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Kinder- und Jugendmedizin 2005; 5(04): 165-171
DOI: 10.1055/s-0037-1617861
Endokrinologie
Schattauer GmbH

Schilddrüse: Hypo- und Hyperthyreose im Kindes- und Jugendalter

Thyroid: hypo- and hyperthyroidism in childhood and adolescence
Beate Karges
1   Universitätsklinik für Kinder- und Jugendmedizin Ulm (Direktor: Prof. Dr. med. K.-M. Debatin)
,
Roland Pfäffle
2   Universitätsklinik und Poliklinik für Kinder und Jugendliche Leipzig (Direktor: Prof. Dr. med. W. Kiess)
,
Wolfram Karges
3   Medizinische Universitätsklinik, Abteilung Innere Medizin 1, Universität Ulm (Direktor: Prof. Dr. med. G. Adler)
› Author Affiliations
Further Information

Publication History

Eingegangen: 19 April 2005

angenommen: 13 May 2005

Publication Date:
11 January 2018 (online)

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Zusammenfassung

Funktionsstörungen der Schilddrüse (SD) gehören zu den häufigsten endokrinen Erkrankungen im Kindes- und Jugendalter. Ihre Erkennung und frühzeitige Behandlung ist notwendig, um ein altersentsprechendes Wachstum und eine normale psychomotorische Entwicklung zu gewährleisten. Während die angeborene primäre Hypothyreose durch das Neugeborenen-TSH-Screening entdeckt wird, bleibt die Erkennung der zentralen Hypothyreose eine klinische Herausforderung. Die häufigste Ursache der erworbenen Hypothyreose ist die Autoimmunthyreoiditis, die durch den Nachweis von SD-Autoantikörpern und ihr typisches Ultraschallbild diagnostiziert wird. Auch die Hyperthyreose im Kindes- und Jugendalter entsteht vorwiegend durch autoimmune Mechanismen (Basedow-Erkrankung) mit TSHRezeptor-Antikörpern (TRAK) und einem oft chronisch-rezidivierenden Verlauf. Bei fehlendem Antikörpernachweis kann hingegen eine konstitutive Aktivierung des TSH-Rezeptors vorliegen. Die Identifizierung dieser und anderer genetischer Defekte hat in den letzten Jahren wesentlich zum molekularen Verständnis von Entwicklung und Funktion der SD beigetragen.

Summary

Functional thyroid disorders are among the most frequent endocrine diseases in childhood and adolescence. Early detection and treatment is mandatory to ensure normal growth and psychomotor development of affected children. While congenital primary hypothyroidism is readily identified by TSH-based neonatal screening, the detection of central hypothyroidism remains a clinical challenge. Autoimmune thyroiditis is the most frequent cause of acquired hypothyroidism in infancy. The diagnosis is based on detection of thyroid autoantibodies and typical ultrasonographic findings. Hyperthyroidism in infancy is predominantly caused by autoimmune mechanisms (Graves’ disease) characterized by antibodies against the TSH-receptor and a chronic-relapsing clinical course. Antibody-negative hyperthyroidism may be caused by activating TSH-receptor mutations. The identification of this and other genetic defects in recent years has improved the molecular understanding of thyroid development and function.

Schlüsselwörter

Schilddrüse - Hypothyreose - Hyperthyreose - Autoimmunthyreoiditis - Basedow-Erkrankung

Keywords

Thyroid - hypothyroidism - hyperthyroidism - autoimmune thyroiditis - Graves’ disease
 

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