Section of Pediatric Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
The University of Louisville School of Medicine, Louisville, Kentucky.
JAMA Dermatol. 2017 Dec 1;153(12):1307-1310. doi: 10.1001/jamadermatol.2017.3694.
The incidence of thyroid disease in children with alopecia areata (AA) has been widely studied with no consensus on whether a true association with AA exists. In addition, screening practices for thyroid dysfunction in children with AA vary widely among clinicians.
To reduce health care costs, eliminate unnecessary testing, and standardize clinical practices, we sought to characterize thyroid function in children with AA to establish guidelines for screening.
DESIGN, SETTING, AND PARTICIPANTS: A single-site retrospective medical chart review was carried out in an outpatient pediatric dermatology clinic in a tertiary referral medical center between January 1, 2008 and January 1, 2016. The study included 298 patients (ages 0-21 years) who received a clinical diagnosis of AA and underwent thyroid function tests.
Age at diagnosis of AA, duration of disease, severity, location, and type were documented. Past medical history and family medical history of patients were also recorded. Results of laboratory tests including thyrotropin (formerly thyroid-stimulating hormone [TSH]), free T4 (FT4), triiodothyronine (T3), thyroid peroxidase antibodies (TPO-Abs), and thyroglobulin antibodies (Tg-Abs).
During the 8-year period, 298 patients with AA had thyroid function screening. Of those with thyroid screening, patterns of AA included patchy (68%), ophiasis (13%), totalis (9%), and universalis (10%). Severity was determined by percentage of hair loss on the scalp and were divided into mild (30.2%), moderate (32.9%), and severe (36.9%). A total of 59 (20%) patients had abnormalities on thyroid testing results. In this group of patients, hypothyroidism was the most frequent finding 29 (49%), with Hashimoto thyroiditis being the most common cause(24 [41%]). Other abnormalities included hyperthyroidism secondary to Grave disease (12 [20%]) and subclinical thyroid dysfunction (7 [12%]). Whereas age, duration of disease, pattern of alopecia, and diagnosis of autoimmune diseases had no significant association with abnormal thyroid findings, a personal history of Down syndrome (P = .004), atopy (P = .009), and family history of thyroid disease (P = .001) did.
We recommend that routine thyroid function screening should be restricted to AA patients with a medical history of Down syndrome, personal history of atopy, a family history of thyroid disease, or clinical findings (goiter) suggestive of potential thyroid dysfunction in the individual patient.
儿童斑秃（AA）患者的甲状腺疾病发病率已被广泛研究，但目前尚无法确定 AA 是否与甲状腺疾病存在真正的关联。此外，AA 患儿甲状腺功能障碍的筛查实践在临床医生中差异很大。
为了降低医疗保健成本、避免不必要的检测，并规范临床实践，我们旨在研究 AA 患儿的甲状腺功能，以制定筛查指南。
设计、地点和参与者：这是一项单中心回顾性病历审查，在一家三级转诊医疗中心的门诊儿科皮肤科诊所进行，时间为 2008 年 1 月 1 日至 2016 年 1 月 1 日。研究纳入了 298 名（0-21 岁）接受临床诊断为 AA 并接受甲状腺功能检查的患者。
记录 AA 的发病年龄、疾病持续时间、严重程度、部位和类型。还记录了患者的既往病史和家族病史。实验室检测结果包括促甲状腺激素（促甲状腺激素）、游离 T4（FT4）、三碘甲状腺原氨酸（T3）、甲状腺过氧化物酶抗体（TPO-Abs）和甲状腺球蛋白抗体（Tg-Abs）。
在 8 年期间，对 298 名 AA 患者进行了甲状腺功能筛查。在进行甲状腺筛查的患者中，AA 模式包括斑片状（68%）、 ophiasis（13%）、 totalis（9%）和 universalis（10%）。严重程度根据头皮上脱发的百分比确定，分为轻度（30.2%）、中度（32.9%）和重度（36.9%）。共有 59 名（20%）患者的甲状腺检测结果异常。在这组患者中，最常见的是甲状腺功能减退症 29 例（49%），其中桥本甲状腺炎最常见（24 例[41%]）。其他异常包括格雷夫斯病引起的甲状腺功能亢进（12 例[20%]）和亚临床甲状腺功能障碍（7 例[12%]）。然而，年龄、疾病持续时间、脱发模式和自身免疫性疾病的诊断与异常甲状腺发现无显著相关性，但 Down 综合征病史（P=.004）、特应症病史（P=.009）和甲状腺疾病家族史（P=.001）与异常甲状腺发现相关。
我们建议，对于有 Down 综合征病史、特应症病史、甲状腺疾病家族史或个体临床发现（甲状腺肿）提示潜在甲状腺功能障碍的 AA 患者，应限制进行常规甲状腺功能筛查。
