Predictors for thyroid dysfunction after discontinuation of levothyroxine in children and adolescents with Hashimoto thyroiditis.

IF 2.8 Q3 ENDOCRINOLOGY & METABOLISM
Min Jee Kim, Yun Jeong Lee, Yunsoo Choe, Choong Ho Shin, Young Ah Lee
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引用次数: 0

Abstract

Purpose: Few data on the clinical course after levothyroxine (L-T4) discontinuation in pediatric patients with Hashimoto thyroiditis (HT) are available. We investigated outcomes and predictors for successful withdrawal from L-T4 among children with HT.

Methods: Among 168 patients diagnosed with HT between January 2000 and March 2021 at Seoul National University Children's Hospital and in whom L-T4 therapy was initiated during childhood, we attempted to discontinue this therapy in 47, 3 boys and 44 girls. L-T4 was restarted when patients developed overt or subclinical hypothyroidism (thyroid-stimulating hormone [TSH] levels≥10 mIU/L) after L-T4 discontinuation.

Results: Median age at discontinuation was 15.4 years (12.7-18.4 years) with a median duration of L-T4 therapy of 47 months (20.3-80.3 months). During the median 30 months of follow-up (10.6-61.0 months) after L-T4 discontinuation, 33 (70.2%) developed thyroid dysfunction. Among these patients, 17 were eventually restarted on L-T4. TSH levels over 50 mIU/L at L-T4 initiation (hazard ratio, HR 3.5, P=0.002), age under 12 years at L-T4 discontinuation (HR 11.1, P=0.0001), and TSH levels higher than the upper 50% of normal (above 2.25 mIU/L in the present study) at L-T4 discontinuation (HR 2.7, P=0.014) were significantly predictive for overt hypothyroidism or subclinical hypothyroidism after L-T4 discontinuation. In addition, age under 12 years at L-T4 discontinuation was only predictive factor for restarting L-T4 medication (HR 4.3, P=0.012).

Conclusion: L-T4 discontinuation in pediatric patients with HT resulted in thyroid dysfunction in 70.2% of cases; 36.2% of patients who attempted discontinuation required resumption of L-T4. Older age and lower TSH levels at L-T4 discontinuation were advantageous for successful withdrawal.

桥本氏甲状腺炎儿童和青少年停用左甲状腺素后出现甲状腺功能障碍的预测因素。
研究目的有关桥本氏甲状腺炎(HT)儿童患者停用左甲状腺素(L-T4)后的临床过程的数据很少。我们调查了桥本甲状腺炎儿童患者成功停用左旋甲状腺素(L-T4)的结果和预测因素:2000年1月至2021年3月期间,首尔国立大学儿童医院诊断出168名儿童期开始接受L-T4治疗的桥本甲状腺炎患者。如果患者在停用 L-T4 后出现明显或亚临床甲状腺功能减退(促甲状腺激素 [TSH] 水平≥10 mIU/L),则重新开始 L-T4:中位停药年龄为 15.4 岁(12.7-18.4 岁),中位 L-T4 治疗时间为 47 个月(20.3-80.3 个月)。在停用 L-T4 后中位 30 个月(10.6-61.0 个月)的随访期间,33 名患者(70.2%)出现了甲状腺功能障碍。其中,17 名患者最终重新开始服用 L-T4。开始使用 L-T4 时 TSH 水平超过 50 mIU/L(危险比,HR 3.5,P=0.002),停用 L-T4 时年龄小于 12 岁(HR 11.1,P=0.0001),TSH 水平高于正常值的上 50%(本研究中高于 2.25 mIU/L)(HR 2.7,P=0.014)均可显著预测L-T4停用后是否会出现明显的甲状腺功能减退或亚临床甲状腺功能减退。此外,停用L-T4时年龄小于12岁是重新开始服用L-T4药物的唯一预测因素(HR 4.3,P=0.012):结论:70.2%的儿童高血压患者停用L-T4会导致甲状腺功能障碍;36.2%试图停用L-T4的患者需要重新开始服用L-T4。停用L-T4时年龄较大和TSH水平较低有利于成功停药。
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来源期刊
CiteScore
4.00
自引率
18.20%
发文量
59
审稿时长
24 weeks
期刊介绍: The Annals of Pediatric Endocrinology & Metabolism Journal is the official publication of the Korean Society of Pediatric Endocrinology. Its formal abbreviated title is “Ann Pediatr Endocrinol Metab”. It is a peer-reviewed open access journal of medicine published in English. The journal was launched in 1996 under the title of ‘Journal of Korean Society of Pediatric Endocrinology’ until 2011 (pISSN 1226-2242). Since 2012, the title is now changed to ‘Annals of Pediatric Endocrinology & Metabolism’. The Journal is published four times per year on the last day of March, June, September, and December. It is widely distributed for free to members of the Korean Society of Pediatric Endocrinology, medical schools, libraries, and academic institutions. The journal is indexed/tracked/covered by web sites of PubMed Central, PubMed, Emerging Sources Citation Index (ESCI), Scopus, EBSCO, EMBASE, KoreaMed, KoMCI, KCI, Science Central, DOI/CrossRef, Directory of Open Access Journals(DOAJ), and Google Scholar. The aims of Annals of Pediatric Endocrinology & Metabolism are to contribute to the advancements in the fields of pediatric endocrinology & metabolism through the scientific reviews and interchange of all of pediatric endocrinology and metabolism. It aims to reflect the latest clinical, translational, and basic research trends from worldwide valuable achievements. In addition, genome research, epidemiology, public education and clinical practice guidelines in each country are welcomed for publication. The Journal particularly focuses on research conducted with Asian-Pacific children whose genetic and environmental backgrounds are different from those of the Western. Area of specific interest include the following : Growth, puberty, glucose metabolism including diabetes mellitus, obesity, nutrition, disorders of sexual development, pituitary, thyroid, parathyroid, adrenal cortex, bone or other endocrine and metabolic disorders from infancy through adolescence.
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