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Valenzise M, D'Amico F, Tripodi E, Zirilli G, Alibrandi A, Gallizzi R, Sutera D, Cafarella G, Lugarà C, Wasniewska MG. Thyroid function in pediatric patients with juvenile idiopathic arthritis. Endocrine 2024; 84:571-576. [PMID: 37982947 DOI: 10.1007/s12020-023-03600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease characterized by chronic synovitis, sometimes associated with fever, rash, pericarditis and uveitis. Limited data are available concerning autoimmune diseases associated with JIA in childhood. THE AIMS OF OUR STUDY WERE (a) evaluating the thyroid function in a group of Italian children affected by JIA; (b) identifying which Autoimmune Thyroid Diseases (ATDs) are related to JIA in this population. METHODS A population of 51 patients with JIA was investigated. Each patient enrolled was evaluated clinically (family history for Autoimmune Diseases (ADs), personal history and physical examination). In the sample were evaluated thyroid function, inflammation's index and anti-thyroid antibodies. RESULTS The 68.6% (35) of our patients had the oligoarticular form, 27.5% (14) had the polyarticular one, 2% (1) had systemic onset and 2% (1) had undifferentiated arthritis. We focused our attention on the differences between the first two forms. We did not find any difference on the gender prevalence (p > 0.05). A higher presence of anti-TPO antibodies was found in the polyarticular form, with a significant difference with the oligoarticular one (p = 0.032). We researched the anti-hTG antibodies (p > 0.05) and ANA for each group (p > 0.05). We found a significant prevalence of family history for ADs in the polyarticular form (p < 0.05). CONCLUSION Our findings show the necessity to focus on thyroid function in patients with JIA. Although the oligoarticular form is the most frequent, the polyarticular form shows a higher frequency of thyroid function's alteration. This suggests the need for specific attention in polyarticular form.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
| | - Federica D'Amico
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Eleonora Tripodi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giuseppina Zirilli
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | | | - Romina Gallizzi
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Diana Sutera
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giulia Cafarella
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Cecilia Lugarà
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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Pravin RR, Kan SY, Soh SY, Chan D, Farhad Vasanwala R. Atypical presentations of primary acquired hypothyroidism - a case series. BMC Endocr Disord 2023; 23:242. [PMID: 37926822 PMCID: PMC10626719 DOI: 10.1186/s12902-023-01488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Primary acquired hypothyroidism in children manifests with a myriad of clinical presentations. Clinical features can be insidious in nature, often under the guise of non-specific presentations to other subspecialties prior to referral to the endocrinologist. Growth failure is a hallmark feature in these children alongside their presenting clinical symptomology which needs to be identified through detailed history, physical examination and analysis of the growth charts. In this case series, we discuss 5 atypical presentations of acquired primary hypothyroidism with multisystemic involvement, including musculoskeletal, hepatobiliary, gynaecological and haematological manifestations. This is of importance as untreated hypothyroidism leads to fatigue, decreased physical activity, suboptimal height gain, disordered puberty and poor neurocognitive development in children with long term detrimental outcomes.
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Affiliation(s)
- R R Pravin
- General Paediatrics, KK Women's & Children's Hospital, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Sheau Yun Kan
- General Paediatrics, KK Women's & Children's Hospital, Singapore, Singapore
| | - Ser Yee Soh
- General Paediatrics, KK Women's & Children's Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Endocrinology Service, KK Women's & Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rashida Farhad Vasanwala
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Endocrinology Service, KK Women's & Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Munarin J, Tuli G. Differences in the clinical picture at the onset of diagnosis of severe autoimmune hypothyroidism in children depending on the time of diagnosis: before or during the SARS-CoV-2 pandemic. Pediatr Endocrinol Diabetes Metab 2023; 29:253-258. [PMID: 38282494 PMCID: PMC10826695 DOI: 10.5114/pedm.2023.133123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/20/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION There are few data about effects of COVID-19 on thyroid disease presentation in children, due to difficulties in healthcare services access. AIM OF THE STUDY To assess the differences in hypothyroidism presentation before and during the COVID-19 pandemic. MATERIAL AND METHODS All paediatric patients with autoimmune hypothyroidism (AIT) diagnosed from January 2017 to December 2022 were analysed. RESULTS A total of 150 subjects were enrolled (94 in before and 56 during the pandemic period). Severe AIT was detected in 7.4% before and 12.5% during the pandemic. Age at the onset in the pre-pandemic period was lower ( p = 0.04). Diagnosis delay (time elapsed from onset of symptoms and diagnosis) was significantly different between the before and during the pandemic groups ( p = 0.02). In the pre-pandemic period the TSH value was 447.7 ±59.1, and it was 713.7 ±104.4 mUI/l during the pandemic ( p = 0.04), whereas mean fT4 values were 2.66 ±0.34 and 0.58 ±0.08 ng/l, respectively ( p = 0.0002). Significantly greater thyroid volume and bone age delay SDS were observed during the pandemic ( p = 0.04). Neurological symptoms were mostly observed during the pandemic, especially slow speech and impaired school performance. CONCLUSIONS A higher rate of severe AIT was observed during the pandemic period, mostly related to difficulties in access to healthcare services. The diagnosis delay led to a more severe biochemical thyroid hormone profile, goitre, and more frequent presence of bone age delay and neurological symptoms at the onset. Recognizing hypothyroidism and recalling symptoms in child-hood, even if often non-specific, is fundamental for avoiding diagnosis delay.
