细针吸取细胞学检查在儿童甲状腺炎诊断中的应用

目的：　探讨细针吸取细胞学 (FNAC)检查对儿童甲状腺炎的诊断价值。方法：　采用FNAC检查法诊断儿童甲状腺。结果：　经细胞学诊断为甲状腺炎共计 10 0例,经临床治疗及其它实验室检查结果相符的98例(98%),只有2例(2%)在分类上出现误差,而血清学(T3 ,T4 ,TG ,TM ,TSH)检查敏感性则相对较低,桥本氏甲状腺炎为63.1%～73.6%,淋巴细胞性甲状腺炎为26.0%～84.7%,其它血清学检查均无意义。结论：　FNAC检查法吸出细胞成分充足,几乎不含血液成分,有利于甲状腺炎的诊断及分类。     

人类白细胞抗原DQA1等位基因与桥本甲状腺炎的相关性研究

目的研究人类白细胞抗原DQA1（HLA-DQA1）等位基因与桥本甲状腺炎（HT）的相关性。方法采用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）基因分型技术,对51例HT患儿及51名正常儿童对照进行了HLA-DQA1基因分型并计算比较其基因频率。所有研究对象均为天津汉族儿童。结果在HT组,HLA-DQA1*0301等位基因频率明显高于正常对照（44.12%对28.43%,RR=1.99,P<0.025）而HLA-DQA1*0201等位基因频率则明显低于正常对照(5.88%对18.63%,RR=0.27,P<0.01）。结论HLA-DQA1*0301可能是HT的一个易感等位基因,而HLA-DQA1*0201则可能是一个保护等位基因,HT的发病与HLA-DQA1基因位点密切相关。     

Atypical presentation of subacute thyroiditis.

Subacute thyroiditis is extremely rare during the first decade of life. We describe a case of subacute thyroiditis in a 2 year old child whose initial clinical, sonographic, and radioisotopic features were indistinguishable from acute suppurative thyroiditis. The diagnosis was established by a raised antibody titre against adenovirus and typical increased thyroid function tests.     

Thyroiditis. Differentiation of acute suppurative and subacute. Case report and review of the literature

Acute suppurative thyroiditis is rarely seen during childhood. The classic clinical features of this illness (fever, neck pain, and a swollen, tender mass over the thyroid gland) can differentiate acute thyroiditis from the more common subacute thyroiditis. In less typical cases, however, this distinction can be difficult. An adolescent male presented with a swollen, tender thyroid gland. Atypical laboratory findings and the lack of fever and toxicity delayed the diagnosis and treatment of acute suppurative thyroiditis. A review of the pediatric literature summarizes clinical and diagnostic features valuable in the differential between acute suppurative thyroiditis and subacute thyroiditis in childhood. The important contribution of fistulae between the piriform sinus and thyroid gland to the pathogenesis and acute suppurative thyroiditis is emphasized. Such a fistula should be sought in every patient in whom this entity is diagnosed.     

Autoimmune thyroiditis in a child with steroid-dependent nephrotic syndrome

Autoimmune thyroiditis is rarely described in association with nephrotic syndrome. Herein we report a girl who developed autoimmune thyroiditis insidiously during the course of minimal change nephrotic syndrome. She was streroid-sensitive, but developed severe steroid dependency and did not respond to cyclophosphamide therapy. She went into stable remission with levamisole. Five months after introduction of levamisole a mild goiter was found on systematic examination at school. The diagnosis of autoimmune thyroiditis was established with typical ultrasound appearance of the thyroid gland along with significant titers of antithyroid antibodies. It is very unlikely that levamisole was responsible for thyroiditis because experimental animal administration of high doses of levamisole inhibited lymphocyte infiltration of the thyroid. Since levamisole has had a beneficial effect on the nephrotic syndrome in our patient we decided to continue the treatment. She has been receiving levamisole for 3 years, and no adverse effects have been observed during the treatment period.     

