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Deveci Sevim R, Gök M, Öztürk S, Çevik Ö, Erdoğan Ö, Güneş S, Ünüvar T, Anık A. Thyroid volume in Turkish school-age children living in an iodine-sufficient region. J Pediatr Endocrinol Metab 2024; 37:228-235. [PMID: 38366903 DOI: 10.1515/jpem-2023-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/12/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES We aimed to obtain local normative data on thyroid volume evaluated by ultrasonography and iodine status by measuring urine iodine levels in school-age children living in Aydın province. METHODS In this cross-sectional study, a sample comprising 1,553 cases was meticulously selected from a total cohort of 170,461 children aged 6-17, drawn from 21 distinct educational institutions located within the Aydın region, as participants in the investigation. Those with a known chronic disease or thyroid disease were excluded from the study. The children underwent physical examinations and ultrasonography imaging of the thyroid gland, and urine samples were collected to measure urinary iodine concentration (UIC). RESULTS The median UIC was 189.5 (IQR=134.4) μg/L, which was optimal according to WHO criteria. Thyroid volume was found to be 4.6 (IQR=3.5) mL in girls and 4.2 (IQR=4.0) mL in boys (p=0.883). The thyroid volumes in our study were found to be smaller when compared to the WHO. According to WHO age and body surface area criteria, thyroid volume was over 97 % in 0.9 % (n=15) of cases. Thyroid volume was found to have a positive correlation with age, height, weight, body mass index (BMI), and body surface area (BSA) in both genders (p<0.001). However, there was no significant correlation between thyroid volume and UIC. CONCLUSIONS This cross-sectional study provides normative data on thyroid volume and iodine status in school-age children in iodine-sufficient population, revealing a low prevalence of goiter and correlations between thyroid volume and anthropometric measures.
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Affiliation(s)
- Reyhan Deveci Sevim
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkiye
| | - Mustafa Gök
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkiye
- Research Affiliate in Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sercan Öztürk
- Department of Pediatrics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkiye
| | - Özge Çevik
- Department Biochemistry, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkiye
| | - Ömer Erdoğan
- Department Biochemistry, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkiye
| | - Sebla Güneş
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkiye
| | - Tolga Ünüvar
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkiye
| | - Ahmet Anık
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkiye
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Sarli WM, Ricci S, Lodi L, Cavone F, Pacillo L, Giancotta C, Ubertini G, Baroncelli G, Cancrini C, Azzari C, Stagi S. Risk of thyroid neoplasms in patients with 22q11.2 deletion and DiGeorge-like syndromes: an insight for follow-up. Front Endocrinol (Lausanne) 2023; 14:1209577. [PMID: 37635986 PMCID: PMC10450035 DOI: 10.3389/fendo.2023.1209577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The chromosome 22q11.2 deletion syndrome comprises phenotypically similar diseases characterized by abnormal development of the third and fourth branchial arches, resulting in variable combinations of congenital heart defects, dysmorphisms, hypocalcemia, palatal dysfunction, developmental or neuropsychiatric disorders, and impairment of the immune system due to thymic dysfunction. Other genetic syndromes, often called DiGeorge-like, share clinical and immunological features with 22q11.2 deletion syndrome. This syndrome has been rarely associated with malignancies, mainly hematological but also hepatic, renal, and cerebral. Rarely, malignancies in the head and neck region have been described, although no aggregate of data on the development of thyroid neoplasms in patients with this clinical phenotype has been conducted so far. Materials and methods To characterize this possible association, a multicenter survey was made. Thus, we present a case series of five pediatric patients with 22q11.2 deletion syndrome or DiGeorge-like syndrome who were occasionally found with confirmed or highly suspected neoplasms of the thyroid gland during their follow-up. In three cases, malignancies were histologically confirmed, but their outcome was good due to an early recognition of suspicious nodules and precocious surgery. Conclusions This study underlines for clinicians the higher risk of neoplasms in the head and neck district for patients affected by these syndromes. It also emphasizes the importance of a prolonged clinical and ultrasound follow-up for patients with this clinical and immunological phenotype.
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Affiliation(s)
- Walter Maria Sarli
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Lorenzo Lodi
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Federica Cavone
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lucia Pacillo
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Research Unit of Primary Immunodeficiency, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Carmela Giancotta
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Graziamaria Ubertini
- Unit of Endocrinology and Diabetology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giampiero Baroncelli
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Caterina Cancrini
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Research Unit of Primary Immunodeficiency, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, Florence, Italy
- Auxoendocrinology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
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Bako D, Kılavuz S, Yasin Köksoy A, Uzan Tatli Z, Beydogan E. A different approach to cystinosis: ultrasound, doppler, and shear wave elastography findings of thyroid gland. Orphanet J Rare Dis 2023; 18:173. [PMID: 37391835 DOI: 10.1186/s13023-023-02783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND While thyroid dysfunction develops in about 50% of untreated children with cystinosis, there is no data about how the sonography of thyroid tissue appears in this disease. Therefore, the purpose of this study was to assess the sonographic appearance, color doppler findings in this disease and to evaluate how cystine crystal accumulation affect tissue stiffness using shear wave elastography (SWE). METHODS Sixteen children diagnosed with cystinosis and a control group consisting of 34 healthy children were included in this study. B mode ultrasound, color doppler imaging and real-time SWE of thyroid tissue were performed. RESULTS Ultrasound imaging revealed lower echogenicity and diffuse heterogeneous echotexture in 7 of the 16 cystinosis patients. Thyroid gland volumes were lower in cystinosis patients (p 0.005). Doppler ultrasound demonstrated increased flow in 8 patients. On SWE, the thyroid tissue stiffness was established to be lower in patients compared to healthy children (p 0.003). CONCLUSIONS This is the first study evaluating thyroid gland B mode, color doppler ultrasonography, and SWE findings in cystinosis. Our findings indicate that cysteamine treatment still cannot completely prevent the disease infiltration process of thyroid gland. The other important finding-that thyroid tissue stiffness was established to be lower than that of the controls-also demonstrates the ongoing disease infiltration process.
