Evaluation of clinical and auxological characteristics of children and adolescents followed with diagnosis of autoimmune thyroiditis in the pediatric endocrinology clinic over the last 15 years

Objective: In this study, it was aimed to retrospectively investigate the clinical and auxological characteristics of children and adolescents followed by a diagnosis of autoimmune thyroiditis in the Çukurova University Faculty of Medicine Pediatric Endocrinology Clinic. Materials and Methods: A total of 101 patients with a diagnosis of autoimmune thyroiditis in our hospital's Pediatric Endocrinology clinic between 2008 and 2023 were included in our study. Complaints at presentation, physical examination findings at presentation, presenting symptoms, thyroid function tests at diagnosis and after treatment, thyroid autoantibody levels, thyroid ultrasound results, family history, presence of accompanying autoimmune diseases, height, and weight measurements, pubertal development stages, presence of goiter, initiated treatment agent, duration and characteristics of becoming euthyroid with treatment were evaluated. Results: In our study, 84,2 % of the patients (n=85) were female. The mean age of the patients at the time of diagnosis was 10,5 years. In our study 53,5 % of the patients were hypothyroid and 37,3 % were euthyroid at the time of diagnosis. The mean age at diagnosis was 9,75 for the hypothyroid group and 11,32 for the euthyroid group, and there was a statistically significant difference between these two groups (p<0.05). In addition, 52,3 % of the patients were prepubertal and 47,7 % were in the pubertal period. The thyroid gland was nonpalpable in 19,0 % of the patients and goiter was observed in 81,0 %. In this study 92,9 % of the patients were within normal limits for height measurement and 82,7 % for weight measurement. The most common complaint at the first presentation was goiter with a frequency of 28,3 %. Hypothyroid patients presented most commonly with weight gain (32,6 %), while hyperthyroid patients presented most commonly with anxiety symptoms (40,0 %). At their initial presentation, 39,1 % of the patients had high anti-TG levels while 87,1 % had high anti-TPO levels. After treatment, 17,3 % of the patients had high serum anti-TG levels, while 82,2 % had high serum anti-TPO levels. Among patients with very high TSH levels (>20 mIU/L), 58,8 % had high serum anti-TG levels, showing a significant difference between the groups (p<0.05). Family history was present in 41,5 % of the cases. The rate of accompanying autoimmune diseases was 5,9 %. Thyroid ultrasound was compatible with autoimmune thyroiditis in 93,9 % of the cases. Among those with high serum anti-TPO levels at presentation, 53,1 % were hypothyroid and 37,0 % were euthyroid. In addition, 50,8 % of patients with high anti-TPO levels became euthyroid. The rate of patients who could not become euthyroid with levothyroxine treatment was 9,7 %. In the group treated with methimazole, the rate of patients who could not become euthyroid was 50,0 %. The rate of becoming euthyroid in the group treated with propranolol, methimazole, and L-T4 was 100 %, showing a statistically significant difference between the groups regarding the initiated treatment agent (p<0.05). The mean duration of becoming euthyroid for patients was 205,81 days. Conclusion: We have demonstrated that hypothyroid patients are diagnosed with autoimmune thyroiditis at an earlier age compared to euthyroid. We have shown that male gender is an important factor in autoimmune thyroiditis starting in the prepubertal period. We showed that serum anti-TG levels were significantly elevated in patients with very high TSH levels (>20 mIU/L). We demonstrated that L-T4 treatment is more successful than other treatment approaches. Keywords: Autoantibody, autoimmune thyroiditis, guatr, levothyroxine