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Affiliation(s)
| | - Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Turin, Italy
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Sun Y, Kan X, Zheng R, Hao L, Mao Z, Jia Y. Hashimoto's thyroiditis, vitiligo, anemia, pituitary hyperplasia, and lupus nephritis-A case report of autoimmune polyglandular syndrome type III C + D and literature review. Front Pediatr 2023; 11:1062505. [PMID: 37063678 PMCID: PMC10090315 DOI: 10.3389/fped.2023.1062505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/22/2023] [Indexed: 04/18/2023] Open
Abstract
Objective This study aims to summarize the clinical characteristics of one teenager with autoimmune polyglandular syndrome (APS) type III C + D to improve the understanding of APS III C + D and its effect of thyroid function. Methods This article reported the clinical manifestations, laboratory examinations, treatment methods, and outcomes of an adolescent with anemia admitted to the Pediatrics Department of Tianjin Medical University General Hospital in July 2020 and reviewed the literature. Results A girl, aged 13 years and 1 month, was admitted to the hospital due to anemia for more than 4 years and episodic abdominal pain for 1 week. Four years ago, the girl went to a local hospital for "vitiligo", and a routine blood test revealed anemia. The lowest hemoglobin (HGB) was 61 g/L, and the blood test revealed iron deficiency anemia. She had no menstrual cramps for 2 months. Urine routine showed protein 3+∼4+ and 258 red blood cells (RBCs)/high-power field. Urine protein was 3,380 mg/24 h. Free thyroxine was low, thyroid-stimulating hormone was >100 uIU/ml, thyroid peroxidase antibody was >1,000 IU/ml, and thyroglobulin antibody and thyrotropin receptor antibody were negative. Pituitary magnetic resonance imaging showed a mass in the sellar region with a uniform signal and a maximum height of about 15.8 mm. The result of the antinuclear antibody was 1:80 homogeneous type, and anti-dsDNA and anticardiolipin antibodies IgA and IgM were slightly higher. Thyroxine and iron were given for 1 month, menstruation resumed, and urine protein and RBC count decreased. After 5 months of treatment, free thyroid function, HGB, RBCs in urine, and pituitary returned to normal. Later, a renal biopsy showed changes in focal proliferative glomerulonephritis, and the girl was diagnosed with lupus glomerulonephritis type III. After 3 days of shock therapy with methylprednisolone, prednisone, mycophenolate mofetil, and other treatments were administrated for 1 year. At the time of writing, urine protein was 280 mg/24 h. Conclusion Co-occurrence of Hashimoto's thyroiditis, vitiligo, anemia, pituitary hyperplasia, and lupus nephritis is rare. It is very important to pay attention to the screening of thyroid function.
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Affiliation(s)
- Yongmei Sun
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuan Kan
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
- Correspondence: Xuan Kan
| | - Rongxiu Zheng
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Liping Hao
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zongtao Mao
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Ying Jia
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
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Hwang SM, Hwang JY, Moon JH, Yang I, Woo JY, Lee HJ. Children and adolescent patients with goiter and normal thyroid function: US findings related to underlying autoimmune thyroid diseases. Medicine (Baltimore) 2022; 101:e30095. [PMID: 36107500 PMCID: PMC9439828 DOI: 10.1097/md.0000000000030095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
This study was conducted to investigate and compare thyroid ultrasonography (US) findings in children and adolescents with goiter and normal thyroid function with positive or negative thyroid autoimmunity. From 2000 to 2020, we reviewed initial thyroid US images in 33 autoimmune thyroid diseases (AITDs) patients and 52 nonAITD patients. Our review of the images focused on thyroid parenchymal hypoechogenicity and heterogeneous echopattern subdivided into 2 groups according to severity: hypoechogenicity 1 and 2 (HO1 and HO2) and heterogeneity 1 and 2 (HE1 and HE2). HO1 and HE1 were observed more frequently in the nonAITD group (86.5% and 42.3%, respectively), while HO2 and HE2 were observed more frequently in the AITDs group (36.4% and 81.8%, respectively). More patients in the AITDs group showed change of both US groups and thyroid function state within the follow-up periods than in nonAITD group (33.3% and 5.77%, respectively). Children and adolescent AITDs patients showed more severe parenchyma hypoechogenicity and heterogeneous echopattern compared with nonAITD patients with goiter and normal thyroid function.