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Affiliation(s)
- Derya Bako
- Department of Pediatric Radiology, Van Regional Training and Research Hospital, Van, Turkey.
| | - Sebile Kılavuz
- Department of Pediatric Pediatric Metabolism and Nutrition, Van Regional Training and Research Hospital, Van, Turkey
| | - Adem Yasin Köksoy
- Department of Pediatric Pediatric Nephrology, Van Regional Training and Research Hospital, Van, Turkey
| | - Zeynep Uzan Tatli
- Department of Pediatric Pediatric Endocrinology, Zeynep Uzan Tatli, Van Regional Training and Research Hospital, Van, Turkey
| | - Engin Beydogan
- Department of Radiology, Van Regional Training and Research Hospital, Van, Turkey
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Koca SB, Seber T. Factors Affecting Thyroid Elastography in Healthy Children and Patients with Hashimoto’s Thyroiditis. J Clin Res Pediatr Endocrinol 2023; 15:7-15. [PMID: 35984228 PMCID: PMC9976168 DOI: 10.4274/jcrpe.galenos.2022.2022-4-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Hashimoto’s thyroiditis (HT) is the most common form of thyroiditis in childhood. In addition to thyroid ultrasonography, shear-wave elastography (SWE) can evaluate thyroid parenchyma tissue stiffness, and more detailed findings can be obtained with this method. We aimed to evaluate the relationship between SWE values and clinical, biochemical and hormonal parameters of patients with HT and in healthy individuals. METHODS We compared 46 newly diagnosed HT cases with 46 healthy controls. We examined the effect of all metabolic parameters and thyroid-related markers on SWE values. RESULTS The mean SWE values in those patients with euthyroid HT were 12.5±5.1 kilopascal (kPa), whereas it was 8.2±2.82 kPa in healthy controls (p<0.001). Although the clinical [age, gender and body mass index (BMI)] and laboratory parameters (such as thyroid function tests, homeostasis model assessment of insulin resistance, insulin-like growth factor-1 values, which we think may affect SWE scores) of those children with HT and the healthy controls were statistically similar (p>0.05), except for their thyroid autoantibodies and thyroglobulin, SWE values and thyroid volume were significantly higher in those individuals with HT (p<0.001). Multiple linear regression analysis was performed to evaluate the direction and degree of the effect of the variables on thyroid elasticity scores. It was observed that age (p=0.002), BMI standard deviation score (SDS) (p=0.04) and anti-thyroid peroxidase (p=0.008) levels were effective on the thyroid elasticity score in the regression model. We detected a SWE cut-off value of 9.68 kPa with 68% sensitivity and 72% specificity, a 70% positive predictive value, and a 69% negative predictive value in thyroid elastography when differentiating between cases with HT and healthy controls. CONCLUSION Our results show that no metabolic factor other than BMI SDS has any effect on SWE scores, especially in healthy children. There was a positive correlation between BMI SDS and SWE in healthy children (r=0.353; p=0.02), but not in those patients with HT (r=0.196; p=0.19). Likewise, age is another factor affecting SWE only in healthy children. We do not recommend routine evaluation of any laboratory parameters other than thyroid functions before thyroid elastography.
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Affiliation(s)
- Serkan Bilge Koca
- University of Health Sciences Turkey, Kayseri City Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Kayseri City Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey Phone: +90 537 320 56 41 E-mail:
| | - Turgut Seber
- University of Health Sciences Turkey, Kayseri City Hospital, Clinic of Radiology, Division of Pediatric Radiology, Kayseri, Turkey
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Ultrasound determination of pediatric thyroid mass. Pediatr Radiol 2023; 53:28-33. [PMID: 35881167 DOI: 10.1007/s00247-022-05450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/01/2022] [Accepted: 06/30/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Radioiodine therapy for Graves disease can be achieved with dosing based on estimated thyroid gland mass. Thyroid mass can be estimated using linear ultrasound measurements, and conversion factors for volume and density. The choice of conversion factors could impact estimated thyroid mass and thus administered radioiodine dose. OBJECTIVE The objective of this study was to define the relationship between thyroid mass estimated by ultrasound and measured thyroid mass following thyroidectomy. MATERIALS AND METHODS This was a retrospective, exempt study that included patients < 18 years of age with < 6 months between thyroid ultrasound and thyroidectomy January 2010-June 2020. Thyroid dimensions by ultrasound, thyroid mass at thyroidectomy and histopathological diagnosis were collected. Published conversion factors were used to estimate thyroid volume with conversion to mass using a density of 1.05 g/cm3. Pearson correlations and Bland-Altman difference analyses were used to define the relationship between estimated mass and specimen weight. Linear regression was used to calculate an optimal conversion factor for estimating thyroid mass. RESULTS We included 86 patients, 67 female (78%), with a mean age of 14.5 ± 3.15 years. Mass estimated using all tested conversion factors had similar strong, positive correlation with specimen weight (r = 0.95). The mean difference between thyroid mass estimated by ultrasound and measured mass ranged from - 0.34 g (conversion factor = 0.523) to 1.69 g (conversion factor = 0.554). The optimal simplified factor for estimation of thyroid mass for the study sample was 0.537. CONCLUSION All published conversion factors for estimating thyroid mass based on linear ultrasound measurements produce good estimates of thyroid mass. Errors in estimated mass are less than 2 g on average.
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Lee MK, Na DG, Joo L, Lee JY, Ha EJ, Kim JH, Jung SL, Baek JH. Standardized Imaging and Reporting for Thyroid Ultrasound: Korean Society of Thyroid Radiology Consensus Statement and Recommendation. Korean J Radiol 2023; 24:22-30. [PMID: 36606617 PMCID: PMC9830140 DOI: 10.3348/kjr.2022.0894] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 01/03/2023] Open
Abstract
Ultrasonography (US) is a primary imaging modality for diagnosing nodular thyroid disease and has an essential role in identifying the most appropriate management strategy for patients with nodular thyroid disease. Standardized imaging techniques and reporting formats for thyroid US are necessary. For this purpose, the Korean Society of Thyroid Radiology (KSThR) organized a task force in June 2021 and developed recommendations for standardized imaging technique and reporting format, based on the 2021 KSThR consensus statement and recommendations for US-based diagnosis and management of thyroid nodules. The goal was to achieve an expert consensus applicable to clinical practice.
