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Chronic thyroiditis in children

 
, medical expert
Last reviewed: 05.07.2025
 
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Chronic non-specific thyroiditis includes autoimmune and fibrous thyroiditis. Fibrous thyroiditis is almost never seen in childhood. Autoimmune thyroiditis or chronic thyroiditis is the most common thyroid disease in children and adolescents.

The disease is determined by an autoimmune mechanism, but the underlying immunological defect is unknown. Histologically, lymphocytic infiltration, hyperplasia of thyroid tissue, and then thyrocyte atrophy are detected.

Synonyms

Lymphocytic thyroiditis, Hashimoto's goiter

ICD-10 code

  • E06 Thyroiditis.
  • E06.2 Chronic thyroiditis with transient thyrotoxicosis.
  • E06.3 Autoimmune thyroiditis.
  • E06.5 Other chronic thyroiditis.
  • E06.9 Thyroiditis, unspecified.

Epidemiology

Girls over 6 years of age are more likely to get sick, with the highest incidence rate found in adolescents.

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Causes of Chronic Thyroiditis in Children

Chronic lymphocytic thyroiditis is an organ-specific autoimmune disease. In this case, antibodies suppress the secretion of thyroid hormones and participate in the destruction of thyrocytes. Antibodies to thyroid peroxidase and thyroglobulin are detected in the serum. These antibodies block the addition of iodine to thyroglobulin and have a toxic effect on thyrocytes. Autoantibodies stimulating thyrocyte proliferation have also been detected.

Impaired iodine binding to thyroglobulin inhibits the synthesis of T3 and T4, which in turn stimulates the secretion of TSH. Increased TSH levels cause compensatory hyperplasia of the thyroid gland, so patients remain in a euthyroid state for many months or even years. Goiter in chronic lymphocytic thyroiditis is caused by both hyperplasia and lymphocytic infiltration of the thyroid gland.

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Symptoms of chronic thyroiditis in children

Goiter develops gradually. In most children, the gland is diffusely enlarged, hard to the touch and painless. In about 1/3 of cases, the gland is lobulated, which may "appear" to be nodular. As a rule, patients do not complain, hormone levels are usually normal, and sometimes subclinical hypothyroidism is detected in the laboratory (high TSH levels with normal T3 and T4 levels). In some cases, lymphocytic thyroiditis may manifest as transient thyrotoxicosis (hashitoxicosis).

The clinical course of autoimmune thyroiditis is highly variable. The goiter may spontaneously shrink and disappear, or hyperplasia of the thyroid gland with a clinical and laboratory euthyroid state may persist for many years. Hypothyroidism often develops months or years later. Autoimmune thyroiditis is the most common cause of non-goitrogenic juvenile hypothyroidism. Autoimmune thyroiditis may be asymptomatic, and many children recover spontaneously.

Diagnosis of chronic thyroiditis in children

Based on the determination of serum antibodies to microsomal thyroid antigens - the titer of antibodies to microsomal thyroid peroxidase is increased. Most patients also have an increased titer of antibodies to thyroglobulin. Ultrasound of the thyroid gland is used as an additional method of examination.

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Differential diagnosis

Differential diagnostics of autoimmune thyroiditis in children most often has to be carried out with juvenile goiter, diffuse toxic goiter, subacute thyroiditis, nodular and mixed goiter, thyroid cancer. Subacute thyroiditis develops after viral infections, tends to have a wave-like course, and ends in complete recovery. Acute purulent thyroiditis in childhood is extremely rare, it is usually preceded by a respiratory infection or injury. In this case, extreme pain in the gland, swelling, redness and limited mobility of the neck, dysphagia are characteristic.

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Treatment of chronic thyroiditis in children

If the patient has antithyroid autoantibodies against the background of a euthyroid state, treatment with sodium levothyroxine is not necessary, since the drug does not affect the duration and severity of the autoimmune process. Determination of T4 and TSH in the blood serum every 6-12 months is indicated . In hypothyroidism, sodium levothyroxine is prescribed to children under 12 years of age at 3-4 mcg / kg per day, adolescents - 1-2 mcg / kg per day. In latent hypothyroidism (concentration; T4 is normal, TSH is increased), sodium levothyroxine is also recommended.

Prognosis for chronic thyroiditis in children

Thyroid function in autoimmune thyroiditis may vary depending on the prevalence of thyroid-stimulating or thyroid-blocking autoantibodies. Spontaneous recovery or, conversely, the development of persistent hypothyroidism are possible.

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