Goiter and chronic lymphocitic thyroiditisSixty patients with goiter, aged 3 to 16 years, 58 girls, were studied for evidence of chronic lymphocytic thyroiditis (CLT). Thirtyeight patients, 63%, presented two or more diagnostic elements of TLC, according to Fisher's criteria, with a high frequency of thyroid function involvement (47.4% had hypothyroidism and 18.4% had hyperthyroidism). The rest of the patients with diffuse goiter (37%) did not meet Fisher's criteria, they were mostly euthyroidal (95%) and they were designated "non thyroiditis goiter". All patients with probable CLT had positive antimiciosomal antibodies at relatively high liter (> 1 x 600 in 71 % of the cases) and 32% of them had both antimicTosomal and antithyroglobulin antibodies. In the "non thyroiditis goiter" group we found 28% of children with positive antimicrosomal antibodies at low tilers (1 x 100 and 1 x 400, respectively). In a control group of 28 children of similar ages, without endocrine diseases neither familiar history of thyroid diseases only 3 (11%) cases showed positive antimicrosomal antibodies, always at low serum titers. (Key words: goiter, lymphocitic thyroiditis, diagnosis, circulating antibodies, antimicrosomal antibodies, antithyroglobulin antibodies.) El bocio es la afeccion tiroidea de mayor consulta en nifios y adolescentes. Su aparicion puede ser el resultado de multiples factores: estimulacion de la glandula tiroidea por aumento de la hormona tirotrofica (TSH) secundaria a dishormonogenesis; anticuerpos estimulantes del tiroides, como sucede en la enfermedad de Graves; infiltracion del tiroides por quisles, tumores benignos o malignos u otras enfermedades o inflamacion de la glandula tiroides de etiologia autoinmune, infecciosa, viral bacteriana o traumatica. En el desarrollo del bocio puede estar comprometido mas de un mecanismo. Asi, por ejemplo, en enfermedades tiroideas autoinmunes, como la tiroiditis linfocitaria cronica (TLC), por lo general la glandula es infiltrada por linfocitos y foliculos linfoides y, ademas, puede estar estimulada por exceso de hormona tiroestimulante (TSH).En Chile la carencia de yodo era una causa frecuente de bocio, problema que deberia haber mejorado por lo menos en parte mediante la suplementacion con yodo de la sal de mesa, de 198acuerdo con la Iegislaci6n que se esta aplicando desde 1978 1 ' 2 . No obstante, el bocio continua siendo frecuente en ninos y adolescentes, por lo que deben plantearse otras etiologias. Estudios efectuados en otros pai'ses tienden a demostrar que la TLC sen'a causa importante de bocio en nifios 3~7 . El diagnostico de certeza de TLC se hace mediante biopsia tiroidea, pero por la naturaleza invasiva de este procedimiento se han buscado otros medios para orientar el diagnostico. Fisher ha propuesto que la asociacion de dos o mas de los siguientes elementos sugiere la presencia de TLC 8 : bocio difuso de superficie finamente granular; cintigrafia algo irregular; anticuerpos antitiroideos por hemaglutinacion positives; concentration elevada de TSH en el sue...

An adolescent cirl with severe longstanding hyperthyro aism, poor response to propylthiouracil and two previous episoces of au^dice, had clinical,y oclive hyperhyroidisn during propylthiouracil treatment, *ogethe r with jaundice and liver enargemert. The etiologic study of her hepa'ic disease was oriented to several posibilities of hepatic dysfunction including d r ug ^oxicity, cardiac failure, hyperthyrcidism by its own and autoimmune hepcritis. Conrrol of hyperthircidism was eventually achieved by stoping propylthiouracil administration and a management schedule that included high calory diet, propanolol and two doses of I 13] . Labo'atory workup showed high serum total and direct oillirrubin, SGOT, SPT and plasma garnmaglobulin levels. Liver biopsy specimens showed mononuclear and polinuclear inflamatory infi'trates, with moderate fibrosis, mic'ovccualated hepotocytes and hepatocelluiar necrosis, which were considered to be consisrent with ch'onically active hepatitis, that has been managed with oral prednisone. Liver functional tests became normal two months after supression of t^e antithyroid drug and one month after begining stero^cal treatment. Two months later reduction or 'he inflarratory reaction but persistent hepatic cell necrosis was shown oy the second liver biopsy.