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Affiliation(s)
- Min Kyoung Lee
- Department of Radiology, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea.
| | - Leehi Joo
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Paik C, Osterbauer B, Sahyouni G, Park S, Gomez G, Kwon D, Austin J. Thyroid tumor ratio: Improving the assessment of the impact of size in pediatric thyroid cancer. Head Neck 2022; 44:1342-1348. [PMID: 35322489 DOI: 10.1002/hed.27029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The impact of thyroid nodule size is less useful in children who have smaller thyroid volumes than in adults. We investigate using a novel thyroid tumor ratio measurement in children with thyroid cancer. METHODS Patient and pathologic characteristics were investigated via Student's t-test in a univariate analysis for any correlation with the log-transformed tumor ratio, followed by a multivariate linear regression. RESULTS Of 75 patients with malignancy and tumor ratio information, mean ratio decreased with increasing age (p = 0.04). Out of several clinical factors, patients with lymph node metastases and those treated with postoperative radioactive iodine had significantly higher mean tumor ratios on multivariate analysis (p = 0.04 for both factors). CONCLUSIONS Our study is the first to describe thyroid tumor volume in pediatric thyroid cancer and shows that increased tumor ratio was associated with indicators of more advanced disease such as lymph node metastases and use of radioactive iodine.
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Affiliation(s)
- Connie Paik
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Beth Osterbauer
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Grace Sahyouni
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Soyun Park
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Gabriel Gomez
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Daniel Kwon
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Juliana Austin
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
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Acar S, Gürsoy S, Arslan G, Nalbantoğlu Ö, Hazan F, Köprülü Ö, Özkaya B, Özkan B. Screening of 23 candidate genes by next-generation sequencing of patients with permanent congenital hypothyroidism: novel variants in TG, TSHR, DUOX2, FOXE1, and SLC26A7. J Endocrinol Invest 2022; 45:773-786. [PMID: 34780050 DOI: 10.1007/s40618-021-01706-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/07/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To date, many genes have been associated with congenital hypothyroidism (CH). Our aim was to identify the mutational spectrum of 23 causative genes in Turkish patients with permanent CH, including thyroid dysgenesis (TD) and dyshormonogenesis (TDH) cases. METHODS A total of 134 patients with permanent CH (130 primary, 4 central) were included. To identify the genetic etiology, we screened 23 candidate genes associated with CH by next-generation sequencing. For confirmation and to detect the status of the specific familial variant in relatives, Sanger sequencing was also performed. RESULTS Possible pathogenic variants were found in 5.2% of patients with TD and in 64.0% of the patients with normal-sized thyroid or goiter. In all patients, variants were most frequently found in TSHR, followed by TPO and TG. The same homozygous TSHB variant (c.162 + 5G > A) was identified in four patients with central CH. In addition, we detected novel variants in the TSHR, TG, SLC26A7, FOXE1, and DUOX2. CONCLUSION Genetic causes were determined in the majority of CH patients with TDH, however, despite advances in genetics, we were unable to identify the genetic etiology of most CH patients with TD, suggesting the effect of unknown genes or environmental factors. The previous studies and our findings suggest that TSHR and TPO mutations is the main genetic defect of CH in the Turkish population.
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Affiliation(s)
- S Acar
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey.
| | - S Gürsoy
- Division of Pediatric Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - G Arslan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - Ö Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - F Hazan
- Department of Medical Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Ö Köprülü
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - B Özkaya
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - B Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
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Saydam BO, Adiyaman S, Demir T, Comlekci A, Yener S. THE USE OF LOW DOSE PREDNISOLONE IN PATIENTS WITH SUBACUTE THYROIDITIS AND ITS EFFECT ON IMPAIRED LIFE AND SLEEP QUALITY. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2022; 18:64-73. [PMID: 35975250 PMCID: PMC9365404 DOI: 10.4183/aeb.2022.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Subacute thyroiditis is an inflammatory thyroid disease, which is treated by nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids. OBJECTIVE Defining characteristics of patients with subacute thyroiditis at diagnosis and during follow-up. Investigating the efficacies of NSAID and different doses of steroids and their effects on rates of relapse, recurrence, development of hypothyroidism and on quality of life and sleep parameters. DESIGN A 3-year observational study in a tertiary referral center. SUBJECTS AND METHODS A total of 63 patients with subacute thyroiditis were included. Clinical outcomes of patients treated with NSAIDs and NSAID unresponsive patients treated with prednisolone with initial doses of 0.5 mg/kg/day and 15 mg/day were evaluated. RESULTS White blood cell count at diagnosis was an independent predictor of NSAID unresponsiveness. No relapse or recurrence was observed in patients receiving low dose of steroids. Long symptom duration until diagnosis and treatment with NSAIDs were associated with development of hypothyroidism. Subacute thyroiditis caused significant deterioration in quality of life and sleep of patients and low dose of steroid was as effective as higher doses in improving these parameters. CONCLUSIONS For patients with no response to NSAID therapy, an initial low dose of prednisolone (15 mg/day) is determined as a safe treatment method when dose reduction is performed with appropriate timing.
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Affiliation(s)
- B. Ozgen Saydam
- “Dokuz Eylul” University, Faculty of Medicine, Division of Endocrinology and Metabolism, Izmir, Turkey
| | - S.C. Adiyaman
- “Dokuz Eylul” University, Faculty of Medicine, Division of Endocrinology and Metabolism, Izmir, Turkey
| | - T. Demir
- “Dokuz Eylul” University, Faculty of Medicine, Division of Endocrinology and Metabolism, Izmir, Turkey
| | - A. Comlekci
- “Dokuz Eylul” University, Faculty of Medicine, Division of Endocrinology and Metabolism, Izmir, Turkey
| | - S. Yener
- “Dokuz Eylul” University, Faculty of Medicine, Division of Endocrinology and Metabolism, Izmir, Turkey
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Guo W, Tan L, Dong S, Jin Y, Zhu M, Wei H, Chen Y, Fan L, Du C, Zhang W. New Reference Values for Thyroid Volume and a Comprehensive Assessment for Influencing Factors in Chinese Adults with Iodine Sufficiency. Eur Thyroid J 2021; 10:447-454. [PMID: 34956917 PMCID: PMC8647106 DOI: 10.1159/000513494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The reference values for thyroid volume (Tvol) determined by ultrasound require supportive data of normal Tvol from local iodine-sufficient populations. This study aimed to explore new reference values for Tvol in Chinese adults and comprehensively evaluate the factors associated with enlarged Tvol. METHODS A cross-sectional study was conducted in Tianjin, China. Tvol was measured by ultrasound in adults with long-term iodine sufficiency. Blood and urine samples were collected to evaluate biochemical indexes, thyroid function, and iodine status. RESULTS A total of 1,991 adults from the urban and suburban areas were analysed. The trend of Tvol increasing with age was observed in men under age 40 years and in women under age 52 years. In the quantile regression analyses, we found that body surface area (BSA) (β = 7.22, 95% CI: 5.33, 9.12), thyroid-stimulating hormone (TSH) (β = -1.48, 95% CI: -2.39, -0.57), thyroid nodules (TNs) (β = 6.70, 95% CI: 2.19, 11.22), and metabolic syndrome (MetS) (β = 1.40, 95% CI: 0.63, 2.17) had a strong effect on Tvol at higher percentiles in males. The dominant factors influencing Tvol were BSA (β = 9.64, 95% CI: 2.66, 16.61), TSH (β = -0.78, 95% CI: -1.16, -0.39), and TNs (β = 1.11, 95% CI: 0.43, 1.79) in females. The largest reference values for Tvol based on BSA were 20.18 (17.79, 24.32) mL in males and 15.31 (14.05, 16.70) mL in females. CONCLUSIONS Quantile regression analyses showed that a high BSA index, a decreased TSH level, and the prevalence of TNs were essential factors associated with the enlargement of the thyroid gland. Our findings reported the new reference values for Tvol determined by ultrasound based on gender and BSA in Chinese adults.