Thyroiditis in children. Personal observations

Enlargement of the thyroid gland, local tenderness and thyroid function disorder are common symptoms of thyroiditis. Hashimoto's thyroiditis (chronic lymphocytic thyroiditis) is the most common form of thyroiditis in children. This disease is a frequent cause of acquired hypothyroidism. Hashimoto's thyroiditis (HT) is characterised by infiltration of the thyroid gland by lymphocytes, gradual destruction of the gland and production of various thyroid autoantibodies, mainly antimicrosomal (ATM) and antithyroglobulin antibodies (ATGL). 54 children (45 girls and 9 boys) aged from 11 to 18 with confirmed or suspected HT were observed. The clinical diagnosis of HT was confirmed by fine needle aspiration biopsy (FNAB) in 27 patients. In one case HT was histologicaly confirmed after thyroid surgery. FNAB was not carried out in 19 patients and in 7 cases FNAB was thyroiditis negative. All patients were positive for ATM and/or ATGL. Initially 24 patients were euthyroid. Hypothyroidism was recognized in 8 children, subclinical hypothyroidism in 11 children. One patient was hyper- thyroid. 51 patients were treated with l-thyroxin. Ultrasonography revealed variable thyroid abnormality in all patients: hyperplasia in 38 patients, multinodular goiter or solitary nodule in 15 patients. 8 children suffered from associated disease: 5 patients from allergy, 1 patient from trombocytopenia, 1 from alopecia areata, 1 from secondary amenorrhea. Follow up examination of children with HT must be continued due to the risk of hypothyroidism or neoplastic disease of thyroid.     

Diagnostic role of thyroid elastography in pediatric patients with Hashimoto's thyroiditis and Graves’ disease: A prospective controlled study

ObjectiveHashimoto's thyroiditis and Graves’ disease are autoimmune diseases of the thyroid gland, and both diseases are diagnosed with ultrasound findings and autoantibody height. However, ultrasound (US) findings may be normal in both diseases rarely. In some pediatric studies, it was reported that shear wave velocity values in autoimmune thyroiditis were significantly higher than normal thyroid parenchyma and it was recommended to be used as a diagnostic method. Our study will address the evaluation of patients with Hashimoto's thyroiditis and Graves’ disease by thyroid elastography and the role of this method in diagnosis.Materials and methods28 patients with Hashimoto's thyroiditis, 20 patients with Graves’ disease and 40 healthy controls were enrolled in our study prospectively. Thyroid Elastography and US were applied to all patients.ResultsIn US, Hashimoto's thyroiditis had a hypoechoic echo pattern compared to graves’ disease (p < 0.05). When shear wave velocity (SWV) value of children with Hashimoto's thyroiditis and Graves’ disease were compared with the control group, thyroid tissue showed more stiffness in both disease groups (p = 0.001). When SWV values were compared between Hashimoto's thyroiditis and Graves’ disease, there was no statistically significant difference (p = 0.73).ConclucionSWV values were found to be higher in children with Hashimoto's thyroiditis and Graves’ disease compared to the control group and contributes to the diagnosis of these diseases. However, the elastography technique alone is not sufficient to differentiate. Hashimoto's thyroiditis and Graves’ disease.     

Thyroid antibodies in children and adolescents with thyroid disorders

Thyroid antibodies were determined by three different techniques in the sera of 125 children and adolescents with thyroid disorders and in the sera of 53 short, normal children without thyroid dysfunction. The incidence of antithyroglobulin antibodies in patients with thyroiditis was highest when measured by radioimmunoassay (85%), less than when measured by hemagglutination (24%), and least by antimicrosomal antibodies (7%). No patient who had initially negative serum for RATA subsequently had positive tests during follow-up of five to 24 months, whereas eight of 31 patients with initially negative serum for ATA later developed positive tests. Treatment appeared to have a suppressive effect on RATA, but not on ATA titers, in hypothroid patients with clinical thyroiditis. The incidence of hypothyroidism in the patients with clinical thyroiditis on initial presentation was significant (37%) and suggests that identification of children and adolescents with thyroiditis is important to ensure adequate medical follow-up.     

Congenital piriformo-thyroid fistula as a cause of recurrent suppurative thyroiditis

A previously healthy five year old boy presented with suppurative, febrile thyroiditis of the left lobe with pronounced general and local signs of inflammation, normal thyroid function and lack of thyroid antibodies. Intravenous antibiotic therapy improved the condition quickly. Six and nine months later however recurrent left lobe thyroiditis occurred. Endoscopic examination showed an internal fistula from the left piriform sinus to the left thyroidal lobe which was cut out. The case report confirms previous communications, that recurrent suppurative thyroiditis is nearly always caused by a piriform sinus fistula, probably a fourth pharyngeal pouch remnant which can be cured surgically.     

