VARIATIONS IN CLINICAL, HORMONAL AND SEROLOGICAL EXPRESSIONS OF CHRONIC LYMPHOCYTIC THYROIDITIS (CLT) IN CHILDREN AND ADOLESCENTS

Abstract

SUMMARY A diagnosis of chronic lymphocytic thyroiditis (CLT) was made in forty‐two children and adolescents according to Fisher's criteria. The age of the group ranged between 4±3 and 18±5 years. On the basis of serum TSH, T4 and RAI uptake, three groups of patients were distinguished at the time of diagnosis: 1, euthyroid group ( n = 3) with normal TSH and T4; 2, hypothyroid group ( n = 36) with high values of TSH, where three subgroups were distinguished: (a) compensated hypothyroidism ( n = 14) with normal T4, (b) overt hypothy‐roidism with high or normal RAI uptake and low T4 ( n = 19), (c) overt hypothyroidism with low RAI uptake and low T4 ( n = 3); 3, Hyperthyroid group ( n = 3) with high T4. In CLT, variability is a feature not only of the initial presentation, but also of the subsequent evolution of the disease. Sixteen patients were followed for periods between 4 months and 6 years. Thyroid function did not change in six. Six patients with compensated or overt hypothyroidism improved, four became euthyroid with normal basal TSH and T4 values, however, all three tested had an exaggerated response to TRH. Three patients who were initially hyperthyroid progressed to a state of compensated hypothyroidism. One patient with overt hypothyroidism on presentation developed hyperthyroidism after 15 months and became hypothyroid once more 8 months later. The variable clinical course of CLT is characteristic of immunological disturbances.