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Affiliation(s)
- Wenxing Guo
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Long Tan
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shuyao Dong
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ya Jin
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Mei Zhu
- The Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyan Wei
- The Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanting Chen
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lili Fan
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Cong Du
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wanqi Zhang
- The Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
- The Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
- *Wanqi Zhang,
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11
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Cordes M, Coerper S, Kuwert T, Schmidkonz C. Ultrasound Imaging of Cervical Anatomic Variants. Curr Med Imaging 2021; 17:966-972. [PMID: 33504311 PMCID: PMC8653420 DOI: 10.2174/1573405617666210127162328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Embryologic developmental variants of the thyroid and parathyroid glands may cause cervical anomalies that are detectable in ultrasound examinations of the neck. For some of these developmental variants, molecular genetic factors have been identified. Ultrasound, as the first-line imaging procedure, has proven useful in detecting clinically relevant anatomic variants. The aim of this article was to systematically summarize the ultrasound characteristics of developmental variants of the thyroid and parathyroid glands as well as ectopic thymus and neck cysts. Quantitative measures were developed based on our findings and the respective literature. Developmental anomalies frequently manifest as cysts that can be detected by cervical ultrasound examinations. Median neck cysts are the most common congenital cervical cystic lesions, with a reported prevalence of 7% in the general population. Besides cystic malformations, developmental anomalies may appear as ectopic or dystopic tissue. Ectopic thyroid tissue is observed in the midline of the neck in most patients and has a prevalence of 1/100,000 to 1/300,000. Lingual thyroid accounts for 90% of cases of ectopic thyroid tissue. Zuckerkandl tubercles (ZTs) have been detected in 55% of all thyroid lobes. Prominent ZTs are frequently observed in thyroid lobes affected by autoimmune thyroiditis compared with normal lobes or nodular lobes (P = 0.006). The correct interpretation of the ultrasound characteristics of these variants is essential to establish the clinical diagnosis. In the preoperative assessment, the identification of these cervical anomalies via ultrasound examination is indispensable.
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Affiliation(s)
- Michael Cordes
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Germany
| | - Stephan Coerper
- Klinik für Chirurgie, Martha-Maria-Krankenhaus, Nürnberg, Germany
| | - Torsten Kuwert
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Germany
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12
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Çolak E, Özkan B, Genç S, Polat B. Ultrasonographic determination of thyroid volume in infants and children from Aegean region of Turkey and comparison with national and international references. J Pediatr Endocrinol Metab 2021; 34:457-464. [PMID: 33626602 DOI: 10.1515/jpem-2020-0514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/25/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Accurate diagnosis and follow-up of pediatric patients with thyroid disorders, depends on the availability of appropriate data for normal thyroid volume (TV). The aim of this study was to determine the TV by ultrasonography (US) in subjects from the newborn period up to 18 years of age from the Aegean region of Turkey. METHODS We measured the thyroid volumes in 513 children using US and compared them with the children's age, gender, standard deviation score (SDS) of body height (BH-SDS), body weight (BW-SDS), body mass index (BMI-SDS), and body surface area (BSA-SDS). The 3rd, 50th, and 97th percentiles of the age-dependent distribution of the TV were calculated and compared with national and international references. RESULTS The BH, BW, BMI, and BSA of all the participants were within the normal ranges for Turkish children. The TV was significantly positively correlated with age, gender, BH-SDS, BW-SDS, BMI-SDS, and BSA-SDS in all subjects (r=0.748, r=0.267, r=0.730, r=0.735, r=0.664 and r=0.735, respectively; p<0.0001 for all). The most important predictors for TV were age and BW-SDS, followed by BSA-SDS and BH-SDS. In multivariate regression, age and BW-SDS were the only significant independent predictors for TV. Our results were nearly similar to the corresponding data reported by the World Health Organisation in 2004. CONCLUSIONS The present study provides updated values for TV that can serve as a potential tool in differentiating the normal from the abnormal size of the thyroid gland in children aged 0-18 years from the Aegean region of Turkey.
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Affiliation(s)
- Edis Çolak
- Department of Radiology, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Behzat Özkan
- Department of Pediatric Endocrinology and Metabolism, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Sinan Genç
- Department of Pediatric Radiology, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Burak Polat
- Department of Radiology, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
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13
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de Souza LRMF, Sedassari NDA, Dias EL, Dib FCM, Palhares HMC, da Silva AP, Tomé JM, Borges MDF. Ultrasound measurement of thyroid volume in euthyroid children under 3 years of age. Radiol Bras 2021; 54:94-98. [PMID: 33854263 PMCID: PMC8029934 DOI: 10.1590/0100-3984.2020.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective To establish ultrasound reference values for thyroid volumes in children up to 3 years of age, given that ultrasound of the thyroid is an essential examination in the diagnosis of childhood thyroid disease. Materials and Methods This was a prospective study conducted in an iodine-sufficient city in southeastern Brazil. A total of 100 healthy children underwent clinical evaluation, anthropometric examination, and cervical ultrasound in accordance with conventional protocols. We evaluated characteristics such as echotexture, thyroid lobe volume, and total thyroid volume. The children were divided into five groups, by age: < 2 months; 2-12 months; 12-18 months; 18-24 months; and 24-36 months. Results The mean thyroid volume was lower in the < 2 month age group than in the other groups (0.4 mL vs. 0.18-0.70 mL; p < 0.001). For the subjects between 2 and 36 months of age, the mean volume was 1.0 mL (range, 0.30-2.0 mL). No other significant differences were observed between groups, thyroid lobes, or gender. However, body mass index correlated significantly with total thyroid volume (r = 0.347; p = 0.001). Conclusion The mean thyroid dimensions were smallest in the < 2 month age group (0.35 ± 0.16 mL). For the subjects between 2 and 36 months of age, a reference value of 0.85 ± 0.42 mL can be used. Our data could guide the diagnostic investigation of thyroid disease, especially congenital hypothyroidism, in childhood.