Acquired hypothyroidism in a very young infant with Omenn's syndrome

A very young male infant with Omenn's syndrome had acquired hypothyroidism that was most likely caused by autoimmune thyroiditis. The hypothyroidism appeared at 3 months of age. These 2 rare conditions have not previously been reported occurring together. This case suggests that autoimmune thyroiditis may be another abnormal finding in Omenn's syndrome.     

Subacute thyroiditis in children: patient report and review of the literature

Subacute thyroiditis is extremely rare during childhood. We treated a 10 year-old prepubertal girl who presented with typical clinical features of subacute thyroiditis. Considering this case and previous reports in children, we characterized the clinical features of this disorder as it occurs in childhood. In contrast to the predominance of subacute thyroiditis in adults, the incidence of subacute thyroiditis is lower than that of acute suppurative thyroiditis in children. This may cause difficulty with differential diagnosis, particularly when leukocytosis is present or the lesion is localized to the left lobe. Ultrasonography can be helpful in differentiation.     

Thyrotropin binding inhibitor immunoglobulin. Its pathogenetic importance in hypothyroidism

Two patients with hypothyroidism had detectable serum levels of thyrotropin binding inhibitor immunoglobulin (TBII). Patient 1 was a newborn infant who had transient neonatal hypothyroidism due to transfer of TBII from the mother with nongoitrous autoimmune thyroiditis. Patient 2 was an 8-year-old girl with Down's syndrome who presented with signs of myxedema and central precocious puberty. She had no goiter, and the recognition of thyroid disease was delayed; the histological diagnosis of chronic lymphocytic thyroiditis was established by aspiration biopsy, and TBII had strong thyroid adenyl cyclase-inhibiting activity in vitro. It appears that TBII may be pathogenetically important for occurrence of neonatal hypothyroidism and nongoitrous autoimmune thyroiditis without goiter.     

A young boy with a thyroid yo-yo

We describe a boy with Hashimoto's thyroiditis and Addison's disease who was initially hypothyroid, developed hyperthyroidism and eventually became euthyroid. A rise and fall in thyroid binding inhibitory immunoglobulin and thyroid stimulating antibodies were demonstrated to have correlated with the appropriate changes in thyroid status. The fact that Hashimoto's thyroiditis can evolve in such a way emphasizes the importance of lifetime follow-up in these patients.     

自身免疫性甲状腺炎由甲状腺功能减退症自发发展为甲状腺功能亢进症2例并文献复习

目的：探讨自身免疫性甲状腺炎由甲状腺功能减退症（甲减）自发发展为甲状腺功能亢进症（甲亢）的临床特点。方法：对2例自身免疫性甲状腺炎由甲减自发发展为甲亢患儿的临床资料进行分析,并复习相关中英文文献。 结果：2例自身免疫性甲状腺炎患儿最初表现为甲减,经左旋甲状腺素片替代治疗,甲状腺功能恢复正常,分别于替代治疗20个月和9个月后自发发展为甲亢,予抗甲状腺药物治疗后甲亢缓解。复习文献,有17例儿童及35例成人自身免疫性甲状腺炎患者由甲减自发发展为甲亢的文献报道。52例患者平均年龄为32.8（3~80）岁,男10例,女42例。原发疾病均为自身免疫性甲状腺炎。除18例甲减至甲亢整个过程均未检测TRAb、TBAb和TSAb外,其他病例在甲减时均有TPOAb、TGAb和TBAb显著增高,TSAb正常或降低,在发展为甲亢过程中,TPOAb和TGAb维持在较高水平,TBAb显著下降,TSAb持续升高。部分仅检测TRAb的病例,在甲亢时均出现TRAb增高。结论自身免疫性甲状腺炎由甲减自发发展为甲亢极罕见。发生机制可能与TRAb相关,早期TBAb和TSAb抗体检测有助于早期诊治和随访。     

Actinomycotic suppurative thyroiditis in a child

AIM: To present a rare case of actinomycotic suppurative thyroiditis in an infant with provision of the etiology, pathogenesis, clinical findings and treatment of this rare disease. DESIGN: A report of an 18-month-old female infant who presented with fever, erythema, induration and tenderness of the neck. The patient had the diagnosis of acute suppurative thyroiditis after a series of laboratory evaluation. RESULT: She was treated successfully with surgical debridement and intravenous penicillin G. CONCLUSION: Although rare, Actinomyces spp. should be considered in the etiology of acute suppurative thyroiditis. Because of its fastidious nature the probability of positive culture is low, thus, the microbiology laboratory should be called in advance to make preparations before culture and transport.     