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Affiliation(s)
- Sook Min Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji-Young Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin Hee Moon
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ik Yang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji Young Woo
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hye Jin Lee
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Rivera-Hernández A, Madrigal-González MM, Espinosa-Peniche R, Zurita-Cruz J, Balcázar-Hernández L. Van Wyk-Grumbach syndrome and trisomy 21. Proc AMIA Symp 2022; 35:569-571. [DOI: 10.1080/08998280.2022.2054048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Aleida Rivera-Hernández
- Pediatric Endocrinology Department, Hospital de Pediatría, UMAE CMN Siglo XXI, IMSS, Mexico City, Mexico
| | | | | | - Jessie Zurita-Cruz
- Nutrition Research Unit, Hospital de Pediatría, UMAE CMN Siglo XXI, IMSS, Mexico City, Mexico
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Zhu S, Pang Y, Xu J, Chen X, Zhang C, Wu B, Gao J. Endocrine Regulation on Bone by Thyroid. Front Endocrinol (Lausanne) 2022; 13:873820. [PMID: 35464058 PMCID: PMC9020229 DOI: 10.3389/fendo.2022.873820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As an endocrine organ, the thyroid acts on the entire body by secreting a series of hormones, and bone is one of the main target organs of the thyroid. SUMMARY This review highlights the roles of thyroid hormones and thyroid diseases in bone homeostasis. CONCLUSION Thyroid hormones play significant roles in the growth and development of bone, and imbalance of thyroid hormones can impair bone homeostasis.
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Affiliation(s)
- Siyuan Zhu
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yidan Pang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jun Xu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xiaoyi Chen
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Junjie Gao, ; Bo Wu, ; Changqing Zhang,
| | - Bo Wu
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Junjie Gao, ; Bo Wu, ; Changqing Zhang,
| | - Junjie Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
- *Correspondence: Junjie Gao, ; Bo Wu, ; Changqing Zhang,
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Becker M, Blankenstein O, Lankes E, Schnabel D, Krude H. Severe Acquired Primary Hypothyroidism in Children and its Influence on Growth: A Retrospective Analysis of 43 Cases. Exp Clin Endocrinol Diabetes 2021; 130:217-222. [PMID: 34607373 DOI: 10.1055/a-1538-8241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Severe acquired hypothyroidism in childhood is a rare condition, mostly caused by autoimmune thyroiditis. Scarce and inconsistent data based on small patient numbers exist concerning its impact on growth in height. METHODS Patient files at a single centre university hospital over 8 years were retrospectively reviewed. We identified 43 patients (mean age 10.6 years, 3.3-15.25, 59% prepubertal, 88% females) in a cohort of children older than 3 years with an initial TSH>30 mIU/l and reduced T4 or fT4; congenital and drug-induced hypothyroidism were excluded. RESULTS All patients had signs of autoimmune thyroiditis (93% positive autoantibodies, 95% typical ultrasonography, 63% goiter). Median TSH was 100 mIU/l [0.3-4 mIU/l]), median fT4 3.55 pg/ml [8-19 pg/ml], median T4 2.85 µg/dl [5.3-11 µg/dl]. Presenting symptoms included goiter (26%), tiredness (23%), weight gain (19%), and growth retardation (19%). The diagnosis was made incidentally in 26% patients. In 75% growth was retarded (median height standard deviation score (SDS)-0.55), in 17% height SDS was<-2 at diagnosis. Midparental height SDS at diagnosis correlated significantly with T4 and fT4 (r=0.77, p=0.0012 and r=0.53, p=0.021 respectively). Catch-up growth under T4 substitution was significantly greater in prepubertal than in pubertal children (p 0.049). CONCLUSION This so far largest pediatric cohort with severe acquired hypothyroidism confirms a serious impact on growth which, however in most cases, showed a certain catch-up growth after adequate L-thyroxine therapy. The pubertal state seems to be important for catch-up growth. A significant number of patients were not diagnosed clinically, although affected by severe hypothyroidism.
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Affiliation(s)
- Marianne Becker
- Sozial-Pädiatrisches Zentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Blankenstein
- Institute for Experimental Pediatric Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Erwin Lankes
- Sozial-Pädiatrisches Zentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dirk Schnabel
- Sozial-Pädiatrisches Zentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Krude
- Institute for Experimental Pediatric Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany
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