Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Front Endocrinol (Lausanne). 2020 Apr 17;11:229. doi: 10.3389/fendo.2020.00229. eCollection 2020.
The incidence of autoimmune thyroid diseases (ATD) may vary with the beginning of reproductive function, although few reports differentiate the incidence before and during the onset of puberty, examining gender bias. We analyzed onset of ATD in a pediatric population to assess gender differences in onset age, disease subtype, pubertal status, autoimmune co-morbidity, family history and treatment, focusing on the interaction between gender and pubertal stage. We retrospectively recorded 382 children and adolescents with ATD. In each patient physical examination was considered. The presence of other associated autoimmune diseases (AAD) and familial predisposition was also recorded. Predominant prevalence was noted in females compared to males ( < 0.001), both in Hashimoto's diseases (HD or HT) and Graves' disease (GD) ( < 0.001). Mean age at diagnosis showed no significant difference between sexes ( > 0.05). A higher prevalence in pubertal subjects was noted compared to prepubertal ( < 0.001, particularly HT in early and GD in late pubertal stage), without sexes difference intra-(prepubertal vs. pubertal) and inter-puberty groups (prepubertal vs. early pubertal vs. late pubertal). Both in HT and in GD, the prevalence of autoimmune associated diseases (AAD) was higher in males compared to females ( = 0.04), with similar distribution according to the pubertal maturation. The familial predisposition was similarly distributed in both genders ( > 0.05) and into pubertal stages ( > 0.05). Females are more prone to develop ATD during puberty, earlier in HT than in GD. The effect of puberty is not different between genders, suggesting the role of additional factors other than hormones. The screening for detection of ATD is recommended in all patients with positive family history and other autoimmune diseases, mostly in males. Considerations of gender in pediatrics could be important to define pathogenic mechanisms of ATD and to help in early diagnosis and clinical management.
自身免疫性甲状腺疾病（ATD）的发病率可能因生殖功能的开始而有所不同，尽管很少有报道区分青春期前和青春期发病的发病率，并检查性别偏见。我们分析了儿科人群中 ATD 的发病情况，以评估发病年龄、疾病亚型、青春期状态、自身免疫合并症、家族史和治疗方面的性别差异，重点关注性别与青春期阶段的相互作用。我们回顾性记录了 382 名患有 ATD 的儿童和青少年。在每位患者中都进行了体格检查。还记录了其他相关自身免疫性疾病（AAD）和家族易感性的存在。与男性相比，女性的患病率更高（<0.001），无论是桥本甲状腺炎（HD 或 HT）还是格雷夫斯病（GD）（<0.001）。性别之间的诊断年龄无显著差异（>0.05）。与青春期前相比，青春期患者的患病率更高（<0.001，尤其是 HT 在青春期早期和 GD 在青春期晚期），青春期前与青春期内（青春期前与青春期）和青春期间（青春期前与青春期早期与青春期晚期）组之间无性别差异。在 HT 和 GD 中，男性自身免疫性相关疾病（AAD）的患病率均高于女性（=0.04），且根据青春期成熟度分布相似。家族易感性在两性中分布相似（>0.05），且在青春期各阶段分布相似（>0.05）。女性在青春期更容易患上 ATD，HT 比 GD 更早。性别之间青春期的影响没有差异，表明除了激素之外还有其他因素的作用。建议对有阳性家族史和其他自身免疫性疾病的所有患者进行 ATD 筛查，尤其是男性。在儿科中考虑性别因素可能对确定 ATD 的发病机制以及帮助早期诊断和临床管理很重要。
