Aspects of chronic autoimmune thyroiditis in children and adolescents

Research output: ThesisDoctoral Thesis (compilation)

Abstract

The aims of this thesis were to 1) compare different methods for detection of antibodies against thyroglobulin (TgAb) and thyroid peroxidase (TPOAb), particulary in children with chronic autoimmune thyroditis (AIT), 2) investigate if maternal enterovirus infection is a risk factor for development of AIT in offspring, 3) ascertain the prevalence of thyroid autoantibodies in cord blood sera from children who later developed AIT, 4) develop a new reference standard for interpretation of normative thyroid volumes in Swedish children, and 5) evaluate the effect of Levothyroxine (L-thyroxine) treatment on thyroid size in children and adolescents with AIT.

We found that 1) Methods based on radioimmunoassay (RIA) were more efficient in detecting both TgAb and TPOAb in children with AIT than methods based on agglutination. TgAb (RIA) was the only method able to detect antibodies in all children with AIT. We believe that methods for detection of TgAb and TPOAb should be based on immunoassays, such as RIA, and that TgAb still is valuable in the clinical diagnosis of AIT. 2) Immunoglobulin M (IgM) against enterovirus, indicating an enterovirus infection late in pregnancy were more common among mothers of children with AIT, as compared to controls (16% vs. 7%). The difference did not reach statistical significance. However, children of enterovirus IgM-positive mothers were significantly younger and more often overtly hypothyroid upon diagnosis of AIT than children of enterovirus IgM-negative mothers, suggesting a promoting effect on the autoimmune process in genetically-susceptible individuals. 3) Children with AIT had had a significantly higher prevalence of thyroid autoantibodies in cord blood, as compared to controls (44% vs. 16%). Whether this intrauterine exposure to maternal thyroid autoantibodies had a pathogenic role in the development of AIT in these children, or simply mirrored the inheritance of AIT, remains to be investigated. 4) Thyroid volume correlated independently with age and with anthropometrics, to a significant degree. To accurately interpret thyroid volume, we feel that both age and anthroprometrics need to be considered. To accomplish this, we propose applying a multivariate model using age and body surface area (BSA) as predictors. 5) Based on the muiltivariate model for interpretation of thyroid volume, L-thyroxine treatment was found to reduce thyroid size in children with goiter due to AIT, irrespective of thyroid function when treatment commenced. We, therefore, recommend L-thyroxine for treatment of goiter in children with AIT.
Original languageEnglish
QualificationDoctor
Awarding Institution
  • Paediatric Endocrinology
Supervisors/Advisors
  • Ivarsson, Sten, Supervisor
Award date2006 Jan 20
Publisher
ISBN (Print)91-85481-29-7
Publication statusPublished - 2006

Bibliographical note

Defence details

Date: 2006-01-20
Time: 09:15
Place: Universtitetsklinikernas aula, ingång 35. Universitetssjukhuset MAS

External reviewer(s)

Name: Gustafsson, Jan
Title: Professor
Affiliation: Institutionen för kvinnors och barns hälsa. Akademiska barnsjukhuset. Akademiska sjukhuset. Uppsala

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<div class="article_info">B Lindberg, J Svensson, UB Ericsson, P Nilsson, E Svenonius and SA Ivarsson. <span class="article_issue_date">2000</span>. <span class="article_title">Comparison of some different methods for analysis of thyroid autoantibodies: importance of thyroglobulin autoantibodies.</span> <span class="journal_series_title">Thyroid</span>, <span class="journal_volume">vol 11</span> <span class="journal_pages">pp 265-9</span>.</div>
<div class="article_info">J Svensson, B Lindberg, B Jonsson, UB Ericsson, P Olofsson, H Hyöty and SA Ivarsson. <span class="article_issue_date">2004</span>. <span class="article_title">Intrauterine exposure to maternal enterovirus infection as a risk factor for development of autoimmune thyroiditis during childhood and adolescence.</span> <span class="journal_series_title">Thyroid</span>, <span class="journal_volume">vol 14</span> <span class="journal_pages">pp 367-70</span>.</div>
<div class="article_info">J Svensson, B Lindberg, UB Ericsson, P Olofsson, B Jonsson and SA Ivarsson. <span class="article_issue_date">2006</span>. <span class="article_title">Thyroid autoantibodies in cord blood sera from children and adolescents with autoimmune thyroiditis.</span> <span class="journal_series_title">Thyroid</span>, (accepted)</div>
<div class="article_info">J Svensson, PE Nilsson, C Olsson, JÅ Nilsson, B Lindberg and SA Ivarsson. <span class="article_issue_date">2004</span>. <span class="article_title">Interpretation of normative thyroid volumes in children and adolescents: is there a need for a multivariate model?</span> <span class="journal_series_title">Thyroid</span>, <span class="journal_volume">vol 14</span> <span class="journal_pages">pp 536-43</span>.</div>
<div class="article_info">J Svensson, UB Ericsson, PE Nilsson, C Olsson, B Jonsson, B Lindberg and SA Ivarsson. <span class="article_issue_date">2006</span>. <span class="article_title">Levothyroxine treatment reduces thyroid size in children and adolescents with chronic autoimmune thyroiditis.</span> <span class="journal_series_title">Journal of Clinical Endocrinology and Metabolism</span>, (accepted)</div>

Subject classification (UKÄ)

  • Endocrinology and Diabetes
  • Pediatrics

Keywords

  • adolescents
  • thyroid autoantibodies
  • enterovirus infection
  • thyroid ultrasonography
  • reference standard
  • goiter
  • chronic autoimmune thyroiditis
  • levothyroxine treatment
  • Medicin (människa och djur)
  • Medicine (human and vertebrates)
  • children

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