Peculiarities of Graves' disease in children and adolescents with Down's syndrome

Luca, Filippo De; Corrias, Andrea; Salerno, Mariacarolina; Wasniewska, Malgorzata; Gastaldi, Roberto; Cassio, Alessandra; Mussa, Alessandro; Aversa, Tommaso; Radetti, Giorgio; Arrigo, Teresa

doi:10.1530/eje-09-0751

Cited by 60 publications

(87 citation statements)

References 12 publications

(9 reference statements)

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“…19 HT presentation in our DS children occurred at a younger age and did not show any gender predominance, as against what was recorded in the control group. These two peculiarities have also already been described in DS children with GD, 11,20 a finding which underlines the atypical phenotype of autoimmune above their own 95 th percentile. 30 However, it must also be considered that the study of Meyerovitch et al 30 included only individuals with idiopathic and mild thyroid dysfunctions.…”

Section: Discussionsupporting

confidence: 64%

Peculiarities of presentation and evolution over time of Hashimoto’s thyroiditis in children and adolescents with Down’s syndrome

Aversa¹,

Salerno²,

Radetti³

et al. 2015

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BACKGROUND: Studies concerning presentation and evolution over time of Hashimoto's thyroiditis (HT) in children with Down's syndrome (DS) are few, are based on limited study populations and do not include control HT groups without DS. The aim of this multicenter study was to shed further light on the relationships between DS and HT in childhood. DE-SIGN: In this retrospective study we compared thyroid function patterns at HT presentation in 2 groups of children with (group A) or without DS (group B), including 146 and 553 cases, respectively. All group A patients were subsequently re-examined after a median interval of 5.1 years in order to prospectively re-evaluate the evolution over time of thyroid function patterns in DS. RESULTS: In group A, female predominance, age at HT diagnosis and rates of familiarity for thyroid diseases were significantly lower than in group B, whilst the association with non-thyroidal autoimmune diseases was more frequent. The hormonal patterns that were most frequently found in the 2 groups were, respectively, subclinical hypothyroidism (in group A) and euthyroidism (in group B). Thyroid dysfunctions were, overall, more frequent in group A (86.3 vs 45.7%, p<0.001). At re-evaluation, DS children exhibited further deterioration of thyroid function with some cases switching towards Graves' disease (GD). CONCLUSIONS HT in DS children: a) presents earlier, is not associated with female predominance and is more frequently associated with other autoimmune diseases; b) presents only very infrequently with a euthyroid hormonal profile; c) in a limited rate of cases switches with time to GD.

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Section: Discussionsupporting

confidence: 64%

Peculiarities of presentation and evolution over time of Hashimoto’s thyroiditis in children and adolescents with Down’s syndrome

Aversa¹,

Salerno²,

Radetti³

et al. 2015

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“…This is not surprising considering that such a conversion is known to be detectable in the natural history of patients with HT (42,43,44,45,46) and has also been specifically described in children with either TS (29,30,31) or DS (38,47). Moreover, the shifting HT/GD has been, just recently, found to be more common in GD children with these chromosomal aberrations than in those without them (48).…”

Section: Discussionmentioning

confidence: 79%

Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology

Waśniewska

Aversa

Salerno

et al. 2015

European Journal of Endocrinology

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Aim: To follow-up for 5 years thyroid status evolution in 127 girls with mild (TSH 5-10 mU/l) subclinical hypothyroidism (SH) of different etiologies. Patients: The population was divided into two age-matched groups of 42 and 85 girls with either idiopathic (group A) or Hashimoto's thyroiditis (HT)-related SH (group B). Group B was in turn divided into three subgroups, according to whether SH was either isolated or associated with Turner syndrome (TS) or Down syndrome (DS). Results: At the end of follow-up the rate of girls who became euthyroid was higher in group A (61.9% vs 10.6%), whereas the rates of patients who remained SH (55.3% vs 26.2%), became overtly hypothyroid (30.6% vs 11.9%) or required levothyroxine (L-T 4 ) therapy (63.5% vs 23.8%) were higher in group B. Among the girls of group B, the risk of remaining SH or developing overt hypothyroidism was higher in the subgroups with TS or DS than in those with isolated HT. Conclusions: Long-term prognosis of mild and idiopathic SH is frequently benign, even though a L-T 4 treatment may be needed throughout follow-up in almost a quarter of cases; long-term prognosis is different in the girls with either idiopathic or HT-related SH; and the association with either TS or DS impairs the outcome of HT-related SH.

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“…Together with data from twin studies, this suggests that GD is largely determined by genetic factors (approximately 80% of the susceptibility to this disease), with environmental factors playing a lesser role (20% of susceptibility) (6,7,8). The frequency of GD is higher in children with other comorbid autoimmune disorders (or conditions associated with such disorders, such as Turner's, Down's or Di George syndrome), and in children from families with a history of autoimmune thyroid diseases (9,10,11).…”

Section: Introductionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Léger

Carel

2017

European Journal of Endocrinology

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Graves' disease is an autoimmune disorder. It is the leading cause of hyperthyroidism, but is rare in children. Patients are initially managed with antithyroid drugs (ATDs), such as methimazole/carbimazole. A major disadvantage of treatment with ATD is the high risk of relapse, exceeding 70% of children treated for duration of 2 years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus-pituitary-thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in approximately 40-50% of cases after prolonged treatment with ATD, for several years, in recent studies. Alternative ablative treatments such as radioactive iodine and, less frequently and mostly in cases of very high volume goiters or in children under the age of 5 years, thyroidectomy, performed by pediatric surgeons with extensive experience should be proposed in cases of noncompliance, intolerance to medical treatment or relapse after prolonged medical treatment. Ablative treatments are effective against hyperthyroidism, but they require the subsequent administration of levothyroxine throughout the patient's life. This review considers

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Peculiarities of Graves' disease in children and adolescents with Down's syndrome

Cited by 60 publications

References 12 publications

Peculiarities of presentation and evolution over time of Hashimoto’s thyroiditis in children and adolescents with Down’s syndrome

Peculiarities of presentation and evolution over time of Hashimoto’s thyroiditis in children and adolescents with Down’s syndrome

Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

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