Prevalence of Autoimmune Thyroiditis Among Children with Autoimmune Hepatitis

Overview

Journal Ital J Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2024 Apr 17

PMID 38632644

Authors

Engy Adel Mogahed

Hend M Soliman

Dalia Saber Morgan

Hoda Mohammed Abd Elaal

Rasha Abd El Razek Mahmoud Khattab

Ragaey A Eid

Mahmoud Hodeib

Affiliations

Soon will be listed here.

Abstract

Background: Autoimmune hepatitis (AIH) is an organ specific autoimmune disease, which can manifest at any age of life. there is a high prevalence of extrahepatic autoimmune diseases in patients with AIH. Autoimmune thyroid diseases (ATDs) are the most frequent extrahepatic autoimmune disorders among patients with AIH. Aim of work is to detect the frequency of ATDs among Egyptian children with AIH.

Methods: This research is a cross-sectional study conducted on 58 children with AIH aged ≤ 18 years. All patients were tested for free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG). Thyroid ultrasound (US) and thyroid scan were performed for patients with abnormal thyroid profile, borderline values, positive anti-TPO or anti-TG.

Results: The mean ± standard deviation (SD) for the age of the patients was 11.3 ± 4.5 years. Out of 58 patients of AIH, 28 patients (48.3%) had associated other autoimmune diseases. Autoimmune thyroiditis was the most common associated autoimmune disease being present in 10 patients (17.2%). The thyroid status of AIT patients showed that 6 patients (60%) were euthyroid, 3 patients (30%) had subclinical hypothyroidism and only one patient (10%) was hyperthyroid.

Conclusion: Autoimmune hepatitis in Egyptian children is commonly associated with other autoimmune diseases. Autoimmune thyroiditis is the most common to be associated with AIH in pediatric patients. As it is not usually clinically manifesting, regular screening for AIT in children with AIH is mandatory.

References

Afaa T, Amegan-Aho K, Dono M, Odei E, Awuku Y . Clinical characteristics of paediatric autoimmune hepatitis at a referral hospital in Sub Saharan Africa. PLoS One. 2020; 15(12):e0239964. PMC: 7757864. DOI: 10.1371/journal.pone.0239964. View

Vierling J . Autoimmune Hepatitis and Overlap Syndromes: Diagnosis and Management. Clin Gastroenterol Hepatol. 2015; 13(12):2088-108. DOI: 10.1016/j.cgh.2015.08.012. View

Khoury T, Kadah A, Mari A, Sbeit W, Drori A, Mahamid M . Thyroid Dysfunction is Prevalent in Autoimmune Hepatitis: A Case Control Study. Isr Med Assoc J. 2020; 22(2):100-103. View

Muratori L, Longhi M . The interplay between regulatory and effector T cells in autoimmune hepatitis: Implications for innovative treatment strategies. J Autoimmun. 2013; 46:74-80. DOI: 10.1016/j.jaut.2013.06.016. View

Jain V, Yachha S, Bhatia E, Sarma M, Srivastava A . Concurrent extrahepatic autoimmune disorders: unexplored dimension of autoimmune liver disease in children. Eur J Gastroenterol Hepatol. 2018; 30(8):910-917. DOI: 10.1097/MEG.0000000000001122. View

Muratori P, Fabbri A, Lalanne C, Lenzi M, Muratori L . Autoimmune liver disease and concomitant extrahepatic autoimmune disease. Eur J Gastroenterol Hepatol. 2015; 27(10):1175-9. DOI: 10.1097/MEG.0000000000000424. View

Betterle C, Zanchetta R . Update on autoimmune polyendocrine syndromes (APS). Acta Biomed. 2003; 74(1):9-33. View

Floreani A, De Martin S, Secchi M, Cazzagon N . Extrahepatic autoimmunity in autoimmune liver disease. Eur J Intern Med. 2018; 59:1-7. DOI: 10.1016/j.ejim.2018.10.014. View

Casto C, Pepe G, Li Pomi A, Corica D, Aversa T, Wasniewska M . Hashimoto's Thyroiditis and Graves' Disease in Genetic Syndromes in Pediatric Age. Genes (Basel). 2021; 12(2). PMC: 7913917. DOI: 10.3390/genes12020222. View

10.

Brown R . Autoimmune thyroiditis in childhood. J Clin Res Pediatr Endocrinol. 2012; 5 Suppl 1:45-9. PMC: 3608006. DOI: 10.4274/jcrpe.855. View

11.

Foley Jr T, Abbassi V, Copeland K, Draznin M . Brief report: hypothyroidism caused by chronic autoimmune thyroiditis in very young infants. N Engl J Med. 1994; 330(7):466-8. DOI: 10.1056/NEJM199402173300704. View

12.

Skarpa V, Kousta E, Tertipi A, Anyfandakis K, Vakaki M, Dolianiti M . Epidemiological characteristics of children with autoimmune thyroid disease. Hormones (Athens). 2011; 10(3):207-14. DOI: 10.14310/horm.2002.1310. View

13.

Teufel A, Weinmann A, Kahaly G, Centner C, Piendl A, Worns M . Concurrent autoimmune diseases in patients with autoimmune hepatitis. J Clin Gastroenterol. 2010; 44(3):208-13. DOI: 10.1097/MCG.0b013e3181c74e0d. View

14.

Efe C, Wahlin S, Ozaslan E, Berlot A, Purnak T, Muratori L . Autoimmune hepatitis/primary biliary cirrhosis overlap syndrome and associated extrahepatic autoimmune diseases. Eur J Gastroenterol Hepatol. 2012; 24(5):531-4. DOI: 10.1097/MEG.0b013e328350f95b. View

15.

Wong G, Yeong T, Lawrence D, Yeoman A, Verma S, Heneghan M . Concurrent extrahepatic autoimmunity in autoimmune hepatitis: implications for diagnosis, clinical course and long-term outcomes. Liver Int. 2016; 37(3):449-457. DOI: 10.1111/liv.13236. View

16.

Kyle U, Shekerdemian L, Coss-Bu J . Growth failure and nutrition considerations in chronic childhood wasting diseases. Nutr Clin Pract. 2014; 30(2):227-38. DOI: 10.1177/0884533614555234. View

17.

Guo L, Zhou L, Zhang N, Deng B, Wang B . Extrahepatic Autoimmune Diseases in Patients with Autoimmune Liver Diseases: A Phenomenon Neglected by Gastroenterologists. Gastroenterol Res Pract. 2017; 2017:2376231. PMC: 5278196. DOI: 10.1155/2017/2376231. View

18.

Vergani D, Mieli-Vergani G . Aetiopathogenesis of autoimmune hepatitis. World J Gastroenterol. 2008; 14(21):3306-12. PMC: 2716585. DOI: 10.3748/wjg.14.3306. View

19.

Lapierre P, Alvarez F . Type 2 autoimmune hepatitis: Genetic susceptibility. Front Immunol. 2022; 13:1025343. PMC: 9556705. DOI: 10.3389/fimmu.2022.1025343. View

20.

Wasniewska M, Corrias A, Salerno M, Mussa A, Capalbo D, Messina M . Thyroid function patterns at Hashimoto's thyroiditis presentation in childhood and adolescence are mainly conditioned by patients' age. Horm Res Paediatr. 2012; 78(4):232-6. DOI: 10.1159/000343815. View