Aversa Tommaso, Lombardo Fortunato, Corrias Andrea, Salerno Mariacarolina, De Luca Filippo, Wasniewska Malgorzata
1 Department of Pediatrics, University of Messina , Messina, Italy .
Thyroid. 2014 Apr;24(4):744-7. doi: 10.1089/thy.2013.0452. Epub 2014 Jan 29.
It is known that, in the general population, there exists a continuum between Hashimoto's thyroiditis (HT) and Graves' disease (GD) within the spectrum of autoimmune thyroid diseases, although the mechanisms involved in the metamorphosis from HT to GD or vice versa have not been elucidated as of yet. The aim of this study was to ascertain whether the association with Down or Turner syndromes (DS and TS) may affect the switching process from HT to GD.
Thirty-five young GD patients with either DS or TS (group A) and 109 age-matched GD patients with neither DS nor TS were retrospectively investigated in order to either confirm or exclude antecedents of HT. The investigations were based on either clinical records or questionnaires addressed to family pediatricians. Retrospective investigations also aimed to ascertain how many patients in each group exhibited a biochemical picture of either subclinical or overt hypothyroidism at the time of HT diagnosis, and how many had received levothyroxine (L-T4) therapy prior to the onset of GD. In both groups, all the patients with documented antecedents of HT underwent an assessment of their iodine status after GD diagnosis.
Antecedents of HT were significantly more common in group A than in group B (25.7% vs. 3.7%, p=0.0004), with a time interval between HT and GD that was significantly higher in group A (p=0.003). Both thyroid function and autoimmunity tests at HT presentation and the prevalence of patients who underwent L-T4 therapy prior to GD diagnosis were not significantly different in the two groups, nor was the iodine status after GD diagnosis.
In young patients with TS or DS, GD presentation is often (25.7% of cases) preceded by HT. This evolution trend does not seem to be conditioned by either thyroid tests at HT diagnosis, or L-T4 treatment, or iodine status alterations. Patients with these chromosomopathies and coexisting HT may be at high risk of progressing to GD. The pathophysiological bases of these findings need to be clarified.
众所周知，在普通人群中，自身免疫性甲状腺疾病范围内，桥本甲状腺炎（HT）和格雷夫斯病（GD）之间存在连续变化，尽管从HT转变为GD或反之的机制尚未阐明。本研究的目的是确定与唐氏综合征或特纳综合征（DS和TS）的关联是否会影响从HT到GD的转变过程。
回顾性调查了35例患有DS或TS的年轻GD患者（A组）和109例年龄匹配的既无DS也无TS的GD患者，以确认或排除HT病史。调查基于临床记录或向家庭儿科医生发放的问卷。回顾性调查还旨在确定每组中有多少患者在HT诊断时表现出亚临床或显性甲状腺功能减退的生化特征，以及有多少患者在GD发病前接受过左甲状腺素（L-T4）治疗。在两组中，所有有记录的HT病史患者在GD诊断后均接受了碘状态评估。
A组中HT病史明显比B组更常见（25.7%对3.7%，p = 0.0004），A组中HT和GD之间的时间间隔明显更长（p = 0.003）。两组在HT出现时的甲状腺功能和自身免疫测试以及GD诊断前接受L-T4治疗的患者比例均无显著差异，GD诊断后的碘状态也无显著差异。
在患有TS或DS的年轻患者中，GD的出现通常（25.7%的病例） preceded by HT。这种演变趋势似乎不受HT诊断时的甲状腺测试、L-T4治疗或碘状态改变的影响。患有这些染色体病并伴有HT的患者可能有发展为GD的高风险。这些发现的病理生理基础需要阐明。 （注：原文中“preceded by HT”表述不太完整准确，推测可能是想说“ preceded by a history of HT”之类的，但按要求未做修改）
