Growth in Autoimmune Thyroiditis: Clinical Features, Controversies, and Outcomes in the Pediatric Population

  • Susan Demartini
  • Mark D. DeBoer


Chronic lymphocytic thyroiditis (CLT) is an autoimmune process that is the most common cause of acquired hypothyroidism and can lead to severe growth failure. CLT is a frequent hormone abnormality in pediatrics, being present in up to 2.5% of children. Growth failure from severely low levels of thyroid hormone usually occurs as a late finding, because the onset of symptoms is often insidious. Hypothyroidism from CLT is associated with delayed bone age, and early diagnosis and treatment should preserve final height. Nevertheless, initial treatment with a full replacement dose of levothyroxine has been associated with rapid advancement of the bone age and a compromise in final adult height. Additionally, treatment of CLT with severe bone age delay during puberty may result in a decreased final height. Because of the relatively high incidence of the condition and the non-specific nature of many of the symptoms, physicians caring for children are encouraged to keep a low threshold for checking thyroid function in children. Though data are few, early discovery and treatment of the disease is felt to avoid significant growth effects.


Obese Child Subclinical Hypothyroidism Adult Height Congenital Hypothyroidism Autoimmune Thyroiditis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Adenosine monophosphate


Bone age


Body mass index


Chronic lymphocytic thyroiditis


Follicle-stimulating hormone


Human chorionic gonadotropin


Height age


Human leukocyte antigen


Subclinical hypothyroidism


Standard deviation score


Thyrotropin-releasing hormone


TSH receptor blocking antibody


Thyroid-stimulating hormone


Thyroid-stimulating immunoglobulin


  1. Beierwaltes WH. Incomplete growth associated with hypothyroidism. J Clin Endocrinol Metab. 1954;14:1551–9.PubMedCrossRefGoogle Scholar
  2. Bhowmick SK, Dasari G, Levens KL, Rettig KR. The prevalence of elevated serum thyroid-stimulating hormone in childhood/adolescent obesity and of autoimmune thyroid diseases in a subgroup. J Natl Med Assoc. 2007;99:773–6.PubMedGoogle Scholar
  3. Boersma B, Otten BJ, Stoelinga GBA, Wit JM. Catch-up growth after prolonged hypothyroidism. Eur J Pediatr. 1996;155:362–7.PubMedCrossRefGoogle Scholar
  4. Bongers-Schokking JJ, de Muinck Keizer-Schrama SM. Influence of timing and dose of thyroid hormone replacement on mental, psychomotor, and behavioral development in children with congenital hypothyroidism. J Pediatr. 2005;147:768–74.PubMedCrossRefGoogle Scholar
  5. Brown RS, Bellisario RL, Botero D, Fournier L, Abrams CA, Cowger ML, David R, Fort P, Richman RA. Incidence of transient congenital hypothyroidism due to maternal thyrotropin receptor-blocking antibodies in over one million babies. J Clin Endocrinol Metab. 1996;81:1147–51.PubMedCrossRefGoogle Scholar
  6. Counts D, Varma SK. Hypothyroidism in children. Pediatr Rev. 2009;30(7):251–8.Google Scholar
  7. Dallas JS. Autoimmune thyroid disease and pregnancy: relevance for the child. Autoimmunity. 2003;36:339–50.Google Scholar
  8. de Vries L, Bulvik S, Phillip M. Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up. Arch Dis Child. 2009;94:33–7.PubMedCrossRefGoogle Scholar
  9. Demirbilek H, Kandemir N, Gonc EN, Ozon A, Alikasifoglu A, Yordam N. Hashimoto’s thyroiditis in children and adolescents: a retrospective study on clinical, epidemiological and laboratory properties of the disease. J Pediatr Endocrinol Metab. 2007;20:1199–205.PubMedCrossRefGoogle Scholar
  10. Dimitropoulos A, Molinari L, Etter K, Torresani T, Lang-Muritano M, Jenni OG, Largo RH, Latal B. Children with congenital hypothyroidism: long-term intellectual outcome after early high-dose treatment. Pediatr Res. 2009;65:242–8.PubMedCrossRefGoogle Scholar