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Chun S, Lee YS, Yu J. Thyroid imaging study in children with suspected thyroid dysgenesis. Ann Pediatr Endocrinol Metab 2021; 26:53-59. [PMID: 33819958 PMCID: PMC8026338 DOI: 10.6065/apem.2040120.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/27/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Thyroid dysgenesis is one of the most common causes of permanent congenital hypothyroidism. Thyroid ultrasonography or scan is used to detect thyroid dysgenesis. We analyzed the sensitivity and specificity of thyroid ultrasonography and scan in diagnosing thyroid dysgenesis to determine the clinical utility of each thyroid imaging method. METHODS Sixty-one patients younger than 7 years of age were investigated via thyroid scan. Nineteen patients who were initially interpreted as having thyroid dysgenesis, such as ectopia, hemiagenesis, or aplasia, by thyroid scan were included in the study. Clinical characteristics and findings of a thyroid imaging study were reviewed. RESULTS Initially, thyroid scan results were interpreted as ectopia (n=9), hemiagenesis (n=1), and nonvisualization (n=9). In contrast, the results of thyroid ultrasonography were normal thyroid gland (n=5), ectopia (n=6), and hypoplasia (n=8). After reviewing the results of both studies, final imaging diagnoses were as follows: normal thyroid gland (n=5), hemiagenesis (n=1), ectopia (n=9) including 2 dual ectopy, hypoplasia (n=3), and aplasia (n=1). Thyroid ultrasonography showed higher sensitivity and specificity in detecting presence of normal thyroid gland. Thyroid scan was better to detect ectopia. Among 8 patients who were initially interpreted as having hypoplasia by ultrasonography, 4 were confirmed as ectopia and one as aplasia. CONCLUSION This study showed that thyroid ultrasonography is useful as the first-line imaging study to detect normal-sized eutopic thyroid gland. Thyroid scan should be performed to investigate the presence of ectopia if hypoplasia or aplasia is suspected by ultrasonography.
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Affiliation(s)
- Sangwoo Chun
- Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Young Seok Lee
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jeesuk Yu
- Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea,Address for correspondence: Jeesuk Yu Department of Pediatrics, Dankook Universit y Hospital, Dank ook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea
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15
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Pediatric thyroid ultrasound: a radiologist's checklist. Pediatr Radiol 2020; 50:563-574. [PMID: 32166365 DOI: 10.1007/s00247-019-04602-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/26/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
Ultrasonography (US) is the imaging method of choice for evaluating the pediatric thyroid gland, complemented by scintigraphy and thyroid function tests, especially when evaluating children with suspected congenital hypothyroidism, goiter, infectious or autoimmune diseases, or neoplasm. Diagnostic considerations in newborns with congenital hypothyroidism mainly include dysgenesis, dyshormonogenesis, transient hypothyroidism and central (hypophyseal) hypothyroidism. The midline of the neck should be scrutinized for thyroid tissue from the floor of the mouth to the thoracic inlet. Cystic and echogenic ultimobranchial remnants should not be misinterpreted as orthotopic thyroid tissue. Diffuse thyroid diseases affect older children; these comprise Hashimoto and Graves diseases and infectious thyroiditis and exhibit features similar to those in adults. It is important to note that the diffuse sclerosing variant of papillary thyroid cancer can complicate thyroiditis and should not be confused with Hashimoto disease. In children with solid nodules the threshold for fine-needle aspiration biopsy or surgery should be lower compared to adults because of a higher likelihood of malignancy compared with adults. Biopsy should be considered in nodules with suspicious ultrasonographic features, even when smaller than 1 cm. Adult classification systems of thyroid nodules, although useful, are not sufficient to safely discriminate the nodules' likelihood of malignancy in children. We describe key sonographic findings and suggest a standard checklist that might be considered while performing and interpreting thyroid US in neonates and children.
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16
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Azak E, Uçaktürk SA, Çetin İİ, Gürsu HA, Mengen E, Pamuk U. Subclinical Myocardial Dysfunction Demonstrated by Speckle Tracking Echocardiography in Children with Euthyroid Hashimoto’s Thyroiditis. J Clin Res Pediatr Endocrinol 2019; 11:410-418. [PMID: 31218876 PMCID: PMC6878337 DOI: 10.4274/jcrpe.galenos.2019.2018.0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/19/2019] [Indexed: 12/01/2022] Open
Abstract
Objective Thyroid hormones have an important role in the regulation of the cardiovascular system. The aim of this study was to investigate the presence of subclinical myocardial dysfunction in children with euthyroid Hashimoto’s thyroiditis (eHT) without evident heart disease using tissue doppler imaging (TDI) and speckle tracking echocardiography (STE) methods. Methods TDI and STE were peformed in 50 children with eHT and in 35 healthy children. To assess myocardial velocities and time intervals, including peak systolic velocity (Sm), peak early diastolic velocity (Em), peak late diastolic velocity (Am), isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT) and ejection time (ET), TDI was performed at the base of the interventricular septum (IVS) and in the left and right ventricles (LV and RV, respectively). Analysis of myocardial deformation by STE including strain (S) and strain rate (SR) was performed globally in two planes, longitudinal (L) and mid-circumferential (C) in LV [LV global longitudinal strain (LVGLS), LV global longitudinal strain rate (LVGLSR), LV global circumferential strain (LVGCS), LV global circumferential strain rate (LVGCSR)] and RV [(RV global longitudinal strain (RVGLS), RV global longitudinal strain rate (RVGLSR)]. Results Among TDI parameters, ET at LV and IVS were significantly lower, IVRT and myocardial performance index at LV and IVS were significantly higher in the eHT group compared to controls (p=0.001). There were no significant differences in Sm, Em, Am and IVCT values between patients and controls. LVGLS, LVGLSR, LVGCS and LVGCSR values were significantly lower in patients than controls (p=0.01). There was a negative correlation between thyroid antibody levels and LV global longitudinal and circumferential strain and strain rate values (TPO-Ab and Tg-Ab between LVGLS, LVGLSR, LVGCS and LVGCSR; r=-411, p<0.001; r=-541, p<0.001; r=-430, p<.0.001; r=-502, r<0.01 and r=-397, p<0.001; r=-473, p<0.001; r=-519, p<0.001; r=-421, p<0.00, respectively). Conclusion The results show that myocardial function in children with eHT is impaired in the absence of any clinical symptoms and that conventional echocardiography is inadequate to determine these changes.
