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The autoimmune thyroiditis in children and adolescents. Ethiopathogenetic aspects and clinical outcomes
The autoimmune thyroiditis (AT) and type 1 diabetes are the most frequent autoimmune inflammatory diseases in children and adolescents. AT is a genetically complex disease, the result of the combined effects of polymorfisms of HLA class II genes and polymorphisms of non-HLA genes: CTLA-4, PTPN22, AIRE and / or FoxP3 that are altogether involved in immunological synapses, T-cell activation and immune response regulation. AT may be considered as a model of an autoimmune disease mediated by both humoral and cellular mechanisms. At least two main forms of AT have been described: Hashimoto’s thyroiditis (HT) characterized by rapid increase in thyroid volume and atrophic thyroiditis or spontaneous primary hypothyroidism (idiopathic myxedema) without goiter but with a slight increased, normal or small thyroid gland. The clinical course of AT is variable and may be characterized by spontaneous remission in some adolescents with a self-limited form of HT and by irreversible thyroid insufficiency as the consequence of atrophic and fibrouse transformation of the thyroid gland in other cases. AT may be associated with many other autoimmune endocrine and nonendocrine disorders. The understanding of ethiopathogenetic mechanisms and clinical characteristics of this endocrine desease is particulary important for prompt therapeutical intervention necessary to prevent the effects of autoimmune hypothyroidism on growth and development in children and adolescents.
Key words: autoimmune thyroiditis, hypothyroidism, associated diseases, children and adolescents