  11. Eliakim A, Barzilai M, Wolach B, Nemet D. Should we treat elevated thyroid stimulating hormone levels in obese children and adolescents? Int J Pediatr Obes. 2006;1:217–21.PubMedCrossRefGoogle Scholar
  12. Foley TP, Abbassi V, Copeland KC, Draznin MB. Brief report: hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. N Engl J Med. 1994;330:466–8.PubMedCrossRefGoogle Scholar
  13. Gopalakrishnan S, Chugh PK, Chhillar M, Ambardar VK, Sahoo M, Sankar R. Goitrous autoimmune thyroiditis in a pediatric population: a longitudinal study. Pediatrics. 2008;122:e670–4.PubMedCrossRefGoogle Scholar
  14. Kaloumenou I, Mastorakos G, Alevizaki M, Duntas LH, Mantzou E, Ladopoulos C, Antoniou A, Chiotis D, Papassotiriou I, Chrousos GP, Dacou-Voutetakis C. Thyroid autoimmunity in schoolchildren in an area with long-standing iodine sufficiency: correlation with gender, pubertal stage, and maternal thyroid autoimmunity. Thyroid. 2008;18:747–54.PubMedCrossRefGoogle Scholar
  15. Kendle FW. Case of precocious puberty in a female cretin. BMJ. 1905;1:246.PubMedCrossRefGoogle Scholar
  16. Lomenick JP, El-Sayyid M, Smith WJ. Effect of levo-thyroxine treatment on weight and body mass index in children with acquired hypothyroidism. J Pediatr. 2008;152:96–100.PubMedCrossRefGoogle Scholar
  17. Maenpaa J, Raatikka J, Rasanen J, Taskinen E, Wager O. Natural course of juvenile autoimmune thyroiditis. J Pediatr. 1985;107:898–904.PubMedCrossRefGoogle Scholar
  18. Oerbeck B, Sundet K, Kase BF, Heyerdahl S. Pediatrics. Congenital hypothyroidism: influence of disease severity and L-thyroxine treatment on intellectual, motor, and school-associated outcomes in young adults. 2003;112:923–30.PubMedCrossRefGoogle Scholar
  19. Pantsiotou S, Stanhope R, Uruena M, Preece MA, Grant DB. Growth prognosis and growth after menarche in primary hypothyroidism. Arch Dis Child. 1991;66:838–40.CrossRefGoogle Scholar
  20. Radetti G, Gottardi E, Bona G, Corrias A, Salardi S, Loche S. The natural history of euthyroid Hashimoto’s thyroiditis in children. J Pediatr. 2006;149:827–32.PubMedCrossRefGoogle Scholar
  21. Rallison ML, Dobyns BM, Meikle AW, Bishop M, Lyon JL, Stevens W. Natural history of thyroid abnormalities: prevalence, incidence, and regression of thyroid diseases in adolescents and young adults. Am J Med. 1991;91:363–70.PubMedCrossRefGoogle Scholar
  22. Reinehr T, deSousa G, Andler W. Hyperthyrotropinemia in obese children is reversible after weight loss and is not related to lipids. J Clin Endocrinol Metab. 2006;91:3088–91.PubMedCrossRefGoogle Scholar
  23. Rivkees SA, Bode HH, Crawford JD. Long-term growth in juvenile acquired hypothyroidism: the failure to achieve normal adult stature. N Engl J Med. 1988;318:599–602.PubMedCrossRefGoogle Scholar
  24. Ryan GL, Feng X, d’Alva B, Zhang M, Van Voorhis BJ, Pinto EM, Kubias AEF, Antonini SR, Latronico AC, Segaloff DL. Evaluating the roles of follicle-stimulating hormone receptor polymorphisms in gonadal hyperstimulation associated with severe juvenile primary hypothyroidism. J Clin Endocrinol Metab. 2007;92:2312–7.PubMedCrossRefGoogle Scholar
  25. Setian N. Hypothyroidism in children: diagnosis and treatment. J Pediatr (Rio J). 2007;83:S209–16.CrossRefGoogle Scholar
  26. Stitchel H, l’Allemand D, Gruters A. Thyroid function and obesity in children and adolescents. Horm Res. 2000;54:14–9.CrossRefGoogle Scholar
  27. Wada K, Kazukawa I, Someya T, Watanabe T, Minamitani K, Minagawa M, Wataki K, Nishioka T, Yasuda T. Maternal hypothyroidism in autoimmune thyroiditis and the prognosis of infants. Endocr J. 2000;47 Suppl:S133–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of VirginiaCharlottesvilleUSA

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