. Two of them had factitious hyperthyroidism, one toxic nodular goiter and another neonatal Graves' disease. Twenty children (6M, 14F) had Graves' disease. Their age at presentation was 10.86 +/- 2.02 years and duration of symptoms ranged from 2.5 months to 7 years. Neuropsychiatric manifestations, such as hyperkinesis, irritability, excitability and behavioral problems, were the most common initial presenting symptoms (90%). Goiter of varying grades was present in 18 children. Eye involvement of mild or moderate intensity was present in 85% and cardiac involvement in 30%. Serum free thyroxine and triiodothyronine levels were high and radioactive iodine uptake was elevated. All of them received carbimazole 0.5-0.7 mg/kg in three divided doses. Seventeen responded to therapy over a period of time while three did not. On withdrawal, six of the responders relapsed. Hyperthyroidism in children is rare and when it occurs it is almost always due to Graves' disease. The prominence of neuropsychiatric symptoms, insidious onset and absence of severe infiltrative ophthalmopathy differentiates it from the adult type of disease. Prolonged medical therapy is needed to induce good continued remission.

Subclinical thyroid disease

Thyroid disease can roughly be divided into functional and anatomical disorders. Subclinical disease is by definition not accompanied by symptoms or signs and usually goes unrecognized for the bearer (and the observer). In this communication an overview will be given of existing literature and some own results concerning subclinical hypothyroidism, subclinical thyrotoxicosis and thyroid incidentalomas. Apart from definitions, data on prevalence, clinical effects, prognostic significance and the need for and response to therapy will be discussed.

Thyroid scintigraphy in children and adolescents with Hashimoto disease

Between 1989 and 1994, 58 children and adolescents with Hashimoto thyroiditis seen at the Sainte-Justine Hospital had thyroid scintigraphy. Their medical records and films were reviewed retrospectively. Eighty-nine percent of the patients had a homogeneous distribution of tracer on thyroid scintigraphy, unlike the heterogeneous distribution classically reported in adults. In children and adolescents, thyroid scintigraphy is not helpful in the diagnosis of typical Hashimoto thyroiditis.

Frequency, clinical and laboratory features of thyroiditis in girls with Turner's syndrome. The Italian Study Group for Turner's Syndrome

A total of 478 patients, mean age 15.5 (3.6-25.3) years, suffering from Turner's syndrome, were studied in order to determine the frequency of autoimmune thyroiditis, which is defined as the presence of antithyroid antibodies (AT-Ab) and typical ultrasound findings. We found 106 (22.2%) patients positive for AT-Ab and of those 49 (10%) also had positive ultrasound findings, and were therefore considered to be affected by thyroiditis. This frequency is significantly higher (p < 0.001) than that seen in the normal population. Goitre was detected on clinical examination in only 16 (33%) and by ultrasound in 19 (39%) patients. Hormonal evaluation showed that 17 patients were euthyroid, 27 had compensated hypothyroidism, 2 were hypothyroid and 3 were in a hyperthyroid phase. Clinical signs or symptoms of hypothyroidism were absent in all hypothyroid patients. In patients with thyroiditis, neither a higher frequency of malformations and autoimmune diseases nor a correlation with karyotype, oestrogens or growth hormone therapy was found.