Hashimoto thyroiditis in Child
HT most commonly presents in the teen years and has a variable clinical presentation ranging from asymptomatic (clinical euthyroidism with or without goiter) to overt symptoms of hypothyroidism. Initially, thyrotropin and levorotatory thyroxine (T4) may be normal, with some patients developing an enlarged thyroid gland resulting from lymphocytic infiltration of the thyroid from thyroid growth-stimulating antibodies. The thyrotropin will usually rise with a normal to low normal T4. During this phase, patients may develop a goiter but are often clinically euthyroid (no overt hypothyroid symptoms other than a goiter).
As the condition progresses and more of the gland is destroyed, thyrotropin levels continue to rise and free T4 levels fall below the normal range. Clinical symptoms of hypothyroidism are often present during this stage. Up to 40% of these patients may revert back to a euthyroid state and do not progress to overt hypothyroidism. Sometimes a transient hyperthyroid state called Hashitoxicosis can be encountered. During this period of time, active thyroid hormone is released from destroyed glandular tissue and results in a transient hyperthyroid state, which is usually followed by true hypothyroidism. Symptoms of hypothyroidism include slow growth rate, unexplained weight gain, dry skin, coarse dry hair, goiter, fatigue, constipation, cold intolerance, irregular menses, or delayed puberty.
This condition is 5 times more common in females. Up to 25% of siblings of a patient with HT may have HT. HT can be found more commonly in patients with other autoimmune disorders and in those with Turner syndrome or Down syndrome.
E06.3 – Autoimmune thyroiditis
21983002 – Hashimoto Thyroiditis
Differential Diagnosis & Pitfalls