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Affiliation(s)
- Emine Azak
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Seyit Ahmet Uçaktürk
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - İbrahim İlker Çetin
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Hazım Alper Gürsu
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Eda Mengen
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Utku Pamuk
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
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Johnson A, Edwards C, Reddan T. A review of sonographic thyroid volume and iodine sufficiency in children: An Australian perspective. Australas J Ultrasound Med 2019; 23:33-38. [PMID: 34760580 DOI: 10.1002/ajum.12189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sonographic measurement of the thyroid gland volume is a safe and reliable method for epidemiologic studies in iodine deficiency disorders. Several factors such as age, sex and anthropometric characteristics are known to be the determinants of thyroid gland size but the most widely studied is the effect of insufficient iodine intake. Low iodine intake induces enlargement of the thyroid gland known as goitre. The assessment of urinary iodine concentration alone is not reliable as it can vary daily within individuals. Urinary iodine concentration in conjunction with sonographic thyroid gland measurements is a widely used method of thyroid gland assessment. Establishment of normative thyroid volume is essential for the assessment of iodine deficiency disorders, and studies have been conducted in several countries. These studies have shown that thyroid gland volumes are likely population-specific even in iodine-sufficient countries limiting the effectiveness of international reference ranges. Based on currently available data of sonographic thyroid gland volume measurements and how they vary across populations of school children, this review argues for the establishment of population-specific reference ranges in regions such as Australia, which are now considered iodine-sufficient.
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Affiliation(s)
- Ayaka Johnson
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane Queensland 4000 Australia
| | - Christopher Edwards
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane Queensland 4000 Australia
| | - Tristan Reddan
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane Queensland 4000 Australia.,Medical Imaging and Nuclear Medicine Queensland Children's Hospital South Brisbane Queensland 4101 Australia
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18
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TUNÇ S, KÖPRÜLÜ Ö, ORTAÇ H, NALBANTOĞLU Ö, DİZDARER C, DEMİR K, ÖZKAN B. Long-term monitoring of Graves’ disease in children and adolescents: a single-center
experience. Turk J Med Sci 2019; 49:464-471. [PMID: 30862149 PMCID: PMC7018247 DOI: 10.3906/sag-1804-177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim Graves’ disease (GD) is more severe, requires a more complex treatment, and has a lower probability of achieving
remission in children than in adults. There is no consensus on the appropriate duration of antithyroid drug (ATD) treatment. Surgical
or radioactive iodine (RAI) treatments are not definitive and generally result in permanent hypothyroidism. This study’s goal was
examining the effectiveness of ATD treatment in children and adolescents with GD and determining the risk factors of remission and
relapse. Materials and methods This retrospective study included 45 patients (36 females and 9 males, median age 12.5 years) aged 4–18 who
were diagnosed with GD between 2003 and 2017. All patients initially were treated with an ATD. ATD treatment was discontinued at a
mean of 23.2 ± 13.2 months (10–37 months). Results Patients were classified into remission (n = 24) and relapse groups (n = 21). The duration of initial ATD treatment in the
remission group was longer (26.91 ± 5.17 months) than in the relapse group (19.09 ± 7.14 months) (P = 0.01). The total ATD treatment
duration was statistically longer in the remission group (42.14 ± 14.35 months) than in the relapse group (26.95 ± 16.13 months) (P =
0.03). Conclusion Long-term initial ATD treatment and long-term total ATD treatment were evaluated as positive parameters for the
remission of Graves’ disease in children and adolescents. Our findings showed that the chance of long-term remission increases in direct
proportion to the initial ATD treatment duration and the total ATD treatment duration.
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Affiliation(s)
- Selma TUNÇ
- Clinic of Pediatric Endocrinology, Dr. Behçet Uz Children’s Hospital, İzmirTurkey,* To whom correspondence should be addressed. E-mail:
| | - Özge KÖPRÜLÜ
- Clinic of Pediatric Endocrinology, Dr. Behçet Uz Children’s Hospital, İzmirTurkey
| | - Hatice ORTAÇ
- Department of Biostatistics, Faculty of Medicine, Dicle University, DiyarbakırTurkey
| | - Özlem NALBANTOĞLU
- Clinic of Pediatric Endocrinology, Dr. Behçet Uz Children’s Hospital, İzmirTurkey
| | - Ceyhun DİZDARER
- Clinic of Pediatric Endocrinology, Dr. Behçet Uz Children’s Hospital, İzmirTurkey
| | - Korcan DEMİR
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Behzat ÖZKAN
- Clinic of Pediatric Endocrinology, Dr. Behçet Uz Children’s Hospital, İzmirTurkey
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Sea JH, Ji H, You SK, Lee JE, Lee SM, Cho HH. Age-dependent reference values of the thyroid gland in pediatric population; from routine computed tomography data. Clin Imaging 2019; 56:88-92. [PMID: 31026683 DOI: 10.1016/j.clinimag.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate age-dependent reference values for measurements of the thyroid gland in pediatric patients. METHOD In total 425 chest and neck computed tomography images of pediatric patients without pathology of the thyroid gland were retrospectively reviewed. Measurements of the thyroid gland were obtained in three dimensions (width, depth, length). The total volume was the sum of volumes of each lobe. Measurements were compared among the six groups according to age from 0 to 18 years. RESULTS There were moderate to strong positive linear correlations between age and all values (r = 0.58-0.82, all p < 0.001). The total volume of the thyroid gland showed a strong positive linear correlation with the three linear measurements of each lobe (all r > 0.7, all p < 0.001). Among these measurements, the depth of the right lobe showed the highest Pearson correlation coefficient with the total volume of the thyroid gland (r = 0.859). CONCLUSION The depth of right lobe could be a representative measurement of total thyroid gland volume, similar to prior findings in adults.
