Autoimmune Thyroid Disease
Autoimmune thyroid disease affects approximately 2% of the female population and 0.2% of the male population. Its overall prevalence peaks in adulthood, but it is also the most common etiology of acquired thyroid dysfunction in pediatrics. This chapter p
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Stephen A. Huang
Abstract
Autoimmune thyroid disease affects approximately 2% of the female population and 0.2% of the male population. Its overall prevalence peaks in adulthood, but it is also the most common etiology of acquired thyroid dysfunction in pediatrics. This chapter presents a summary of autoimmune thyroid disease, discussing first chronic autoimmune thyroiditis and then Graves’ disease, with an emphasis on their clinical management. Optimal quantities of thyroid hormone are critical to neurodevelopment and growth, and, by maintaining an appropriate index of suspicion, the clinician can often recognize thyroid dysfunction in its early stages. Keywords
Thyroid • Hypothyroidism • Hyperthyroidism • Autoimmune • Hashimoto’s disease • Graves’ disease • Thyroiditis
Autoimmune thyroid disease affects approximately 2% of the female population and 0.2% of the male population [1]. Its overall prevalence peaks in adulthood, but it is also the most common etiology of acquired thyroid dysfunction in pediatrics [2, 3]. This chapter presents a summary of autoimmune thyroid disease, discussing first chronic autoimmune thyroiditis and then Graves’ disease, with an emphasis on
S.A. Huang, M.D. (*) Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA e-mail: [email protected]
their clinical management. Optimal quantities of thyroid hormone are critical to neurodevelopment and growth, and, by maintaining an appropriate index of suspicion, the clinician can often recognize thyroid dysfunction in its early stages.
Chronic Autoimmune Thyroiditis The childhood prevalence of chronic autoimmune thyroiditis peaks in early to mid puberty, and a female preponderance of 2:1 has been reported [4]. Presentation is rare under the age of 3 years, but cases have been described even in infancy [5, 6].
S. Radovick and M.H. MacGillivray (eds.), Pediatric Endocrinology: A Practical Clinical Guide, Second Edition, Contemporary Endocrinology, DOI 10.1007/978-1-60761-395-4_16, © Springer Science+Business Media New York 2013
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S.A. Huang
276 Table 16.1 Classification of autoimmune thyroiditis Type 1 autoimmune thyroiditis (Hashimoto’s disease type 1) 1A Goitrous 1B Nongoitrous Status: Euthyroid with normal TSH Type 2 autoimmune thyroiditis (Hashimoto’s disease type 2) 2A Goitrous (classic Hashimoto’s disease) 2B Nongoitrous (primary myxoedema, atrophic thyroiditis) Status: Persistent hypothyroidism with increased TSH 2C Transient aggravation of thyroiditis (example postpartum thyroiditis) Status: May start as transient, low RAIU thyrotoxicosis, followed by transient hypothyroidism Type 3 autoimmune thyroiditis (Graves’ disease) 3A Hyperthyroid Graves’ disease 3B Euthyroid Graves’ disease Status: Hyperthyroid or euthyroid with suppressed TSH. Stimulatory autoantibodies to the TSH receptor are present (autoantibodies to thyroglobulin and TPO are also usually present) 3C Hypothyroid Graves’ disease Status: Orbitopathy with hypothyroidism. Diagnostic levels of autoantibodies to the TSH receptor (
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