Endocrine Abstracts

JOINT3726

Background: Hashimoto’s thyroiditis (HT) is associated with thyroid atrophy, fibrosis, and nodular changes, with a potential risk of malignancy. However, data on longitudinal thyroid morphology changes in pediatric populations, particularly in India, remain limited.

Objective: To assess the morphological changes in the thyroid gland over time in children with HT and compare thyroid volume standard deviation scores (SDS) between diagnosis and follow-up.

Methods: Children diagnosed with HT between 4–12 years, based on thyroid function tests, antibody positivity, and ultrasound findings, with ≥2 years of follow-up, underwent repeat thyroid ultrasound. Thyroid volume was compared with baseline values. Nodules, if present, were graded using TIRADS, and thyroid scans were performed to assess cold nodules.

Results: 56 children (68% female) were evaluated in a prospective cross-sectional study. The mean age at symptom onset was 7.2 (± 2.70 years, and age at diagnosis was 8.7 (± 2.38) years. Autoimmune comorbidities were present in 18% at diagnosis. The most common symptoms were reduced physical activity (61%) and constipation (51.8%). The median duration of follow up was 2 years. At diagnosis, 41% had goiter, 37.5% had short stature, and 18% were underweight. The median TPO level was 198 IU/ml (IQR: 92–544 IU/ml). Height and weight SDS improved significantly (P = 0.001 and P = 0.003, respectively). Ultrasound revealed increase in heterogenicity (76.8% to 89.3%), hypoechogenicity (10.7% to 21%), and nodules (19.6% to 26.8%) in between diagnosis and follow up. Thyroid volume reduced by mean of 1.448 SDS (P = 0.001), particularly in overt hypothyroidism with a mean reduction of 1.54 SDS (P = 0.001). 63% of the nodules at diagnosis showed resolution over a mean duration of 2.4 years. 19% developed nodules during a mean follow up of 3.1 years and risk of development of nodule did not correlate with follow-up duration (P = 0.823), TSH (P = 0.52), anti-TPO levels (P = 0.664), or delayed diagnosis(P = 0.819). 80% nodules were TIRADS 1, indicating benign nature.

Conclusion: Children with HT exhibit progressive thyroid heterogenicity and nodule development over time, with significant reduction in thyroid volume. The predominance of benign nodules suggests a low risk of malignancy in pediatric population.