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Affiliation(s)
- Jin Hee Sea
- Department of Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Hye Ji
- Department of Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea; Department of Radiology, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Jeong-Eun Lee
- Department of Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea; Department of Radiology, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - So Mi Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea
| | - Hyun-Hae Cho
- Department of Radiology, Ewha Womans University Mokdong Hospital, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
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Viduetsky A, Herrejon CL. Sonographic Evaluation of Thyroid Size: A Review of Important Measurement Parameters. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318824290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
An accurate evaluation of thyroid volume, in patients of all ages, is important for the correct diagnosis of a goiter and for sonographic monitoring of thyroid diseases. It is especially important in pediatrics because the linear measurements of a developing thyroid gland do not correlate well with age, sex, or body composition variables. Diverse methods are used to estimate thyroid size and volume. Sonographic volumetry and visual inspection and palpation are used to evaluate the thyroid. Although thyroid size can be easily assessed on physical examination, due to the superficial location of the gland, palpation has low sensitivity and specificity for the management and diagnosis of thyroid disorders. Therefore, thyroid volume measured sonographically is more accurate than thyroid size assessed with a physical examination. Imprecise calculation of thyroid size and volume may lead to false-positive or false-negative diagnoses of thyromegaly, which may result in unnecessary or delayed care.
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Affiliation(s)
- Alexander Viduetsky
- Beverly Tower Wilshire Advanced Imaging Center, Ultrasound Department, Beverly Hills, CA, USA
| | - Christi Lauve Herrejon
- Beverly Tower Wilshire Advanced Imaging Center, Ultrasound Department, Beverly Hills, CA, USA
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21
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Idigo FU, Okon IE, Okeji MC, Anakwue AMC. Normative Thyroid Volume by Ultrasonography in a Nigerian Pediatric Population. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318793859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective was to establish normal thyroid volume in healthy infants and children, in a select Nigerian population. Using a portable ultrasound equipment with a 7.5-MHz transducer, 500 apparently healthy pediatric patients were sonographically evaluated. The volume for each thyroid lobe was obtained, as well as the summation of both left and right thyroid volumes, which represented the total volume. The mean and median thyroid volumes for the subgroups were 0.69 ± 0.38 cm3/0.7 cm3 (<1 year), 1.50 ± 0.68 cm3/1.4 cm3 (1–5 years), 2.75 ± 0.94 cm3/2.6 cm3 (6–10 years), 4.47 ± 2.83 cm3/3.7 cm3 (11–15 years), and 7.47 ± 4.81 cm3/5.9 cm3 (16 and 17 years). There was a significant difference ( P = .000) between the population studied and the World Health Organization/International Council for Control of Iodine Deficiency Disorders reference values. The baseline values derived for thyroid dimensions may form the basis for thyroid screening in these asymptomatic children.
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Affiliation(s)
| | - Ime Edet Okon
- Radiology Department, University of Uyo Teaching Hospital Uyo, Akwa Ibom State, Nigeria
| | - Mark Chukwudi Okeji
- Department of Medical Radiography and Radiological Sciences, University of Nigeria, Enugu Campus, Nigeria
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Andrade Luz I, Pereira T, Catorze N. Thyroid storm: a case of haemodynamic failure promptly reversed by aggressive medical therapy with antithyroid agents and steroid pulse. BMJ Case Rep 2018; 11:11/1/e226669. [PMID: 30567262 DOI: 10.1136/bcr-2018-226669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hyperthyroidism is a common metabolic disorder, although its presentation as an endocrine emergency called thyroid storm is rare. Here we review a case of a thyroid storm as the initial presentation of thyrotoxicosis, with multiple organ failure and haemodynamic collapse due to low-output cardiac dysfunction. Quick intervention with aggressive antithyroid therapy, including steroid pulse, and supportive intensive care measures led to an outstanding improvement and full recovery. The present case clearly shows the beneficial impact of initial clinical suspicion resulting in an early diagnosis and intensive therapy. Moreover, it supports the additional role of steroids to aggressive antithyroid strategy in order to control associated deleterious systemic inflammatory reactions.
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Affiliation(s)
- Ivan Andrade Luz
- Nephrology, Centro Hospitalar do Médio Tejo EPE, Unidade de Torres Novas, Torres Novas, Santarém, Portugal
| | - Tiago Pereira
- Intensive Care Unit, Centro Hospitalar do Médio Tejo EPE, Unidade de Abrantes, Abrantes, Santarém, Portugal
| | - Nuno Catorze
- Intensive Care Unit, Centro Hospitalar do Médio Tejo EPE, Unidade de Abrantes, Abrantes, Santarém, Portugal
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Cima LN, Martin SC, Lambrescu IM, Stejereanu L, Zaharia C, Colita A, Fica S. Long-term thyroid disorders in pediatric survivors of hematopoietic stem cell transplantation after chemotherapy-only conditioning. J Pediatr Endocrinol Metab 2018; 31:869-878. [PMID: 29935114 DOI: 10.1515/jpem-2018-0020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/14/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroid dysfunction (TD) was usually described in hematopoietic stem cell transplantation (HSCT) recipients who were given total body irradiation (TBI) in the conditioning regimen. Because previous studies have reported discrepant results regarding the presence of long-term thyroid complications in HSCT survivors following chemotherapy-only conditioning, we investigated the frequency of thyroid abnormalities in a series of children treated with HSCT for different disorders without TBI as part of the conditioning protocol. METHODS We compared thyroid-stimulating hormone, free thyroxine, total triiodothyronine (TT3), anti-peroxidase (TPO Ab) and anti-thyroglobulin antibodies and thyroid volume z-score in 28 HSCT survivors and 16 healthy subjects matched for age and sex. RESULTS HSCT recipients had a higher frequency of TD and thyroid complications in total, including TD and euthyroid Hashimoto thyroiditis, compared to the control group. Patients transplanted for Hodgkin lymphoma (HL) were more likely to develop a thyroid complication compared to patients with non-malignant hematologic diseases and leukemia patients. BEAM (carmustine, etoposide, citarabin and melphalan) conditioning compared to busulfan (Bu) and fludarabine (Flu)-based regimens and autologous compared to allogenic grafting were associated with a higher prevalence of TD in our study. HSCT survivors had higher mean serum TT3 levels. A multivariate analysis revealed that autologous (auto)-HSCT recipients had higher mean serum titers of TPO Ab compared to allogenic (allo)-HSCT recipients and controls and the mean thyroid volume z-score was significantly higher in controls compared to auto-/allo-HSCT survivors. CONCLUSIONS We identified a 35.7% prevalence of thyroid abnormalities, emphasizing the need for a long-term surveillance of thyroid function and morphology even in this group of patients who were not exposed to TBI.
