Die Autoimmunthyreoiditis bei Kindern und Jugendlichen: Klinische und biochemische Befunde bei 34 Patienten

Zusammenfassung:

Die Autoimmunthyreoiditis (AT) ist die häufigste Ursache der nichtendemischen Struma und der erworbenen Hypothyreose bei Kindern und Jugendlichen. Ausgehend von einer zunehmenden Diagnosehäufigkeit in den letzten Jahren, analysierten wir retrospektiv die klinischen, biochemischen und sonographischen Befunde von 34 Patienten mit AT, die zwischen 1989 und 1998 behandelt wurden. Die Diagnose der AT wurde durch eine tastbare Struma oder klinische Zeichen der Schilddrüsenfehlfunktion und positive Autoantikörper gegen Schilddrüsengewebe gestellt.

Die Diagnosehäufigkeit der AT hat in unserer Klinik seit 1995 um das dreifache zugenommen. Das Alter bei Diagnose war 5,4 bis 16,3 Jahre (Median 11,3). Eine tastbare Schilddrüsenvergrößerung bestand bei 29 (85 %) unserer Patienten. Drei Patienten hatten ein Myxödem ohne Struma. Die Symptomdauer betrug 6 Wochen bis 7,5 Jahre: Median aller Patienten 6 Monate, Median der hypothyreoten Patienten 9 Monate. Bei Diagnose hatten 15 Patienten eine Hypothyreose, 3 waren hyperthyreot und 7 hatten normale Schilddrüsenwerte. Bei 9 Patienten bestand eine isolierte Erhöhung von Thyreotropin. 12 Patienten waren bei Diagnose präpubertär (Tanner I), 15 Patienten waren pubertär (Tanner II - IV). Bei 5 Patienten bestand eine Dissoziation der Pubertätsentwicklung. Der Ultraschall der Schilddrüse zeigte eine echoarme und inhomogene Struktur in 32 Patienten. 30 Patienten wurden mit Thyroxin behandelt. Patienten mit persistierender Hyperthyreose wurden mit Carbimazol behandelt. Im Verlauf nahm die Schilddrüsenvergrößerung bei einem Drittel der Patienten ab.

Die AT gewinnt eine zunehmende Bedeutung in der Differentialdiagnose der Schilddrüsenvergrößerung. Der hohe Anteil hypothyreoter Patienten ist durch eine verzögerte Diagnose verursacht. Die frühe Diagnose und Therapie der AT sollte die Prävention der Hypothyreose ermöglichen.

Autoimmune thyroiditis (AT) is the most common cause of nonendemic thyromegaly and aquired hypothyroidism in childhood and adolescence. Outgoing from an increasing number of newly diagnosed patients during the last years we performed a retrospective analysis including 34 patients treated between 1989 and 1998. Clinical data, laboratory and sonographical findings are described. Cases were ascertained by palpable thyroid enlargement or clinical signs of thyroid dysfunction and positive autoantibodies against thyroid tissue. Frequency of AT diagnosis has threefold increased since 1995 in our department. Age at diagnosis was 5.4 to 16.3 years (median 11.3). Palpable thyromegaly was present in 29 (85 %) of our patients. Three patients had myxedema without goiter. Symptoms had been present for a period between 6 weeks and 7.5 years: median in all patients 6 months, median in hypothyroid patients 9 months. At time of diagnosis 15 patients suffered from hypothyroidism, 3 from hyperthyroidism and 7 patients showed normal levels of thyroid hormones. In 9 patients we found an isolated elevation of thyrotropin. 12 patients were prepubertal (Tanner I), 15 patients were pubertal (Tanner II - IV). 5 patients showed a dissociation of pubertal maturation. Ultrasound of thyroid gland showed an inhomogeneous and hypoechoic pattern in 32 patients. 30 patients were treated with thyroxine. Patients with persistent hyperthyroidism were treated with carbimazol. During the follow-up period enlargement of the thyroid gland decreased in one third of the patients. Thyromegaly caused by autoimmune thyroiditis gets an increasing importance. The high degree of obviously hypothyroid patients at the time of diagnosis reflects a delay of diagnosis. Early recognition and treatment of the disease should be achieved for a preventive care of hypothyroidism.

Schlüsselwörter:

Autoimmunthyreoiditis - Struma - Hypothyreose - Hyperthyreose

Key words:

Autoimmune thyroiditis - goiter - hypothyroidism - hyperthyroidism

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