Late diagnosis of Hashimoto's thyroiditis and its serious clinical repercussions: Case report
DOI:
https://doi.org/10.33448/rsd-v13i10.47205Keywords:
Hashimoto's thyroiditis, Autoimmune hypothyroidism, Short stature, Pericardial effusion.Abstract
Hashimoto's Thyroiditis is an autoimmune disease, characterized by lymphoplasmic infiltration and atrophy of the thyroid parenchyma, resulting in the decrease or loss of activity of the gland, caused by the presence of antibodies with thyroid antigens. The diagnosis is made through common clinical manifestations, elevated TSH and reduced hormonal activity of the gland with autoantibody positivity. Treatment consists of replacing thyroxine through medication. Late clinical manifestations, such as failure to thrive and cavity effusions, are serious and rare manifestations observed in patients with late diagnosis. The study aims to report the clinical case of a pediatric patient with a late diagnosis of Hashimoto's Thyroiditis and its serious clinical repercussions in the Pediatric Endocrinology service of the Maria Aparecida Pedrossian University Hospital, using electronic medical records and complementary exams performed by the patient. Its purpose is to highlight the importance of early diagnosis of the disease for a better prognosis and quality of life for patients.
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Almani, M. U., Usman, M., Arif, A. W., Ayub, M. T., & Fatima, N. (2020). Rare Presentation of Cardiac Tamponade in a Patient With Subclinical Hypothyroidism. Cureus, 12(12), e12286. https://doi.org/10.7759/cureus.12286
Cyna, W., Wojciechowska, A., Szybiak-Skora, W., & Lacka, K. (2024). The Impact of Environmental Factors on the Development of Autoimmune Thyroiditis-Review. Biomedicines, 12(8), 1788. https://doi.org/10.3390/biomedicines12081788
Decker, T., Schnittka, E., Stolzenberg, L., & Yalowitz, J. (2023). Shear-Wave Elastography for the Diagnosis of Pediatric Hashimoto's Thyroiditis: A Systematic Review and Meta-Analysis. Cureus, 15(2), e35490. https://doi.org/10.7759/cureus.35490
Dong, Y. H., & Fu, D. G. (2014). Autoimmune thyroid disease: mechanism, genetics and current knowledge. European review for medical and pharmacological sciences, 18(23), 3611–3618.
Dujovne, N. V., Gazek, N. A., Lazzati, J. M., Maceiras, M., Belgorosky, A., & Herzovich, V. C. (2019). Predictive outcome measures of adult short stature in patients with severe acquired autoimmune hypothyroidism. Variables predictivas de talla baja adulta en pacientes con hipotiroidismo adquirido grave de origen autoinmune. Archivos argentinos de pediatria, 117(6), 388–391. https://doi.org/10.5546/aap.2019.eng.388
Enoch, M. R., Irfan, M., Budianto, R., & Hardin, A. (2023). Hashimoto's thyroiditis presenting with cardiac tamponade: a case report. The Pan African medical journal, 46, 62. https://doi.org/10.11604/pamj.2023.46.62.41687
Escobar-Morreale, H. F., Botella-Carretero, J. I., Escobar del Rey, F., & Morreale de Escobar, G. (2005). REVIEW: Treatment of hypothyroidism with combinations of levothyroxine plus liothyronine. The Journal of clinical endocrinology and metabolism, 90(8), 4946–4954. https://doi.org/10.1210/jc.2005-0184
Fisfalen, M. E., Palmer, E. M., Van Seventer, G. A., Soltani, K., Sawai, Y., Kaplan, E., Hidaka, Y., Ober, C., & DeGroot, L. J. (1997). Thyrotropin-receptor and thyroid peroxidase-specific T cell clones and their cytokine profile in autoimmune thyroid disease. The Journal of clinical endocrinology and metabolism, 82(11), 3655–3663. https://doi.org/10.1210/jcem.82.11.4336
