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Levothyroxine Treatment Reduces Thyroid Size in Children and Adolescents with Chronic Autoimmune Thyroiditis

Department of Pediatrics (J.S., B.L., S.-A.I.), Pediatric Endocrinology Research Unit (J.S., B.L., S.-A.I.), and Department of Endocrinology (U.-B.E.), Malmö University Hospital, Lund University, SE-205 02 Malmö, Sweden; Department of Diagnostic Radiology (P.N.), Copenhagen University Hospital, DK-2650 Copenhagen, Denmark; Department of Diagnostic Radiology (C.O.), Helsingborg Hospital, S-25187 Helsingborg, Sweden; and Department of Women’s and Children’s Health (B.J.), Uppsala University, SE-751 05 Uppsala, Sweden

Address all correspondence and requests for reprints to: Johan Svensson, M.D., Department of Pediatrics, Malmö University Hospital, SE-205 02 Malmö, Sweden. E-mail: johan.svensson{at}med.lu.se.

Context: The use of levothyroxine to reduce thyroid size in pediatric patients with goiter due to chronic autoimmune thyroiditis (AIT) remains controversial. In overtly hypothyroid patients, reductions in thyroid volume have been reported, whereas the effect in subclinically hypothyroid and euthyroid patients is less clear.

Objective: The objective of the study was to evaluate the effect of levothyroxine treatment on thyroid size (determined with thyroid ultrasonography) in children and adolescents with AIT.

Design and Setting: This study included patients with AIT treated at a university hospital outpatient clinic between 1987 and 2004.

Patients: Ninety children with AIT (73 girls and 17 boys, aged 6.1–17.7 yr) were included in the study.

Intervention: Intervention was treatment with levothyroxine for a median 2.8 yr (range 0.5–10.2).

Main Outcome Measure: Change in thyroid volume SD score (SDS) during the study period was measured.

Results: Median thyroid volume SDS was reduced in patients euthyroid (–0.4 SDS, P < 0.001), subclinically hypothyroid (–1.4 SDS, P < 0.001), and overtly hypothyroid (–1.8 SDS, P < 0.002) at diagnosis of AIT. Both hypothyroid and euthyroid patients with goiter (thyroid volume > 2.0 SDS) at baseline reduced their median thyroid volume SDS (–1.6 and –0.9, respectively, P < 0.001). Hypothyroid patients without goiter also reduced median thyroid volume SDS (–1.2, P < 0.004), whereas no change was noticed in euthyroid children without goiter.

Conclusions: Levothyroxine treatment is effective in reducing thyroid volume in pediatric patients and is suggested in treatment of goiter caused by AIT, especially in cases of hypothyroid, but also in euthyroid children.

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