| Background: Autoimmune thyroid disease(AITD)is the most common organ-specific autoimmune disease in childhood,mainly including Graves’ disease(Graves’ Disease,GD)and Hashimoto ’s thyroiditis(Hashimoto ’s thyroiditis,HT).Therefore,improving their understanding is important for clinical diagnosis and treatment.Objective: To analyze the clinical features of GD and HT in children and adolescents,explore the risk factors associated with disease outcome,and understand the diagnosis and treatment characteristics of AITD in children and adolescents.Method: The medical records of 81 children and adolescents with GD and 67 patients with HT who were first diagnosed with AITD in hospitalized children from January 2011 to December 2020 in General Hospital of xxxx were collected,including general conditions,clinical manifestations,signs,auxiliary examinations and other clinical data,and the prognosis of the patients was followed up.Statistical analysis was performed using SPSS 23.0software.Results:1.General condition of AITD A total of 148 patients with AITD were included in this study,including 81 patients(59.5%)with GD and 67 patients(40.5%)with HT;the incidence in females was significantly higher than that in males in both diseases,with male-to-female ratios of 1:3.5 and 1:4.2,and the mean age of onset was 12.74±3.57 and 12.97±3.25,respectively.2.Clinical characteristics of GD patients.2.1 80.3% of GD patients had thyroid enlargement,and more than half(51.9%)had grade II enlargement.Thyroid enlargement(84.1%)and combined eye disease(46.0%)were more common in female patients during the first visit(P < 0.05);fatigue(44.4%)was more2.2 common in male patients(P < 0.05);the constituent ratios of tachycardia and mood changes were significantly different in affected children of all age groups(P < 0.05).2.3 39.5% of GD patients were complicated with related eye diseases(GO),and the incidence of goiter,Tg Ab,TRAb antibody titer and thyroid hormone FT4 in GO patients were higher than those in non-GO children with Graves’ disease(P < 0.05).2.4 The overall incidences of abnormal hemogram,liver function injury and dyslipidemia in GD patients were 14.8%,30.9% and 8.6%,respectively.Among them,a higher proportion of female patients developed liver function impairment(P < 0.05).Children who showed positive TPOAb were highest in the < 7 years group(92.9%)(P < 0.05);children with positive Tg Ab antibodies were least common in the 13–18 years group(77.3%).2.5 The early response rate in GD patients was 23.5%,and 76.5% of patients remained on oral medication.The results showed that combined related ophthalmopathy was an independent risk factor for poor prognosis in GD patients3.Clinical characteristics of HT patients.3.1 The clinical manifestations of newly diagnosed HT patients were diverse,and thyromegaly and fatigue were the most common modes of onset,accounting for 53.7% and38.8%,respectively.3.2 Most HT patients were in hypothyroid stage at first diagnosis(46.3%),followed by subclinical hypothyroidism(23.9%),euthyroidism(17.9%)and hyperthyroidism(11.9%).3.3 The mean age of patients in the first HT hypothyroidism group was small and the positive rate of autoantibodies was high(P < 0.05).3.4 In this study,patients with newly diagnosed HT hypothyroidism were treated with L-T4 supplementation.By the cut-off for follow-up,some newly diagnosed non-hypothyroid patients had progressed to hypothyroidism.Compared with the euthyroid group,there were no statistically significant differences in age at initial diagnosis,gender,family history,combined other diseases,thyroid hormone levels,and autoantibody titers between patients in the thyroid dysfunction group and those in the euthyroid group(P > 0.05).Conclusion:1.The age of onset of AITD in children and adolescents is mainly in adolescence,mostly in females.2.In this study,thyroid enlargement and tachycardia were the most common clinical manifestations in children and adolescents with GD.3.After treatment,some children and adolescents with GD can achieve complete remission,and the combination of related eye diseases at initial diagnosis is an independent risk factor for the low remission rate of GD in children and adolescents.4.The main clinical manifestation of HT patients at the first diagnosis is thyromegaly and fatigue.5.Thyroid function in children and adolescents with HT is a dynamic process,and age,gender,family history,combined with other diseases,thyroid hormone levels,and autoantibody titers at the time of diagnosis cannot be used as indicators to predict the prognosis of HT,so thyroid function should be monitored regularly in HT patients. |
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