FEATURES OF THYROID STATUS IN CHILDREN AND ADOLESCENTS WITH GRAVES' DISEASE LIVING IN IODINE-DEFICIENT CONDITIONS
Keywords:
thyroid gland, hyperthyroidism, Graves' disease, children, adolescentsAbstract
Relevance. Graves' disease (GD) is a hereditary organ-specific autoimmune disorder. The incidence of GD in children has increased by 27.3-30.1% over the last 10-20 years, with a more pronounced rise in the last decade. However, there is currently no consensus on the impact of iodine deficiency on the development and severity of GD in children. Purpose. To assess the features of thyroid status in children and adolescents living in a region with moderate iodine deficiency. Materials and Methods: A total of 310 children aged 2 years 11 months to 18 years were examined, divided into two groups: 213 patients with autoimmune endogenous hyperthyroidism with various morphological thyroid structures, and 97 relatively healthy children. Results: Diffuse toxic goiter (79.3%) was more frequently diagnosed in children with GD, while nodular goiter was observed in 12.2%, and multinodular goiter in 8.5% of children with hyperthyroidism. Among the latter, and Papillary thyroid cancer was confirmed in 3 children (42.9%) and follicular thyroid cancer in 4 children (57.1%). Girls were 3.8 times more likely to suffer from hyperthyroidism than boys, (p=0.004). 17.8% of children with GD had severe thyrotoxicosis. The mean levels of free T3 in children with hyperthyroidism living in an iodine-deficient region were 6 times higher, and free T4 levels were 4.6 times higher than in children without thyroid pathology. The mean levels of thyroid antibodies in children with hyperthyroidism indicated a pronounced autoimmune process in iodine-deficient conditions. In 79.5% of children with Graves' disease, anti-TSH receptor antibody levels were more than 5 times higher than normal. Conclusion. The data obtained indicate more severe courses of thyrotoxicosis, more frequent occurrence of nodular formations and thyroid cancer, and more pronounced autoimmune aggression in children living in iodine-deficient regions.
References
Балаболкин М.И., Клебанова Е.М., Креминская В.М. Фундаментальная и клиническая тироидология. – М., 2007. – С. 816.
Мельниченко Г.А., Лесникова С.В. Стандартные подходы к лечению синдромов тиреотоксикоза и гипотиреоза // Cons. Med. - 2002. – 2(5). – С.221-226.
Макаров И. В., Галкин Р. А., Романов Р. М., Голубова В. М. Интегральная оценка степени тяжести тиреотоксикоза // Таврический медико-биологический вестник. – 2020. – № 2 (23). – С.119-123 DOI: 10.37279/2070-8092-2020-23-2-119-123.
Муратова Ш.Т., Назарова Ш.А. Тиреоидный статус у детей с узловыми формами зоба, проживающих в условиях йододефицита Республики Узбекистан // Всероссийский терапевтический конгресс с международным участием Боткинские Чтения Сборник тезисов: / СПб.: 2024. – С.145 https://congress-ph.ru/istorija_1_1/2024/botkin24/tezis.
Трошина Е.А., Свириденко Н.Ю., Ванушко В.Э., Румянцев П.О., Фадеев В.В., Петунина Н.А. Федеральные клинические рекомендации по диагностике и лечению тиреотоксикоза с диффузным зобом (диффузный токсический зоб, болезнь Грейвса-Базедова), узловым/многоузловым зобом.: Москва; 2014.
Eleftheriadou AM, Mehl S, Renko K, Kasim RH, Schaefer JA, Minich WB, Schomburg L. Re-visiting autoimmunity to sodium-iodide symporter and pendrin in thyroid disease. Eur J Endocrinol. 2020 Dec;183(6):571-580. doi: 10.1530/EJE-20-0566.
Forssberg M., Arvidsson C.G., Engvall J., Lindblad C., Snellman K., Aman J. Increasing incidence of childhood thyrotoxicosis in a population-based area of cen-tral Sweden // Acta Paediatr. – 2004. – Vol.Jan;93(1):25-9. doi: 10.1080/08035250310008069.
García JS, Sarmiento MP, Bello JD, Zuluaga NA, Forero AC, Niño LF. Hy-perthyroidism in children and adolescents: Experience in a university hospital in Colombia. Biomedica. 2022 Jun 1;42(2):342-354. English, Spanish. doi: 10.7705/biomedica.6244.
Havgaard Kjær R, Smedegård Andersen M, Hansen D. Increasing Incidence of Juvenile Thyrotoxicosis in Denmark: A Nationwide Study, 1998-2012. Horm Res Paediatr. 2015;84(2):102-7. doi: 10.1159/000430985.
Henrichs J., Bongers-Schokking J.J., Schenk J.J., Ghassabian Schmidt H.G., Visser T.J., Hooijkaas H., de Muinck Keizer-Schrama S.M., Hofman A., Jaddoe V.V., Visser W., Steegers E.A., Verhulst F.C., de Rijke Y.B., Tiemeier H. Maternal thyroid function during early pregnancy and cognitive functioning in early child-hood: the generation R study // J. Clin. Endocrinol. Metab. – 2010. – № 95(9). – Р. 4227-4234.
Huang Y, Xu Y, Xu M, Zhao X, Chen M. Application of oral inorganic iodine in the treatment of Graves' disease. Front Endocrinol (Lausanne). 2023 Apr 3;14:1150036. doi: 10.3389/fendo.2023.1150036.
Kumorowicz-Kopiec M, Dziatkowiak H, Starzyk J, Nizankowska-Błaz T, Rybakowa M. Zapadalność dzieci na chorobe Gravesa-Basedowa w wybranych re-gionach Polski południowo-wschodniej [Incidence of Graves disease in children in some regions of south-eastern Poland]. Przegl Lek. 2004;61(8):872-5. Polish. PMID: 15789921.
Le Moal J, Chesneau J, Goria S, Boizeau P, Haigneré J, Kaguelidou F, Léger J. Spatiotemporal variation of childhood hyperthyroidism: a 10-year nationwide study. Eur J Endocrinol. 2022 Oct 3;187(5):675-683. doi: 10.1530/EJE-22-0355.
Mittal M, Ganakumar V. Graves Disease in Childhood. Graves’ Disease. IntechOpen, Dec. 2021. Crossref, doi:10.5772/intechopen.97569.
Muratova Sh., Sattorova M. Population characteristics of thyroid carcinoma in children and adolescents living in conditions of iodine deficiency in the republic of Uzbekistan // 26th European Congress of Endocrinology 2024 European Society of Endocrinology 11–14 May 2024, Stockholm, Sweden https://www.endocrine-abstracts.org/ea/0099/abstract-book/.
Rodanaki M, Lodefalk M, Forssell K, Arvidsson CG, Forssberg M, Åman J. The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden. Horm Res Paediatr. 2019;91(3):195-202. doi: 10.1159/000500265.
Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015 Apr;3(4):286-95. doi: 10.1016/S2213-8587(14)70225-6.
