Wang Shuo-Yu, Tung Yi-Ching, Tsai Wen-Yu, Lee Jing-Sheng, Hsiao Pei-Hung
Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China.
Eur J Pediatr. 2006 Jul;165(7):481-3. doi: 10.1007/s00431-006-0112-5. Epub 2006 Mar 24.
The objective of this prospective study was to evaluate both thyroid function in children with Hashimoto's thyroiditis and the necessity of lifetime thyroxine replacement therapy. A total of 47 patients with goiter and positive thyroid auto-antibodies participated in the study. Serum thyroxine and thyrotropin levels and titers of thyroid auto-antibodies were checked regularly throughout the follow-up period. At the beginning of the study, 25 patients were diagnosed as euthyroid, but at the end of the study, 22 patients initially diagnosed with euthyroidism remained euthyroid, while eight patients with subclinical hypothyroidism and three patients with overt hypothyroidism had become euthyroid. Thus, of the 22 patients with thyroid dysfunction at diagnosis, subclinical or overt, 11 became euthyroid during the follow-up period. The effect of thyroxine treatment on thyroid auto-antibody titers was not significant.
Our data shows that Hashimoto's thyroiditis in children has a benign course and that thyroid function in one half of the patients with thyroid dysfunction at diagnosis reverts to normal. Careful follow-up of thyroid function is important in order to determine the necessity and timing of thyroxine replacement therapy.
本前瞻性研究的目的是评估桥本甲状腺炎患儿的甲状腺功能以及终身甲状腺素替代治疗的必要性。共有47例甲状腺肿且甲状腺自身抗体呈阳性的患者参与了该研究。在整个随访期间定期检查血清甲状腺素、促甲状腺素水平以及甲状腺自身抗体滴度。研究开始时,25例患者被诊断为甲状腺功能正常,但研究结束时,最初诊断为甲状腺功能正常的22例患者仍保持甲状腺功能正常,而8例亚临床甲状腺功能减退患者和3例显性甲状腺功能减退患者已恢复甲状腺功能正常。因此,在诊断时患有亚临床或显性甲状腺功能障碍的22例患者中,有11例在随访期间恢复了甲状腺功能正常。甲状腺素治疗对甲状腺自身抗体滴度的影响不显著。
我们的数据表明,儿童桥本甲状腺炎病程呈良性,诊断时甲状腺功能障碍患者中有一半的甲状腺功能可恢复正常。为了确定甲状腺素替代治疗的必要性和时机,对甲状腺功能进行仔细随访很重要。