title: Unfavorable Course of Subclinical Hypothyroidism in Children with Hashimoto's Thyroiditis Compared to Those with Isolated Non-Autoimmune Hyperthyrotropinemia.
abstract: Subclinical hypothyroidism (SCH) is a common problem in pediatric population, and the natural history of SCH varies depending on its etiology. Whether Hashimoto's thyroiditis (HT) negatively affects the natural course of SCH was investigated in pediatric patients without concomitant diseases. Predictors for levothyroxine medication were also evaluated. Medical records of 109 children with SCH (91 girls, 5?18 years) diagnosed between 2005 and 2014 were retrospectively reviewed. Patients were classified into HT (n = 37) and isolated non-autoimmune hyperthyrotropinemia (iso-NAHT, n = 72). During median 2 years of follow-up, only 10.1% of SCH patients eventually initiated levothyroxine, and HT patients showed a higher probability of requiring levothyroxine medication than iso-NAHT patients (21.6% vs. 4.2%). Underlying HT independently predicted deterioration of thyroid function, leading to levothyroxine medication (hazard ratios [HRs], 4.6 vs. iso-NAHT, P = 0.025). High titers of anti-thyroglobulin antibodies (TGAbs) predicted later medication in the HT group (HRs, 28.2 vs. normal TGAbs, P = 0.013). Most pediatric SCH showed benign and self-remitting courses. Underlying HT significantly increases the risk for levothyroxine medication, especially with high titers of TGAbs.
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yun Jeong
authors.identifier: http://orcid.org/0000-0003-2847-2643
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: So Yoon
authors.identifier: http://orcid.org/0000-0002-0604-5600
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: Hae Woon
authors.identifier: http://orcid.org/0000-0003-0494-4626
authors.initials: HW
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: So Youn
authors.identifier: http://orcid.org/0000-0001-8309-4927
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea. nina337@snu.ac.kr.
authors.forename: Young Ah
authors.identifier: http://orcid.org/0000-0001-9179-1247
authors.initials: YA
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Seong Yong
authors.identifier: http://orcid.org/0000-0002-7077-869X
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Choong Ho
authors.identifier: http://orcid.org/0000-0002-9813-1134
authors.initials: CH
authors.lastname: Shin
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sei Won
authors.identifier: http://orcid.org/0000-0002-5304-5750
authors.initials: SW
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006042:Goiter / Q000209:etiology; D050031:Hashimoto Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D006981:Hyperthyroxinemia / Q000150:complications / Q000175:diagnosis*; D007037:Hypothyroidism / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000627:therapeutic use
chemical_list: D001323:Autoantibodies; C006606:anti-thyroglobulin; D013972:Thyrotropin; D013974:Thyroxine
keywords: Children; Hashimoto Disease; Hypothyroidism; Thyroid Disease