Department of Pediatrics, The University of Sydney, Nepean Clinical School, Penrith, NSW 2751, Australia.
Thyroid. 2010 Oct;20(10):1187-90. doi: 10.1089/thy.2010.0102.
Although it is known that Hashimoto's thyroiditis in children and adolescents can go into long-term remission, and that treatment with thyroxine (T4) may not be necessary, it is difficult to quantify changes in the degree of autoimmune destruction of the thyroid. Here we report a patient in whom there was a relationship between functional and anatomical changes as assessed by hormone measurements and ultrasonography.
The patient was a 12-year-old girl with Hashimoto's thyroiditis who was initially euthyroid and later treated with 50 µg levo-T4 when her free T4 (fT4) had declined from 17 to 7 pmol/L (normal range, 8-22 pmol/L). At this time her thyroid-stimulating hormone (TSH) was 4.1 mIU/L (normal range, 0.30-4.0 mIU/L) and thyroid ultrasonography demonstrated features of early inflammation. Two years later, while on the same dose of T4, ultrasound examination revealed severe end-stage Hashimoto's thyroiditis and thyroid function tests showed a T4 of 14.0 pmol/L and TSH of 0.81 mIU/L. Twelve months later, however, the thyroid ultrasound had returned to almost normal with only minimal features of inflammation. Thyroid function tests showed a fT4 of 12.8 pmol/L and TSH of 0.75 mIU/L. Her T4 treatment was then stopped. Eight, 17, and 30 weeks after this, her fT4 was 16.8, 9.7, and 13.9 pmol/L, respectively, and her respective TSH values at the same times were 0.10, 2.24, and 0.75 mIU/L.
This is the first recording of serial thyroid ultrasound changes in a patient with Hashimoto's thyroiditis that paralleled changes in thyroid function. This indicates that thyroiditis can go into remission in some children. Thyroid ultrasound may be useful to make presumptive therapeutic decisions in children and adolescents with Hashimoto's thyroiditis whose dose of thyroid hormone seems to be less than is full replacement. Thyroid function tests, however, should ultimately guide T4 dosage.
尽管已知儿童和青少年的桥本甲状腺炎可以长期缓解，并且甲状腺素（T4）治疗可能不是必需的，但很难量化甲状腺自身免疫破坏程度的变化。在这里，我们报告了一名患者，其激素测量和超声检查结果之间存在功能和解剖变化的关系。
患者为一名 12 岁桥本甲状腺炎女孩，最初甲状腺功能正常，游离 T4（fT4）从 17 降至 7 pmol/L（8-22 pmol/L 正常范围）后，开始接受 50μg左旋甲状腺素治疗。此时，她的促甲状腺激素（TSH）为 4.1 mIU/L（0.30-4.0 mIU/L 正常范围），甲状腺超声显示早期炎症特征。两年后，在相同剂量的 T4 治疗下，超声检查显示严重的终末期桥本甲状腺炎，甲状腺功能检查显示 T4 为 14.0 pmol/L，TSH 为 0.81 mIU/L。然而，12 个月后，甲状腺超声几乎恢复正常，仅显示轻微炎症特征。甲状腺功能检查显示 fT4 为 12.8 pmol/L，TSH 为 0.75 mIU/L。此后，她停止了 T4 治疗。停药后 8、17 和 30 周，fT4 分别为 16.8、9.7 和 13.9 pmol/L，相应的 TSH 值分别为 0.10、2.24 和 0.75 mIU/L。
这是首例记录桥本甲状腺炎患者甲状腺超声变化与甲状腺功能变化平行的系列病例。这表明在一些儿童中，甲状腺炎可能会缓解。在甲状腺激素剂量似乎低于完全替代剂量的桥本甲状腺炎儿童和青少年中，甲状腺超声可能有助于做出治疗决策。然而，最终应根据甲状腺功能检查来指导 T4 剂量。
