Tiroiditis de Hashimoto: manifestaciones clínicas, bioquímicas y su asociación con enfermedades autoinmunes y no autoinmunes / Hashimoto's thyroiditis: clinical and biochemical manifestations and their association with autoimmune and non-autoimmune diseases

Introducción: la tiroiditis de Hashimoto es la causa más frecuente de disfunción tiroidea en niños, con una incidencia del 1 al 2%. Esta enfermedad autoinmune suele estar relacionada con otras patologías. El objetivo es determinar si existen asociaciones en pacientes pediátricos con tiroiditis de Hashimoto tanto clínicas, como bioquímicas, con otras enfermedades para establecer directrices para su detección y tratamiento oportuno. Material y métodos: estudio observacional descriptivo y transversal en un periodo de 15 años de pacientes con diagnóstico de tiroiditis de Hashimoto menores de 15 años que llevaron seguimiento en la Unidad Médica de Alta Especialidad #25 de Monterrey, Nuevo León, México. Se analizaron variables como antecedentes heredofamiliares de enfermedad tiroidea, autoinmune o neoplásica, sexo, edad, motivo de consulta, función tiroidea en el momento del diagnóstico y la presencia de comorbilidades autoinmunes y no autoinmunes. Resultados: se analizaron 110 pacientes. El motivo de consulta más frecuente en el momento del diagnóstico fue una detección casual de hormona estimulante de la glándula tiroides (TSH) elevada. El 80% debutó con un hipotiroidismo franco bioquímico. El 26% de los pacientes presentó una segunda enfermedad autoinmune no tiroidea, donde predominó la diabetes mellitus tipo 1 en un 18% y, con menor frecuencia, otras como vitíligo, lupus eritematoso sistémico y enfermedad de Addison. La obesidad fue la comorbilidad no autoinmune más frecuente. Conclusiones: los pacientes pediátricos con tiroiditis de Hashimoto tienen alto riesgo de presentar una enfermedad autoinmune no tiroidea, principalmente diabetes mellitus tipo 1. Se encontró que los pacientes en edad pediátrica de sexo masculino con tiroiditis de Hashimoto tienen alto riesgo de desarrollar una enfermedad autoinmune no tiroidea (AU)

Introduction: Hashimoto thyroiditis is the most frequent cause of thyroid dysfunction in children, with an incidence of 1 to 2%. This autoimmune disease is usually associated with other pathologies. The objective of the study was to determine whether Hashimoto thyroiditis (clinical or biochemical) is associated with other diseases in paediatric patients, and to establish guidelines for early detection and treatment.Material and methods: we conducted a cross-sectional observational and descriptive study over a 15-year period in patients with Hashimoto thyroiditis aged less than 15 years managed by Specialty Care Unit #25 in a north-eastern region in Mexico. We analysed variables such as the familial clustering or history of thyroid, autoimmune or malignant disease, sex, age, reason for seeking medical care, thyroid function at diagnosis and the presence of autoimmune and non-autoimmune comorbidities.Results: the sample included 110 patients. The most frequent reason for seeking care at the time of diagnosis was the chance detection of TSH elevation. Eighty percent had onset with overt biochemical hypothyroidism. Twenty-six percent of patients had an associated non-thyroid autoimmune disease, most frequently type 1 diabetes mellitus, found in 18%, followed by others such as vitiligo, systemic lupus erythematosus and Addison disease. Obesity was the most frequent non-autoimmune comorbidity.Conclusions: paediatric patients with Hashimoto thyroiditis are at high risk of non-thyroid autoimmune disease, chiefly type 1 diabetes mellitus. We found that male paediatric patients with Hashimoto thyroiditis were at high risk of having non-thyroid autoimmune disease. (AU)

Alteraciones puberales en adolescentes con leucemia en fase de vigilancia.

OBJECTIVE: To evaluate which factors are associated with alterations in pubertal development in pediatric patients with leukemia in the surveillance phase. METHOD: A case-control study was carried out, including patients aged 8-14 years with diagnosis of acute lymphoblastic leukemia under surveillance. Demographic data were collected, age at diagnosis, type of leukemia, risk of leukemia, duration and type of treatment received, time of surveillance phase; and pubertal development was assessed by Tanner stage, bone age, pelvic ultrasound for women, and LH levels. Fisher's exact test and Mann-Whitney U-test were used. RESULTS: Twenty-five pediatric patients with a diagnosis of acute lymphoblastic leukemia between 8 and 14 years of age with a median of 8 were included, only 4 (16%) presented pubertal alterations, 1 had pubertal delay and 3 advanced puberty. The history of radiotherapy was related to pubertal alterations (p = 0.03). CONCLUSIONS: The antecedent of having received radiotherapy as part of the treatment in patients with acute lymphoblastic leukemia is a risk factor for developing pubertal abnormalities.

[Factors associated with advanced thyroid cancer in pediatric patients in a high specialty medical unit in Northeast Mexico]. / Factores asociados a estadios avanzados de cáncer tiroideo en pacientes pediátricos de una UMAE del noreste de México.

INTRODUCTION: Thyroid cancer represents 2% of all childhood malignances. Its incidence rises 1.1% per year. In comparison with adults, childhood thyroid cancer is detected in a more advanced stage, but with a survival rate above 95%. The objective of this study was to evaluate whether there are factors associated with advanced stages of thyroid cancer in pediatric patients. RESULTS: Nineteen patients were included, 13 (68.4%) were female and six male, all between 7-15 years, with a median of 11 years. Fifteen in advanced and four in early stage. The median age of patients in advanced stage at time of diagnosis was 10.6 years (7-15) and 13.2 (12-14) were in early stage (p=0.075). There was a delay of nine months to get a diagnosis in advanced stage, and 7.2 in early stage (p=0.931). Three of the patients with advanced stage and two with early stage were from Nuevo León (Mexico) and the rest were foreign (p=0.567). In the group with advanced stage, two had thyroid cancer familiar history, and none in the early stage group (p=0.452). Nine patients in advanced stage and three in early stage presented thyroid nodule as the first sign of illness. Six patients in advanced stage and one in early stage presented goiter (p=0.590). None of the studied patients had radiation history. Six patients in advanced stage and one in early stage suffered from Hashimoto's Thyroiditis (p=0.590). Eleven in advanced stage and one in early stage had papillary histologic variety. Four in advanced stage and three in early stage had papillary histologic variety with a follicular patter (p=0.083). Eight patients presented lung metastasis at time of diagnosis (p=0.061). CONCLUSIONS: There are no factors associated with advanced stage thyroid cancer in pediatric populations. Although half of studied patients presented lung metastasis, treatment response and survival is satisfactory.