AIM: Hashimoto thyroiditis (HT) is the most common cause of goiter and acquired hypothyroidism in children and adoles-
cents living in iodine-sufficient regions. In this study, we aimed to investigate the coexistence of other accompanying auto-
immune diseases in patients aged 5–18 years who were diagnosed and followed up at the Pediatric Endocrinology Clinic of
our hospital.
MATERIAL AND METHODS: A total of 220 patients aged 5–18 years who were diagnosed with HT at the Pediatric Endocri-AIM: Hashimoto thyroiditis (HT) is the most common cause of goiter and acquired hypothyroidism in children and adolescents living in iodine-sufficient regions. In this study, we aimed to investigate the coexistence of other accompanying autoimmune diseases in patients aged 5–18 years who were diagnosed and followed up at the Pediatric Endocrinology Clinic of our hospital. MATERIAL AND METHODS: A total of 220 patients aged 5–18 years who were diagnosed with HT at the Pediatric Endocrinology Clinic of the University of Health Sciences Ankara City Hospital. Patient’ age at admission, sex, family history, complaints at admission, comorbidities, physical examination and laboratory findings, and clinical follow-up information were retrospectively reviewed. RESULTS: Of the 220 patients, 77.7% were female and 22.2% were male, with a mean age of 13.8±3.3 years. Of the 51.4 had euthyroidism, 40.4% had subclinical hypothyroidism,and 8.2% had overt hypothyroidism, respectively. Anti-thyroid peroxidase antibody was detected in 97% of patients and anti-thyroglobulin antibody (anti-Tg) was detected in 74% of patients. There was a family history of autoimmune disease in 36.4% of the patients. Autoimmune disease were present in 45 patients (20.4%). The most common autoimmune diseases in the patients were type 1 diabetes mellitus (T1DM) (14%), celiac disease  (5%), skin diseases (2.7%), and rheumatologic diseases (1.3%). No statistically significant differences were found between the sex, age at diagnosis, current age, family history of autoimmune disease and thyroid function status of patients with HT and T1DM. The mean age of the patients followed up with HT with and without additional autoimmune disease was similar (p=0.644). In both groups, female sex was dominant. However, the number of male patients (35.6%) in the group with additional autoimmune disease was statistically significantly elevated than the group without autoimmune disease (19.9%) (p=0.016). The rate of subclinical hypothyroidism was statistically significantly elevated in the group without additional autoimmune disease (p<0.001). A statistically significant relationship was found between elevated Anti-Tg and additional autoimmune disease (OR=2.32 (95% CI; 1.16–4.56). The prevalence of additional autoimmune disease was increased 2.32 times in patients with elevated anti-Tg levels. There was no statistically significant correlation between the sex of the patients, their thyroid function status and thyroid autoantibodies (p=0.507). However, the prevalence of celiac disease was statistically significantly elevated in female patients (43.5%) than in male patients (6.7%) (p=0.014). In addition, the prevalence of T1DM was found to be statistically significantly elevated in males (93.8%) compared to females (52.2%) (p=0.007). 13.3% of patients with additional autoimmune disease were under the age of 10 and 64.4% were above the age of 10, this was statistically significant (p<0.01). T1DM was the most common autoimmune disease in both groups. CONCLUSION: As shown in our study, autoimmune diseases, especially T1DM and celiac disease, are associated with HT. It should be kept in mind that there is an increased risk of autoimmune disease in HT that affects both sexes and increases with age. In particular, regular follow-up of HT patients with elevated anti-Tg levels in terms of autoimmune disease development is important in terms of earlier diagnosis of diseases and reducing their morbidity
nology Clinic of the University of Health Sciences Ankara City Hospital. Patient’ age at admission, sex, family history, com-
plaints at admission, comorbidities, physical examination and laboratory findings, and clinical follow-up information were
retrospectively reviewed.
RESULTS: Of the 220 patients, 77.7% were female and 22.2% were male, with a mean age of 13.8±3.3 years. Of the 51.4 had
euthyroidism, 40.4% had subclinical hypothyroidism,and 8.2% had overt hypothyroidism, respectively. Anti-thyroid perox-
idase antibody was detected in 97% of patients and anti-thyroglobulin antibody (anti-Tg) was detected in 74% of patients.
