title: The natural history of the normal/mild elevated TSH serum levels in children and adolescents with Hashimoto's thyroiditis and isolated hyperthyrotropinaemia: a 3-year follow-up.
abstract: OBJECTIVE
  The natural history of Hashimoto's thyroiditis (HT) and isolated hyperthyrotropinaemia (IH) is not well defined. We therefore studied the natural course of patients with HT and IH and looked for possible prognostic factors.
  
  
  METHODS
  This is retrospective cross-sectional study.
  
  
  METHODS
  Three hundred and twenty-three patients with HT (88 boys and 235 girls) and 59 with IH (30 boys and 29 girls), mean age 9·9 ± 3·8 years were included in the study. When first examined, 236 of the children with HT had a normal TSH (G0) and in 87, it was elevated but <100% of the upper limit (G1). All IH subjects had elevated TSH. Potential risk factors for thyroid failure were evaluated after 3 years and included the presence or familiarity for endocrine/autoimmune diseases, premature birth, signs and symptoms of hypothyroidism, TSH levels, antithyroid antibodies and thyroid volume.
  
  
  RESULTS
  HT: Of those with HT, 170 G0 patients remained stable, 31 moved to G1 and 35 to G2 (hypothyroidism). Thirty-six G1 children moved to G0, 17 remained stable and 34 moved to G2. Of patients with IH: 23 normalized, 28 remained stable and eight became overtly hypothyroid. In patients with HT, the presence of coeliac disease, elevated TSH and thyroid peroxidase antibodies (TPOAb) increased the risk of developing hypothyroidism by 4·0-, 3·4- and 3·5-fold, respectively. The increase in TSH levels during follow-up was strongly predictive of the development of hypothyroidism. In patients with IH, no predictive factor could be identified.
  
  
  CONCLUSIONS
  Coeliac disease, elevated TSH and TPOAb at presentation and a progressive increase in TSH are predictive factors for thyroid failure in HT patients.
authors: Department of Paediatrics, Regional Hospital of Bolzano, via L. Boehler 5, Bolzano, Italy. giorgio.radetti@asbz.it
authors: Giorgio
authors: G
authors: Radetti
authors: Mara
authors: M
authors: Maselli
authors: Fabio
authors: F
authors: Buzi
authors: Andrea
authors: A
authors: Corrias
authors: Alessandro
authors: A
authors: Mussa
authors: Paola
authors: P
authors: Cambiaso
authors: Mariacarolina
authors: M
authors: Salerno
authors: Marco
authors: M
authors: Cappa
authors: Michela
authors: M
authors: Baiocchi
authors: Roberto
authors: R
authors: Gastaldi
authors: Luigi
authors: L
authors: Minerba
authors: Sandro
authors: S
authors: Loche
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D015292:Glycoprotein Hormones, alpha Subunit / Q000097:blood; D050031:Hashimoto Disease / Q000097:blood* / Q000175:diagnosis / Q000276:immunology; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D008297:Male; D009929:Organ Size; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013961:Thyroid Gland / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D013972:Thyrotropin / Q000097:blood*; D037322:Thyrotropin, beta Subunit / Q000097:blood; D013974:Thyroxine / Q000097:blood; D013997:Time Factors; D014284:Triiodothyronine / Q000097:blood
chemical_list: D001323:Autoantibodies; D015292:Glycoprotein Hormones, alpha Subunit; D037322:Thyrotropin, beta Subunit; C056626:thyroid microsomal antibodies; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine