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November 17, 2016 00:07

Chronic thyroiditis in children |Symptoms and treatment of chronic thyroiditis in children

chronic nonspecific thyroiditis are autoimmune and fibrotic.Fibrous thyroiditis almost does not occur in childhood.Autoimmune thyroiditis or chronic thyroiditis - the most common thyroid disease in children and adolescents.

autoimmune disease is determined by the mechanism, however, unknown primary immunological defect.Histologically reveal lymphocytic infiltration, hyperplasia of the thyroid gland, and then atrophy tireotsitov.

Synonyms

lymphocytic thyroiditis, Hashimoto

code in ICD-10

  • E06 Thyroiditis.
  • E06.2 Chronic thyroiditis with transient thyrotoxicosis.
  • E06.3 Autoimmune thyroiditis.
  • E06.5 Other chronic thyroiditis.
  • E06.9 Thyroiditis unadjusted.

Epidemiology

More common in girls after 6 years of age, the maximum incidence was found in adolescents.

Causes of chronic thyroiditis in children

Chronic lymphocytic thyroiditis - organ-specific autoimmune disease.When the antibodies inhibit secretion of thyroid hormones and are involved in the destruction of thyrocytes.The serum anti

bodies to thyroid peroxidase are identified and thyroglobulin.These antibodies block the adherence of iodine to thyroglobulin, have a toxic effect on thyrocytes.Also found autoantibodies that stimulate the proliferation tireotsitov.

Violation iodine connection to thyroglobulin leads to inhibition T3i T4 synthesis, which in turn stimulates secretion of TSH.Increased TSH level is a compensatory hyperplasia of the thyroid gland, so patients for months or even years is maintained euthyroid state.Goiter in chronic lymphocytic thyroiditis is due to both hyperplasia and lymphocytic infiltration of the thyroid gland.

symptoms of chronic thyroiditis in children

Goiter develops gradually.Most children diffusely enlarged gland, hard to the touch and painless.Approximately 1/3 of the note lobulation gland, which can "seem" knotty.As a rule, patients do not complain, hormones often normal content, sometimes laboratory detected subclinical hypothyroidism (high TSH level with normal values ​​of T3 and T4).In some cases, lymphocytic thyroiditis can manifest transient thyrotoxicosis (hashitoksikoz).

clinical course of autoimmune thyroiditis is very variable.Goiter may spontaneously diminish and disappear, or retained thyroid hyperplasia with clinical and laboratory euthyroid state for many years.Quite often after months or years of developing hypothyroidism.Autoimmune thyroiditis - the most common cause of hypothyroidism nezobogennogo youth.Autoimmune thyroiditis is asymptomatic, and many children recover spontaneously.

diagnosis of chronic thyroiditis in children

Based on the determination of serum antibodies to thyroid microsomal antigens - increased titers of antibodies to microsomal thyroid peroxidase.The majority of patients also reveal elevated titers of antibodies to thyroglobulin.As an additional method of research used thyroid ultrasound.

differential diagnosis

differential diagnosis of autoimmune thyroiditis in children most often have to be carried out with juvenile Strum, diffuse toxic goiter, subacute thyroiditis, nodular and mixed goiter, thyroid cancer.Subacute thyroiditis develops after viral infections, prone to fluctuating course, ends in complete recovery.Acute suppurative thyroiditis in childhood is extremely rare, it obychns preceded by a respiratory infection or injury.This is characterized by extremely painful cancer, swelling, redness and limitation of neck mobility, dysphagia.

Treatment of chronic thyroiditis in children

If the patient antithyroid autoantibodies present in the background of the euthyroid state, treatment with levothyroxine sodium optional, since the drug does not affect the duration and severity of the autoimmune process.Pokazans definition of T4 and TSH in serum every 6-12 months.When hypothyroidism "sodium levothyroxine administered to children under the age of 12 years at 3-4 mg / kg per day to adolescents - 1-2 mg / kg per day.When latent hypothyroidism (concentration; normal T4, TSH - enhanced) also recommended to prescribe levothyroxine sodium.

prognosis of chronic thyroiditis in children

thyroid function in patients with autoimmune thyroiditis may vary depending on the prevalence of thyroid-stimulating autoantibodies or tireoblokiruyuschsh.Perhaps spontaneous recovery or, on the contrary, the development of resistant hypothyroidism.