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Affiliation(s)
- Luminita N Cima
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 030167 Bucharest, Romania, Phone: +4 021 318 0719,
| | - Sorina C Martin
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Endocrinology, Diabetes and Metabolic Disorders, Elias University Hospital, Bucharest, Romania
| | - Ioana M Lambrescu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Endocrinology, Diabetes and Metabolic Disorders, Elias University Hospital, Bucharest, Romania
| | - Lavinia Stejereanu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Zaharia
- Department of Paediatric Bone Marrow Transplantation, Fundeni Hospital, Bucharest, Romania.,Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Anca Colita
- Department of Paediatric Bone Marrow Transplantation, Fundeni Hospital, Bucharest, Romania.,Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Fica
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Endocrinology, Diabetes and Metabolic Disorders, Elias University Hospital, Bucharest, Romania
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Demir K, Özen S, Konakçı E, Aydın M, Darendeliler F. A Comprehensive Online Calculator for Pediatric Endocrinologists: ÇEDD Çözüm/TPEDS Metrics. J Clin Res Pediatr Endocrinol 2017; 9:182-184. [PMID: 28443820 PMCID: PMC5463294 DOI: 10.4274/jcrpe.4526] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Division of Pediatric Endocrinology, İzmir, Turkey, Phone: +90 232 412 60 77 E-mail: ,
| | - Samim Özen
- Ege University Faculty of Medicine, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Ergun Konakçı
- Ege University Faculty of Medicine, Department of Biostatistics and Medical Informatics, İzmir, Turkey
| | - Murat Aydın
- Ondokuz Mayıs University Faculty of Medicine, Division of Pediatric Endocrinology, Samsun, Turkey
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Division of Growth, Development, and Pediatric Endocrinology, İstanbul, Turkey
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25
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Sethy RR, Sinha VK. Effect of lithium on thyroid function in adolescents with mood disorder. Asian J Psychiatr 2016; 24:41-45. [PMID: 27931904 DOI: 10.1016/j.ajp.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/12/2016] [Accepted: 08/09/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the study was to determine thyroid gland volume and the frequency of thyroid dysfunction by using ultrasonography and laboratory parameters (TSH, T3, and T4) in long term lithium treated adolescent patients with mood disorder. METHODOLOGY In a cross-sectional study, we performed ultrasonography and thyroid function test in 30 adolescent patients on long-term lithium treatment for mood disorder. Patients with adequate serum lithium levels for one year or more were taken for the study. Ultrasonography examinations of thyroid gland and thyroid function test were performed in these patients. Patients who were on other mood stabilizers were taken up as controls. RESULT The thyroid stimulating hormone (TSH) levels and ultrasonographically measured thyroid volume were significantly higher in patients receiving lithium in comparison to patients with other mood stabilizers. A significant positive correlation was found between total thyroid volume and TSH levels. CONCLUSION Adolescent mood disorder patients on long term lithium therapy have increased thyroid volume and isolated increases in serum TSH levels compared to those on other mood stabilizers.
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Affiliation(s)
- Rati Ranjan Sethy
- Department of Psychiatry, IMS & SUM Hospital, Bhubaneswar, Odisha, India.
| | - Vinod Kumar Sinha
- Center for Child and Adolescent Psychiatry, Central institute of psychiatry, Kanke, Ranchi, India
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26
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Aversa T, Corrias A, Salerno M, Tessaris D, Di Mase R, Valenzise M, Corica D, De Luca F, Wasniewska M. Five-Year Prospective Evaluation of Thyroid Function Test Evolution in Children with Hashimoto's Thyroiditis Presenting with Either Euthyroidism or Subclinical Hypothyroidism. Thyroid 2016; 26:1450-1456. [PMID: 27541075 DOI: 10.1089/thy.2016.0080] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Whether the course of thyroid function in Hashimoto's thyroiditis (HT) differs in children who present with either euthyroidism or subclinical hypothyroidism (SH) has been incompletely investigated. AIM Using a five-year prospective evaluation of 234 children with HT and no prognostic risk factors, this study investigated whether the evolution of the thyroid status is influenced by the biochemical pattern at initial diagnosis. RESULTS In the entire series, thyrotropin values significantly increased during follow-up, while free thyroxine values decreased and the proportion of children with a thyroid dysfunction increased from 27.3% to 47.4% (p = 0.0001). An increasing proportion of cases with severe thyroid dysfunction was identified, especially among the 64 patients presenting with SH (group B), but also among the 170 children presenting with euthyroidism (group A) at initial diagnosis. At the end of follow-up, the prevalence of children with overt hypothyroidism was 12.3% in group A compared with 31.2% in group B (p = 0.0007). In the overall population, however, the majority of patients (52.6%) exhibited biochemical euthyroidism at the end of follow-up. CONCLUSIONS Children with HT may develop a deterioration of thyroid status during the first five years of disease. Such a trend may be observed, even in the patients who initially present with a mild biochemical picture (either SH or euthyroidism). A total of 57.1% of initially euthyroid children remain euthyroid, and 40.6% of patients with initial SH normalize thyroid function within five years after HT diagnosis. The patients presenting with SH are more prone to the risk of developing severe thyroid dysfunction over time.
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Affiliation(s)
- Tommaso Aversa
- 1 Department of Pediatrics, University of Messina , Messina, Italy
| | - Andrea Corrias
- 2 Department of Pediatrics, University of Turin , Regina Margherita Children's Hospital, Turin, Italy
| | | | - Daniele Tessaris
- 2 Department of Pediatrics, University of Turin , Regina Margherita Children's Hospital, Turin, Italy
| | - Raffaella Di Mase
- 3 Department of Pediatrics, University "Federico II ," Naples, Italy
| | | | - Domenico Corica
- 1 Department of Pediatrics, University of Messina , Messina, Italy
| | - Filippo De Luca
- 1 Department of Pediatrics, University of Messina , Messina, Italy
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