Gopalakrishnan Sripathy, Chugh Pradeep Kumar, Chhillar Mitrabasu, Ambardar Vinod Kumar, Sahoo Maheshwar, Sankar Rajan
Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
Pediatrics. 2008 Sep;122(3):e670-4. doi: 10.1542/peds.2008-0493. Epub 2008 Aug 4.
Patients with autoimmune thyroiditis can present with thyroid function that varies from euthyroidism to frank hypothyroidism or occasionally hyperthyroidism. Although there is a risk of progression from the euthyroid or subclinical hypothyroid state to frank hypothyroidism, the rate of progression is not known.
Subjects with diffuse goiter and autoimmune thyroiditis were followed up to observe the rate of deterioration in thyroid function from euthyroid and subclinical hypothyroid states to hypothyroidism.
Patients who presented with goiter and autoimmune thyroiditis were grouped as those with euthyroidism, subclinical hypothyroidism, and overt hypothyroidism on the basis of levels of thyroxine and thyrotropin at presentation. Patients were followed up for a minimum duration of 24 months with periodic monitoring of thyroid function.
Ninety-eight consecutive subjects (aged of 8-18 years) with a diagnosis of autoimmune thyroiditis and diffuse goiter were studied. At presentation, in 24 subjects (24.5%) thyroid function was normal (euthyroidism), 32 (32.6%) had subclinical hypothyroidism, and the remaining 42 subjects (42.9%) had hypothyroidism. All of the subjects with hypothyroid were maintained euthyroid on thyroxine during follow-up. Hypothyroidism developed in 3 of 24 patients with euthyroidism and in 4 of 32 patients with subclinical hypothyroidism.
Subjects with goitrous autoimmune thyroiditis need periodic monitoring of thyroid function. Development of thyroid dysfunction is insidious and may not be accompanied by symptoms and clinical signs. In pediatric and adolescent age groups it is imperative to correct thyroid dysfunction to achieve optimal growth and development.
自身免疫性甲状腺炎患者的甲状腺功能可从甲状腺功能正常变化为明显的甲状腺功能减退，偶尔也会出现甲状腺功能亢进。虽然存在从甲状腺功能正常或亚临床甲状腺功能减退状态进展为明显甲状腺功能减退的风险，但进展速度尚不清楚。
对患有弥漫性甲状腺肿和自身免疫性甲状腺炎的受试者进行随访，以观察甲状腺功能从甲状腺功能正常和亚临床甲状腺功能减退状态恶化至甲状腺功能减退的速率。
根据就诊时甲状腺素和促甲状腺激素水平，将出现甲状腺肿和自身免疫性甲状腺炎的患者分为甲状腺功能正常、亚临床甲状腺功能减退和明显甲状腺功能减退三组。对患者进行至少24个月的随访，并定期监测甲状腺功能。
对98例连续诊断为自身免疫性甲状腺炎和弥漫性甲状腺肿的受试者（年龄8 - 18岁）进行了研究。就诊时，24例受试者（24.5%）甲状腺功能正常（甲状腺功能正常），32例（32.6%）有亚临床甲状腺功能减退，其余42例受试者（42.9%）有甲状腺功能减退。所有甲状腺功能减退的受试者在随访期间通过甲状腺素维持甲状腺功能正常。24例甲状腺功能正常的患者中有3例出现甲状腺功能减退，32例亚临床甲状腺功能减退的患者中有4例出现甲状腺功能减退。
患有甲状腺肿性自身免疫性甲状腺炎的受试者需要定期监测甲状腺功能。甲状腺功能障碍的发展较为隐匿，可能不伴有症状和体征。在儿童和青少年年龄组中，纠正甲状腺功能障碍对于实现最佳生长发育至关重要。