Verlauf, Therapie und Komorbidität bei Hashimoto-Thyreoiditis im Kindesalter

Background

The present multicenter study was designed for a retrospective assessment of the clinical course, therapy and co-morbidity of autoimmune thyroiditis in childhood and adolescence.

Patients and methods

130 patients (108 female, 22 male) with a mean age of 11.1±3.3 years were evaluated on the basis of patient charts using standardized questionnaires.

Results

In the total group of 130 patients 70, 55, and 13 periods of euthyroidism, hypothyroidism and hyperthyroidism, respectively, were observed. Treatment of euthyroid autoimmune thyroiditis with L-thyroxine was of no benefit with regard to a reduction in thyroid gland volume as evaluated by ultrasound examination. 20% of patients suffered from substantial co-morbidity, among which diabetes mellitus type 1 was the commonest.

Conclusions

The present study suggests no advantage to the treatment of euthyroid autoimmune thyroiditis with L-thyroxine. Special attention should be paid to the early detection of co-morbidity associated with autoimmune thyroiditis of childhood and adolescence.     

Autoimmune thyroiditis in infants with Down's syndrome

Children with Down's syndrome are at high risk of thyroid dysfunction, including autoimmune thyroiditis. We describe two infants with Down's syndrome in whom chronic autoimmune thyroiditis was diagnosed at ages 5 months and 8 months. We suggest that follow-up of thyroid function and thyroid autoantibodies should be started from infancy in Down's syndrome to prevent further deterioration of mental development and growth.     

Thyroiditis and Turner's syndrome

Two patients with Turner's syndrome and Hashimoto's thyroiditis are described. The incidence of the karyotype 46 XX (iq), 45 X is high in this association reported in the literature; thus, 17 patients among 25 with Turner's syndrome and thyroiditis had a structural abnormality of the X chromosome. Routine thyroid antibodies determination should be carried out in patients with gonadal dysgenesis between 10 and 20 years of age, and early replacement therapy should be undertaken in Turner's syndrome with Hashimoto's thyroiditis, since clinical signs of hypothyroidism are usually delayed.     

Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus: prevalence and risk factors

Studies show great variation in prevalence of anti-thyroid antibodies in children with type 1 diabetes mellitus (DM1). There still is no consensus regarding screening of autoimmune thyroiditis in patients with DM1, especially in asymptomatic patients. AIM: To investigate the natural history and prevalence of autoimmune thyroiditis in pediatric patients with DM1 and relate it to potential risk factors. PATIENTS AND METHODS: This study is a historical cohort, through research of the records of 474 patients with DM1 from 9 months to 25 years of age, between 1980 and 2005 - 222 boys (46.8%) and 252 girls (53.2%), with an average duration of DM1 of 9.3 +/- 5.8 years. The sample was selected by having at least one measurement of TSH and anti-thyroid autoantibodies (antithyroperoxidase or anti-microssomal and/or anti-thyroglobulin) at any time from diagnosis of DM1. A questionnaire was answered in order to study the variables of interest for the study. Thyroid function disorder was defined as altered levels of TSH, with or without altered free T4 levels. RESULTS: A total of 383 patients (9 months to 25 years of age) were studied, 199 girls (52%) and 184 boys (48%). Sixty-four (16.7%) had positive anti-thyroid antibodies, predominantly girls (p = 0.064). Average duration of DM1 was 9.3 +/- 5.8 years and those above this age had a higher incidence of thyroiditis (p = 0.01). The prevalence of thyroid function disorder in patients with DM1 was 7.3% (n = 28), mostly with thyroiditis (32.8% vs 2.2% with negative antibodies, p < 0.001). There was a positive association between thyroiditis, as well as thyroid function disorders, and other autoimmune disorders (p < 0.001 and p < 0.02, respectively). CONCLUSIONS: Prevalence of thyroiditis in the diabetic population is considerably higher than in the general population. Annual laboratory determinations of anti-TPO antibodies and dosage of TSH should be part of routine tests in the diabetic population, especially in girls, children with DM1 for > 9 years, patients above 12 years of age, and those in whom DM1 is associated with another autoimmune disease. Anti-thyroid antibody positivity may indicate the necessity for thyroid function testing at shorter intervals.     

Thyroiditis and acquired hypothyroidism.

Chronic lymphocytic thyroiditis or Hashimoto's thyroiditis is the most common childhood cause of goiter and hypothyroidism in iodine-sufficient geographic regions.