In childhood hashimoto's disease in groups with and without treatment progress of thyroid autoantibod levels

Background and Aim: Hashimoto's thyroiditis (chronic autoimmune thyroiditis) is the most common cause of hypothyroidism in areas without iodine deficiency. It is possible to talk about the genetic predisposition of the individual in approximately 20- 30% of the patients followed up with the diagnosis of HT. HT appears as the loss of immunological tolerance of the thyroid gland against autoimmune attack. Pathogenesis of Hashimoto's thyroiditis; It can be defined as a gradually progressive disease in which the autoimmune response, with or without goiter, leads the thyroid gland cells to apoptosis. In our study, patients diagnosed with Hashimoto's disease in childhood were divided into groups that were treated and followed up without treatment. It was aimed to compare the autoantibody course of the treated and untreated groups, together with the patient's clinical and laboratory findings. Materials and Methods: Files of patients diagnosed with hashimoto's thyroid in Ankara City Hospital Pediatrics Clinic were retrospectively analyzed. During the specified period, 249 patient files were examined. Patients who received hormone therapy and those who were followed up without treatment were compared. Age, gender, clinical or biochemical hypothyroidism, euthyroid or hyperthyroidism periods of the patients, whether or not they received hormone therapy, the dose of hormone replacement therapy used, duration of use, the clinic of the patients in the process, thyroid gland changes, additional system findings, antiTG, antiTPO, fT3 , fT4 and TSH levels were recorded. If there is more than one retrospective record of the relevant patient, the most recent record after the start of drug use was included in the study. Results: A total of 249 patients were included in the study. Of these patients, 116 were treated with hormone replacement therapy and 133 were followed without treatment. The mean age of all patients was 13.91±3.71 years, the median age was 14.8, the youngest age was 3.56, and the oldest was 19.95 years. The mean age at which they were diagnosed was 11.51±3.79 years, the median age at diagnosis was 12, the minimum age at diagnosis was 1, and the highest age at diagnosis was 17. 74 of 249 patients (29.7%) had a history of the disease. 77 of these patients (30.9%) had a family history of the disease. In our study, where we aimed to present the data in the literature that the damage caused by the autoimmune response can be prevented by early v hormone replacement therapy, the difference between the first measured anti-TPO values and the anti-TPO values measured after 12 months was found to be statistically significant (p<0.05). In our study, it was shown in our study that anti-TPO values tend to increase in a statistically significant way in patients with a diagnosis of HT who did not receive treatment. When the clinical findings were evaluated, we found that the regression in the treated group was also statistically significant. Conclusion: Hashimoto's thyroiditis is the most common cause of hypothyroidism in childhood. It can also present as goiter or atrophic thyroiditis. This process is defined as the destruction of thyroid follicles secondary to antibody-mediated lymphocytic infiltrates. Although the diagnosis of the disease is based on the demonstration of antibodies, some of the patients may have normal antibody titers at the time of diagnosis. Depending on the damage to the gland in Hashimoto's thyroiditis and the level of its functionality, we may encounter patients with different clinics. In our study, it was aimed to detect the correlation of clinical findings with the laboratory earlier by retrospectively examining the autoantibody levels of patients who received hormone replacement therapy and were followed up without treatment. The regression of clinical findings was also found to be statistically significantly higher in the treatment group. (p=0.044) (Table 10). Thus, we reveal how valuable early hormone replacement therapy, which is initiated in the course of an autoimmune disease such as Hashimoto's thyroiditis, is in terms of reducing the damage caused by autoimmunity, comforting the patient and relieving clinical complaints. Keywords: Hashimoto Thyroiditis, Pediatrics, Hormone Replacement Therapy