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Abstract
Chronic autoimmune thyroiditis is the most common cause of overt hypothyroidism in adults, whereas in children overt hypothyroidism is observed in congenital hypothyroidism, hypopituitarism, severe iodine deficiency, and very rarely in the outcome of CAIT. Here, we present a series of observations of manifest long acquired hypothyroidism in children aged 1 to 12 years, with proven autoimmune thyroid lesions. Hypothyroidism was complicated by growth retardation, anaemia, dyslipidemia, cytolysis hydropericarditis, bradycardia, apathy, constipation.
1. The child of a mother with hepatitis C. Hypothyroidism started at the age of 1 y.o. At the date of diagnosis the TSH level was 60 mIU
/l. Complications: anaemia, inner swelling (including hydropericardium, puncture was required because of the gravity and rise of CD), bradycardia, constipation, delayed physical development (growth SDS −2.0), with cytolysis ALAT 268.3 U/l, ASAT 230.8 U/l, skin and chair dystrophy.
2. The child with Down syndrome. Hypothyroidism started at the age of 1–1.5 years. In identifying (2 y.o.) the TSH:>100.00 mIU/L; fT4<5.15 pmol/L; Complications: delayed physical and motor development, degeneration of the skin, hair, anaemia, bradycardia, constipation, cytolysis ALAT: 253 U/L; ASAT 198 U/L;
3. Girl 12 y.o. When identifying TSH level 100 IU/L fT4 less than 5.1 pmol/L. At the time of detection low growth rates for 3 years.
Complications stunting, hypotension, decreased school performance, drowsiness, skin dystrophy, constipation, anaemia, with cytolysis
(ALAT: 100.3 U/L, ASAT: 166.2 U/L).
4. Girl 9 y.o. In identifying the TSH more than 100 mIU/L, fT4 11.4 pmol/L, at the time of diagnosis dwarfism was observed, height
SDS −3.4, the hypothyroidism duration is unknown. Other complications – weakness, lethargy, anaemia, skin and hair dystrophy, and constipation. In all cases hypothyroidism and its complications were resolved by the levothyroxine replacement in standard (2 mcg/kg/day) doses. This demonstration shows the possibility of severe hypothyroidism in childhood as outcome of autoimmune hypothyroidism.
It’s highly required to detect specific antibody levels and perform ultrasound to make a correct diagnosis.