Gomes Santos, P., Calças Marques, R., Martins Dos Santos, P., Carreira da Costa, C., & Mogildea, M. (2023). Ascites, Pleural, and Pericardial Effusion in Primary Hypothyroidism: A Rare Case Report. Cureus, 15(12), e50429. https://doi.org/10.7759/cureus.50429
Hanley, P., Lord, K., & Bauer, A. J. (2016). Thyroid Disorders in Children and Adolescents: A Review. JAMA pediatrics, 170(10), 1008–1019. https://doi.org/10.1001/jamapediatrics.2016.0486
Hodax, J. K., Topor, L. S., Bialo, S. R., & Quintos, J. B. (2021). Anastrozole Improves Final Adult Height in Severe Hypothyroidism With Rapid Pubertal Progression. Journal of the Endocrine Society, 5(5), bvab025. https://doi.org/10.1210/jendso/bvab025
Iqbal, R., Wilson, J. A., Linn, H. N., Bajwa, A. T., Devi, K., & Devarakonda, P. K. (2024). Cardiac Tamponade in Down's Syndrome Associated With Hypothyroidism: An Uncommon Presentation. Cureus, 16(4), e59023. https://doi.org/10.7759/cureus.59023
Kaur, H., Chakwop Ngassa, H., Elmenawi, K. A., Anil, V., Gosal, H., & Mohammed, L. (2021). Hypothyroidism-Related Cardiac Tamponade. Cureus, 13(10), e18611. https://doi.org/10.7759/cureus.18611
Koca, S. B., & Seber, T. (2023). Factors Affecting Thyroid Elastography in Healthy Children and Patients with Hashimoto’s Thyroiditis. Journal of clinical research in pediatric endocrinology, 15(1), 7–15. https://doi.org/10.4274/jcrpe.galenos.2022.2022-4-5
Lauridsen, M. B., Nærå, R. W., & Leunbach, T. L. (2023). Acquired hypothyroidism in children and adolescents. Ugeskrift for laeger, 185(22), V10220628.
Monte ,O., Longui, C.A., Calliari, E., Kochi, C., et al. (2006) Endocrinologia para o pediatra. (3th ed.). Atheneu
Nebesio, T. D., Wise, M. D., Perkins, S. M., & Eugster, E. A. (2011). Does clinical management impact height potential in children with severe acquired hypothyroidism?. Journal of pediatric endocrinology & metabolism : JPEM, 24(11-12), 893–896. https://doi.org/10.1515/jpem.2011.310
Papakonstantinou, P. E., Gourniezakis, N., Skiadas, C., Patrianakos, A., & Gikas, A. (2018). Massive pericardial effusion without cardiac tamponade due to subclinical hypothyroidism (Hashimoto's disease). Rural and remote health, 18(2), 4384. https://doi.org/10.22605/RRH4384
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Santa Maria/RS. Ed. UAB/NTE/UFSM
Ralli, M., Angeletti, D., Fiore, M., D'Aguanno, V., Lambiase, A., Artico, M., de Vincentiis, M., & Greco, A. (2020). Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmunity reviews, 19(10), 102649. https://doi.org/10.1016/j.autrev.2020.10264
Rivkees, S. A., Bode, H. H., & Crawford, J. D. (1988). Long-term growth in juvenile acquired hypothyroidism: the failure to achieve normal adult stature. The New England journal of medicine, 318(10), 599–602. https://doi.org/10.1056/NEJM198803103181003
Udovcic, M., Pena, R. H., Patham, B., Tabatabai, L., & Kansara, A. (2017). Hypothyroidism and the Heart. Methodist DeBakey cardiovascular journal, 13(2), 55–59. https://doi.org/10.14797/mdcj-13-2-55
Yuan, J., Qi, S., Zhang, X., Lai, H., Li, X., Xiaoheng, C., Li, Z., Yao, S., & Ding, Z. (2023). Local symptoms of Hashimoto's thyroiditis: A systematic review. Frontiers in endocrinology, 13, 1076793. https://doi.org/10.3389/fendo.2022.1076793
Zamwar, U. M., & Muneshwar, K. N. (2023). Epidemiology, Types, Causes, Clinical Presentation, Diagnosis, and Treatment of Hypothyroidism. Cureus, 15(9), e46241. https://doi.org/10.7759/cureus.46241
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Copyright (c) 2024 Maria Clara Collodetto Buraqui; Sandra Regina Chahuan Tobji Hernandes; Géssica Dorta Souza; Laura Jane Monteiro de Oliveira

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