JUVENILE LYMPHOCYTIC THYROIDITIS

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Abstract
Lymphocytic thyroiditis was the most common cause of nontoxic goiters in childhood, comprising about 40% of these and 20% of all goiters seen in our pediatric endocrine clinic. The diagnosis should be considered whenever a nontoxic goiter does not diminish significantly in size within about two weeks in response to thyroid-stimulating-hormone (TSH) suppressive doses of USP thyroid. Observations on 32 children with lymphocytic thyroiditis have been recorded. The diagnosis was proven histologically in 23. In nine patients the diagnosis was presumptive. The condition occurred mostly in preadolescent girls as a slowly developing firm, diffuse, and smooth or nubbly goiter with or without symptoms of anxiety, nervousness and pressure in the neck. The majority of patients were euthyroid when first encountered, though examples both of mild hyperthyroidism and hypothyroidism were also seen. A high protein-bound iodine value, a large discrepancy between protein-bound iodine and butanol-extractable iodine, and positive tanned erythrocyte antibody test results provided the best diagnostic criteria apart from biopsy. The pathological picture is one of hyperplasia with lymphocytic infiltration and atrophy of thyroid follicles and epithelium. Treatment consisted in giving TSH suppressive doses of thyroid for a prolonged period. The results of treatment were not entirely satisfactory. Genetic predisposition, probably manifested in an abnormal cellular hypersensitivity, and excessive TSH stimulation of the thyroid seem for the moment the two factors in pathogenesis best supported by laboratory evidence.

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