There was a family history of autoimmune disease in 36.4% of the patients. Autoimmune disease were present in 45 pa-
tients (20.4%). The most common autoimmune diseases in the patients were type 1 diabetes mellitus (T1DM) (14%), celiac
disease (5%), skin diseases (2.7%), and rheumatologic diseases (1.3%). No statistically significant differences were found
between the sex, age at diagnosis, current age, family history of autoimmune disease and thyroid function status of patients
with HT and T1DM.
The mean age of the patients followed up with HT with and without additional autoimmune disease was similar (p=0.644).
In both groups, female sex was dominant. However, the number of male patients (35.6%) in the group with additional au-
toimmune disease was statistically significantly elevated than the group without autoimmune disease (19.9%) (p=0.016).
The rate of subclinical hypothyroidism was statistically significantly elevated in the group without additional autoimmune
disease (p<0.001). A statistically significant relationship was found between elevated Anti-Tg and additional autoimmune
disease (OR=2.32 (95% CI; 1.16–4.56). The prevalence of additional autoimmune disease was increased 2.32 times in patients
with elevated anti-Tg levels.
There was no statistically significant correlation between the sex of the patients, their thyroid function status and thyroid
autoantibodies (p=0.507). However, the prevalence of celiac disease was statistically significantly elevated in female patients
(43.5%) than in male patients (6.7%) (p=0.014). In addition, the prevalence of T1DM was found to be statistically significantly
elevated in males (93.8%) compared to females (52.2%) (p=0.007). 13.3% of patients with additional autoimmune disease
were under the age of 10 and 64.4% were above the age of 10, this was statistically significant (p<0.01). T1DM was the most
common autoimmune disease in both groups.
CONCLUSION: As shown in our study, autoimmune diseases, especially T1DM and celiac disease, are associated with HT.
It should be kept in mind that there is an increased risk of autoimmune disease in HT that affects both sexes and increases
with age. In particular, regular follow-up of HT patients with elevated anti-Tg levels in terms of autoimmune disease develop-
ment is important in terms of earlier diagnosis of diseases and reducing their morbidity.
KEYWORDS: Hashimoto thyroiditis. Autoimmune disease. Type 1 diabetes mellitus. Anti-thyroid peroxidase antibody. Anti-thyroglobulin
antibody.
AUTOIMMUNE DISEASES ACCOMPANYING HASHIMOTO THYROIDITIS IN PEDIATRIC
PATIENTS
Received: 25.04.2022. Accepted: 11.05.2022.© Endocrinology Research Centre, 2022
Клиническая и экспериментальная тиреоидология 2022;18(1):15-20 Clinical and experimental thyroidology. 2022;18(1):15-20doi: https://doi.org/10.14341/ket12720
*Автор, ответственный за переписку / Corresponding author.
INTRODUCTION
HT is the most common cause of goiter and acquired hy-
pothyroidism in children and adolescents in regions where
iodine exists at sufficient amounts. Although autoimmunity
plays roles in the pathogenesis, genetic predisposition and
environmental factors are also important [1].
Patients are diagnosed with the presence of goiter and
increased thyroid autoantibodies in sera. The application
to a physician may be because of clinical findings based
on decreased thyroid functions e.g. goiter, weakness, dry
skin, constipation, decreased academic performance or
non-thyroid causes e.g. alopecia, vitiligo, atopy, and depres-
sion. In HT, clinical manifestation may range from euthy-
roidism to overt hypothyroidism and hyperthyroidism [2].
It is already known that cellular and humoral immune
response play roles in the etiopathogenesis of HT, and in its
association with other autoimmune diseases [3]. There are
few studies reporting that HT may be associated with
non-thyroid autoimmune diseases. Most studies, which in-
vestigated the coexistence of HT and other autoimmune
diseases, were conducted in the adult patient population,
and examined the prevalence of HT in nonthyroid autoim-
mune diseases [4, 5].