| Objectives:1. To compare the clinical and laboratory changes in children and adolescents with Graves disease (GD)or Hashimoto’s thyroiditis (HT) before and after medication, including clinical manifestations, thyroid hormone and antibody level, and investigate the clinical characteristics of the disease in children with autoimmune thyroid disease (AITD).2.To evaluate the factors which influence the remission of children and adolescents with GD and HT during the process of pharmacological treatment, in order to guide the clinical treatment options.Method:Records of children and adolescents with AITD,who attended the pediatric endocrinology outpatient of Tianjin Medical University General Hospital from January2009to January2014, were collected and retrospectively analyzed. Clinical data included gender, age, family history of thyroid disease, height, weight, body mass indexes (BMI), heart rate, size of the thyroid gland and the date of subsequent visit. Laboratory data included free triiodothyronine (FT3), free thyroxine (FT4), high sensitive thyroid stimulating hormone (sTSH), thyroglobulin antibodies (TGAb), thyroid peroxidase antibody (TPOAb), thyroid-stimulating hormone receptor antibody (TRAb) levels and blood routine test at presentation and follow-up.1. The patients with HT were divided into euthyroid group, subclinical hypothyroidism group, hypothyroidism group, hyperthyroidism group according to thyroid hormone levels at presentation. Finishing the records of at presentation and follow-up to analyze the changes of clinical characteristics and laboratory data of every groups of HT and all GD patients.2.According to the thyroid hormone levels after24months from the first visit,the patients with HT were divided into euthyroid group and thyroid dysfunction group to analyze the prognostic in patients with HT during the process of therapy with L-T4.3The patients with GD were divided into achieving remission group and not achieving remission group according to thyroid hormone levels and maintenance of normal serum FT4concentrations without medication to explore the possible predictive variables by analyzing clinical data of patients.Results:1. A total of183patients were enrolled into the study data,including78HT patients and105GD patients. The average age of patients was10.53±2.74years and the sex ratio(male:female) was1:6.0.The average follow-up time was41.6±16.9months. The mean follow-up time of HT children and adolescents was38.1±14.8months while the GD patient was44.3±18.0months. The discovery of thick neck or neck mass was the most common chief complaint.66.7%(52/78)HT and48.6%(51/105) GD patients attended hospital for that.2. In the HT patients, the average age of hypothyroidism group was younger than euthyroid group at presentation (P<0.05). Patients in hyperthyroidism group were older than that of hypothyroidism group and subclinical hypothyroidism group (P<0.05).3.76.9%(10/13) of euthyroid patients initially maintained euthyroid after24months.87.5%(7/8) of patients who were untreated at presentation needed alternative treatment at last. There was no significant difference between euthyroid group and thyroid dysfunction group in age, heart rate, BMI, thyroid hormone levels, the level of TGAb and TPOAb, size of the thyroid gland, white blood cell, hemoglobin and platelet count.4. The rate of side effects in GD patient using MMI was19%, while the rate of early remission was24.8%.5. Compared to the patients who can’t achieve early remission, patients achieving early remission were older (P<0.05) and had higher BMI (P<0.05), lower heart rates (P<0.05), lower platelet counts (P<0.05) and the level of TRAb (P<0.05), and also had smaller goiters (P<0.001), lower serum FT4and FT3concentrations at presentation (P<0.05). Patients achieving early remission needed shorter time of until to have FT4within normal range (P<0.05). Stepwise logistic regression analysis showed that the duration of treatment until FT4within normal range and goiter size were independent predictors.Conclusion: 1. For HT patients, the euthyroid children have a better prognosis. Most of patients who were untreated at presentation needed accept alternative treatment at last. No predictors were found in this study. Therefore the patients with HT should be monitored periodically.2. The rate of side effects in GD patient using MMI was19%, while the rate of early remission was24.8%. In patients with GD, the children achieving early remission were older and had higher BMI,lower heart rates at presentation than those in not achieving early remission group. Patients with small goiters were more likely to achieve early remission, compared with those with large goiters. Patients who had lower serum FT4、FT3concentrations, TRAb titer, higher platelet count and shorter time of until FT4within normal range were more likely to achieve early remission. The duration of treatment until FT4within normal range and goiter size are independent predictors. These data provide a useful guide for clinical decision-making regarding Graves’disease in children. |
PDF Full Text Request