Prospective evaluation of autoimmune and non-autoimmune subclinical hypothyroidism in Down syndrome children. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Pepe, Giorgia; Corica, Domenico; De Sanctis, Luisa; Salerno, Mariacarolina; Faienza, Maria Felicia; Tessaris, Daniele; Tuli, Gerdi; Scala, Iris; Penta, Laura; Alibrandi, Angela; Pajno, Giovanni Battista; Aversa, Tommaso; Wasniewska, Malgorzata
• Is Part Of: European journal of endocrinology. Volume 182:Issue 4(2020)
• Page Start: 385
• Page End: 392
• Publication Date: 2020-04
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1530/EJE-19-0823
• Languages: English
• ISSNs: 0804-4643

Abstract

Abstract : Objective: To evaluate the prevalence and natural course of autoimmune and non-autoimmune subclinical hypothyroidism (SH) in Down syndrome (DS) children and adolescents. Design: Prospective multicenter study. Methods: For the study, 101 DS patients with SH (TSH 5–10 mIU/L; FT4 12–22 pmol/L), aged 2–17 years at SH diagnosis were enrolled. Annual monitoring of TSH, FT4, BMI, height, and L-thyroxine dose was recorded for 5 years. Thyroid autoimmunity was tested at diagnosis and at the end of follow-up. Results: Thirty-seven out of 101 patients displayed autoantibody positivity (group A); the remaining 64 were classified as non-autoimmune SH (group B). Group A was characterized by higher median age at SH diagnosis and by more frequent family history of thyroid disease (6.6 vs 4.7 years, P = 0.001; 32.4% vs 7.8%, P = 0.001 respectively), whereas congenital heart defects were more common in group B (65.6% vs 43.2%, P = 0.028). Gender, median BMI (SDS), height (SDS), FT4, and TSH were similar in both groups. At the end of follow-up: 35.1% of group A patients developed overt hypothyroidism (OH) vs 17.2% of group B ( P = 0.041); 31.25% of group B vs 10.8% of group A became biochemically euthyroid ( P = 0.02); and 37.8% of group A vs 51.5% of group B still had SH condition ( P = 0.183). Logistic regression suggested autoimmunity (OR = 3.2) and baseline TSH values (OR = 1.13) as predictive factors of the evolution from SH to OH. Conclusions: In DS children, non-autoimmune SH showed higher prevalence and earlier onset. The risk of thyroid function deterioration over time seems to be influenced by thyroid autoimmunity and higher baseline TSH values.