Hashimoto Thyroiditis and Dyslipidemia in Childhood: A Review

Abstract

Hashimoto autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in the pediatric population. Development of AIT is mediated mainly by cellular immune response directed toward thyroid autoantigens, leading to inflammation and impaired function of thyroid gland. Both thyroid dysfunction and inflammation affect the metabolism of plasma lipoproteins. The alterations in lipid profile worsen with the advancement of hypothyroidism, ranging from discrete changes in euthyroid AIT patients, to atherogenic dyslipidemia in the overt hypothyroidism. In this review, characteristics of dyslipidemia in pediatric AIT patients, and the consequences in respect to the risk for cardiovascular disease (CVD) development are discussed. Additionally, benefit of L-thyroxine treatment on serum lipid profile in pediatric AIT patients is addressed. Finally, potential usefulness of novel lipid biomarkers, such as proprotein convertase subtilisin/kexin type 9 (PCSK9), non-cholesterol sterols, low-density lipoprotein particle size and number, and high-density lipoprotein structure and functionality in AIT patients is also covered. Further longitudinal studies are needed in order to elucidate the long-term cardiovascular outcomes of dyslipidemia in pediatric patients with Hashimoto AIT.

Does Hashimoto's Thyroiditis Increase the Risk of Cardiovascular Disease in Young Type 1 Diabetic Patients?

“…Hypertriglyceridemia has been associated with the increased production of small, dense LDL ( 49 ). Long-term consequences of childhood AITD-associated dyslipidemia remain unknown, but the short–term data reveal improvement in lipid profile with L-thyroxine treatment [reviewed in ( 50 )]. Atherogenic dyslipidemia is a huge, recognized but undertreated and pending problem among young people with T1D ( 46 , 51 , 52 ).…”

Common carotid pulsatility is deteriorated by autoimmune thyroiditis in children with type 1 diabetes mellitus – A pilot study

“…Autoimmune thyroiditis also has significant effects on lipoprotein metabolism. Subclinical hypothyroidism can slow down metabolic pathways of cholesterol uptake, synthesis and secretion, with the distinctive feature being reduced synthesis of hepatic LDL receptors (Vukovic et al, 2019). Additionally, the chronic inflammation accompanying any autoimmune disease process also has detrimental effects on vascular health (Bojanin, Milenkovic, & Vekic, 2018).…”

Efecto de la normalización de TSH y T4 libre sobre el perfil lipídico en población pediátrica con hipotiroidismo primario

“…El espectro de su presentación es amplio, cursando desde un estado asinto-mático hasta coma mixedematoso 2 . En pacientes con hipotiroidismo primario por tiroiditis de Hashimoto se ha evidenciado un aumento de marcadores proaterogénicos, dislipidemia y riesgo cardiovascular 3 . Las alteraciones del metabolismo de lípidos por hipotiroidismo se deben a la deficiencia de hormonas tiroideas.…”