Kaloumenou Irene, Mastorakos George, Alevizaki Maria, Duntas Leonidas H, Mantzou Emilia, Ladopoulos Charalambos, Antoniou Aristides, Chiotis Dimitrios, Papassotiriou Ioannis, Chrousos George P, Dacou-Voutetakis Catherine
Endocrine Unit, First Department of Pediatrics, Athens University School of Medicine, Athens, Greece.
Thyroid. 2008 Jul;18(7):747-54. doi: 10.1089/thy.2007.0370.
A strong genetic background and gender are believed to be involved in thyroid autoimmunity (TA). The age these factors become manifest is less clear, however. The objective of the present study was to determine the prevalence of TA in children and adolescents and to determine if there are relationships between the period of onset of TA and gender and between TA and maternal autoimmunity.
Antithyroperoxidase antibodies (anti-TPO Ab), antithyroglobulin antibodies (anti-Tg Ab), thyrotropin, thyroxine, triiodothyronine, and urinary iodine were determined in 440 healthy schoolchildren (200 boys and 240 girls), aged 5-18 years, and in 123 mothers living in an iodine-replete region.
The prevalence of positive anti-TPO and anti-Tg Ab was 4.6% and 4.3%, respectively. In girls, the prevalence of positive anti-TPO Ab was higher in Tanner stage II-V compared to Tanner stage I (8.2% vs. 2.2%; p < 0.05). No difference was detected with regard to anti-Tg Ab. In girls, positive anti-TPO and anti-Tg Ab levels were associated with significantly greater thyroid volume. Hypoechogenicity was detected in 52.6% and 36.8% of the children with positive anti-TPO or anti-Tg Ab, respectively (p = 0.0005). The prevalence of autoimmune thyroiditis, as defined by positive serum anti-TPO and/or anti-Tg and an echographic pattern of the thyroid gland having diffuse or irregular hypoechogenicity, was 2.5%. Mothers of anti-TPO Ab positive children had positive anti-TPO Ab more frequently compared to mothers of anti-TPO Ab negative children (82% vs. 18%; p = 0.0005). Mothers of anti-Tg Ab positive children had positive anti-Tg Ab more frequently compared to mothers of anti-Tg Ab negative children (75% vs. 25%; p = 0.0005).
These findings demonstrate that thyroid antibody positivity in children was significantly associated with maternal autoimmunity and their development in girls emerges at puberty. Since heredity, female gender, and puberty are strongly associated with TA, girls in families with TA should be examined at the onset of puberty.
强大的遗传背景和性别被认为与甲状腺自身免疫（TA）有关。然而，这些因素显现的年龄尚不清楚。本研究的目的是确定儿童和青少年中TA的患病率，并确定TA的发病期与性别之间以及TA与母体自身免疫之间是否存在关联。
对440名年龄在5至18岁的健康学童（200名男孩和240名女孩）以及123名生活在碘充足地区的母亲进行抗甲状腺过氧化物酶抗体（抗-TPO Ab）、抗甲状腺球蛋白抗体（抗-Tg Ab）、促甲状腺激素、甲状腺素、三碘甲状腺原氨酸和尿碘的检测。
抗-TPO和抗-Tg Ab阳性的患病率分别为4.6%和4.3%。在女孩中，坦纳二期至五期抗-TPO Ab阳性的患病率高于坦纳一期（8.2%对2.2%；p<0.05）。抗-Tg Ab方面未检测到差异。在女孩中，抗-TPO和抗-Tg Ab阳性水平与甲状腺体积显著增大有关。抗-TPO或抗-Tg Ab阳性的儿童中，分别有52.6%和36.8%检测到甲状腺低回声（p=0.0005）。血清抗-TPO和/或抗-Tg阳性且甲状腺超声表现为弥漫性或不规则低回声定义的自身免疫性甲状腺炎患病率为2.5%。抗-TPO Ab阳性儿童的母亲抗-TPO Ab阳性的频率高于抗-TPO Ab阴性儿童的母亲（82%对18%；p=0.0005）。抗-Tg Ab阳性儿童的母亲抗-Tg Ab阳性的频率高于抗-Tg Ab阴性儿童的母亲（75%对25%；p=0.0005）。
这些发现表明，儿童甲状腺抗体阳性与母体自身免疫显著相关，且女孩在青春期出现甲状腺抗体阳性。由于遗传、女性性别和青春期与TA密切相关，TA家族中的女孩应在青春期开始时进行检查。
