Clinical Pattern of Acquired Thyroid Disorders in Childhood and Adolescents Attending Endocrine Unit, Tripoli Children Hospital

Background and Aims: Thyroid disorders are one of the endocrine disorders commonly encountered in childhood and adolescence and they manifest with alternations in thyroid hormone secretions, goitre or both. Normal thyroid gland function is critical for early neurocognitive development, as well as for growth and development throughout childhood and adolescence.

This study was aimed to describe the clinical pattern of acquired thyroid disorders in children and adolescents.

Study Design: A descriptive cross-sectional hospital based study.

Place and Duration of Study: The study was conducted at the Tripoli Children hospital from January 2000 to December 2012.

Methodology: All Patients aged between 1- 18 with thyroid disorders, attending the pediatric endocrine clinic were included, the diagnosis of thyroid disorders was based on clinical features, thyroid function tests and anti-thyroid antibodies test. Data included age, gender, clinical features, duration of symptoms before diagnosis, results of investigations including blood tests, bone age x-ray and result of brain Magnetic Resonance Imaging (MRI), family history of autoimmune disease and any associated problem. Data were analysed using the SPSS program.

Results: During 12 years period under review, 148 patients (5.9%) had thyroid disorders, 135 (91.22%) patients had hypothyroidism, 11(7.43%) had hyperthyroidism, 2 (1.35%) had a goitre in euthyroid state. Mean age at presentation for primary hypothyroid was 9 + 3.8 years, for secondary hypothyroidism was 7 + 1.5 years, for hyperthyroid was 9.8+ 2.2 years and for euthyroid goitre was 9.2+ 2.1 years. Male to female ratio was 1:1.3. The family history of autoimmune disease was positive in 33 patients (22.3%), in 29 (41.43%) patients of primary hypothyroidism and 4 (100%) patients with Graves' disease were had a positive family history. Mean duration of symptoms before presentation was 0.43+ 0.1 years for primary hypothyroidism and 1.4+0.21 years for secondary hypothyroidism while for patients with hyperthyroidism was 0.7+0.15 years, in two children with euthyroid goitre was 0.8 years. About 31% of patients with hypothyroidism were of short stature followed by fatigability and sleepiness (23.9%). About 64% of patients with hyperthyroidism had goitre and eye signs followed by palpitation and weight loss (54.5%). There were co morbidities in 75 children out of 148 patients as a result of growth hormone deficiency, diabetes mellitus and some other syndromes. Anti-thyroglobulin antibodies were positive in 21(14.2%) patients, Thyro- peroxidase antibodies were positive in 26 (17.6%) patients. Bone age estimation was delayed in 73(49.3%), advanced in 7(4.7%) patients. Brain MRI was done for 46 patients; which showed pituitary hypoplasia in 15.5%, 10.8% had normal brain MRI, in 4.7% of patients MRI showed other findings.

Conclusion: hypothyroidism constituted the greatest proportion of the thyroid disorders in children and short stature is the commonest presenting symptoms of a hypothyroid child, paediatricians should be aware of the need to screen children who present with a short stature for hypothyroidism.