Levothyroxine Treatment Reduces Thyroid Size in Children and Adolescents with Chronic Autoimmune Thyroiditis

Abstract

Context:The use of levothyroxine to reduce thyroid size in pediatric patients with goiter due to chronic autoimmune thyroiditis (AIT) remains controversial. In overtly hypothyroid patients, reductions in thyroid volume have been reported, whereas the effect in subclinically hypothyroid and euthyroid patients is less clear. Objective:The objective of the study was to evaluate the effect of levothyroxine treatment on thyroid size (determined with thyroid ultrasonography) in children and adolescents with AIT. Design and Setting: This study included patients with AIT treated at a university hospital outpatient clinic between 1987 and 2004.Patients: Ninety children with AIT (73 girls and 17 boys, aged 6.1-17.7 yr) were included in the study.Intervention: Intervention was treatment with levothyroxine for a median 2.8 yr (range 0.5-10.2).Main Outcome Measure: Change in thyroid volume SD score (SDS) during the study period was measured.Results: Median thyroid volume SDS was reduced in patients euthyroid (Ϫ0.4 SDS, P Ͻ 0.001), subclinically hypothyroid (Ϫ1.4 SDS, P Ͻ 0.001), and overtly hypothyroid (Ϫ1.8 SDS, P Ͻ 0.002) at diagnosis of AIT. Both hypothyroid and euthyroid patients with goiter (thyroid volume Ͼ 2.0 SDS) at baseline reduced their median thyroid volume SDS (Ϫ1.6 and Ϫ0.9, respectively, P Ͻ 0.001). Hypothyroid patients without goiter also reduced median thyroid volume SDS (Ϫ1.2, P Ͻ 0.004), whereas no change was noticed in euthyroid children without goiter. Conclusions:Levothyroxine treatment is effective in reducing thyroid volume in pediatric patients and is suggested in treatment of goiter caused by AIT, especially in cases of hypothyroid, but also in euthyroid children.

ENDOCRINE DISORDERS IN CHILDHOOD AND ADOLESCENCE: Natural history of subclinical hypothyroidism in children and adolescents and potential effects of replacement therapy: a review

“…After reviewing the titles, abstracts, and the full-length articles, six were selected for a closer assessment and included in this review (31,32,33,34,35,36). They are summarized in Table 2.…”

“…Of the six selected studies, three were retrospective trials (32,34,35), one of which was a case-control study (32), and three were longitudinal trials (31,33,36), of which one was a crossover study (where L-T 4 was compared with no treatment) (36). Five studies were single center studies (31,32,34,35,36) and one a multicenter (33).…”

“…Five studies were single center studies (31,32,34,35,36) and one a multicenter (33). Overall, data from a total of 202 children were reported.…”

Hashimoto Thyroiditis in Childhood – Review of the Epidemiology, Genetic Susceptibility and Clinical Aspects of the Disease

“…In recent years several studies assessing clinical and epidemiological characteristics of children and adolescents with HT have been published in the literature (Table 1) [7][8][9][10][11][12].…”

“…Their results showed that levothyroxine treatment is effective in reducing thyroid volume in pediatric patients and is suggested in treatment of goiter caused by autoimmune thyroiditis especially in cases of hypothyroid, but also in euthyroid children [7]. Consensus statement on subclinical thyroid dysfunction has recommended LT4 therapy for adults with subclinical hypothyroidism, in whom serum TSH levels are greater than 10 mIU/L [73].…”