| Objectives:1. Study the Clinical value of thyrotropin receptor antibody(TRAb) on diagnosis,treatment and remission of children with autoimmune thyroid disease(AITD).2. Study the clinical value of detecting serum thyroid stimulating antibody(TSAb)and hyroid inhibiting antibody(TSBAb) of children with AITD respectively.Methods:1. Records of children with AITD,who attended the pediatric endocrinology outpatient of Tianjin Medical University General Hospital from January 2012 to December 2014,were collected and retrospectively analyzed.Clinical data included name, gender, age, height, weight, heart rate, exophthalmos, goiter and thyroid B ultrasound(anteroposterior diameter, length, width of left and right lobe thyroid),family history of thyroid disease. Laboratory data included free triiodo thyronine(FT3),free thyroxine(FT4), thyroid stimulating hormone(TSH), thyrotropin receptor antibody(TRAb),thyroid peroxidase antibody(TPOAb), thyroglobulin antibody(TG Ab and blood routine test at presentation and follow-up.There were 156 cases of patient,whose initial data of follow-up is Relatively complete, divided into 92Graves’ disease(GD group) and 64 Hashimoto’s thyroiditis(HT group).After 3 years treatment, 32 cases of patients got remission(GD remission group),but 60 case of patients didn’t get remission(GD no remission group). 50 cases of patients thyroid function is stable(HTI group),but 14 case of patients thyroid function isn’t stable(HTIIgroup).According to the time of treatment years,GD remission group were divided into GD0, GD1, GD2, GD3; HTI group were divided into HT0, HT1,HT2, HT3. 79 cases of healthy children as control group.(1)To compare the onset clinical features of AITD and to calculate the remission rate of GD group after 3years treatment.(2) Compared the clinical and Laboratory data between GD remission group and GD no remission group to find out factors with GD remission.(3) Compared the changes of serum thyroid hormones, antibodies of GD remission group in each treatment stage to analysis the value on predicting GD remission.(4)Compared the clinical data and Laboratory data of HTI group with HTII group tofound out factors that effect thyroid function.(5) Analysis the correlation between serum thyroid hormones, thyroid antibodies, thyroid volume.2. 527 cases of serum from 180 AITD children were divided into 282 cases of Graves disease and 245 cases of Hashimoto’s thyroiditis. According to the status of thyroid function is divided into 157 cases of hyperthyroidism(hyperthyroidism group), 91 cases of hypothyroidism(hypothyroidism group) and 279 cases of normal thyroid function(normal thyroid group),79 healthy children as control group. Serum TSAb and TSBAb were detect by serum TSAb ELISA kit and serum TSBAb ELISA kit respectively.(1)Tested the diagnosis value of TSAb and TSBAb by ROC curve on children with AITD to find out the cut-off value.(2) Compared the difference of serum TSAb,TSBAb among GD group, HT group and control group.Analyze the correlation between serum TSAb, TSBAb and serum FT3, FT4, TSH.(3) Compared the difference of serum TSAb, TSBAb in hyperthyroidism group, hypothyroidism group, normal thyroid hormone and control group.Results:1. A total of 156 patients were enrolled into the study,including 92 GD and 64 HT.The average age of GD group is(10.0 ± 2.7)years,the sex ratio(male:female) is18:74. Goiter accounted for 94.6%, thyroid volume(20.43 ± 11.10) ml.Exophthalmos accounted for 64.1%,heart rate increased accounted for 95.7%, GD family history accounted for 37%.The average age of HT group is(10.1 ± 2.4)years,the sex ratio(male:female) is 12:52. Goiter accounted for 95.3%, thyroid volume(20.43 ± 11.10)ml,heart rate slow accounted for 85.9%.Family history of thyroid disease occupied25%.2. There was no difference among GD group,HT group,and control group in baseline data.(p>0.05).3. Early remission rate of children with GD during the first 3 years was 32%.4. Initial serum TRAb level: GD group was higher than HT group significantly(p<0.05);There were no difference between GD group and GD group on onset thyroid volume,TGAb and TPOAb.5. Preliminary serum TRAb and thyroid volume: GD remission group was lowerthan GD non remission group,(all p<0.05).Serum FT3, FT4,TSH of GD remission group: GD0 and GD1 were higher than the control group(p<0.05), there is no significant difference among GD2, GD3 and control group(p>0.05); TRAb,GD0>GD1>GD2>GD3(p<0.05);TPOAb and TGAb:there is no significant difference among GD0,GD1,GD2 and GD3.6. Thyroid volume and TPOAb: HTI group was lower than HTII group,(p<0.05);Serum FT3, FT4 of HTI group: HT0 was less than control group(p<0.05); There were no significant difference among HT1, HT2, HT3 and control group(p>0.05);TSH level: HT0>HT1>control group(p>0.05); There were no significant difference among HT2, HT3 and control group(p>0.05).TRAb,TPOAb,TGAb: There were no significant difference among HT0, HT1, HT2, HT3 and control group(p>0.05).7. Thyroid volume was positive correlation with age in AITD children(r=0.179,p=0.026<0.05); GD remission group:FT3 was positive correlation with FT4(r=0.513,p<0.01), TSH was negative correlation with FT3 and FT4(r=-0.355,-0.263, all p<0.05, TRAb was positive correlation with FT3 and FT4(r=0.287, 0.289, all p<0.05). HTI group:TPOAb was negative correlated with FT4(r=-0.446, p<0.05).8. Serum TSAb: GD group>HT group>control group(F=11.995, p<0.05); hypert hyroidism group>normal thyroid group>hypothyroidism group>control group(F=27.680, p<0.05). TSBAb:HT group>GD group>control group(F=15.610, p<0.05).hypo thyroidism group>normal thyroid group>hyperthyroidism group>control group(F=2.865,p<0.05).9. Children with GD,TSAb AUG=0.970, above 0.9. That was to say TSAb had a high accuracy for the diagnosis of GD, TSBAb AUG=0.741, in 0.7~0.9, suggested that it is certain accuracy for the diagnosis of GD. Children with HT :TSAb AUG=0.865, TSBAb AUG=0.846, all in 0.7~0.9, suggested that they were certain accuracy of TSAb,TSBAb for the diagnosis of HT.10. TSAb was positive correlation with TSBAb, FT3, FT4, r=0.162,0.091,0.194,p<0.05; And negatively correlated with TSH r=-0.224, p<0.05. TSBAb was negatively correlated with FT3,r=-0.155, p<0.05,and positive correlation with TSH p<0.05.Conclusion:1. 32% Children with GD got relief after three years ATD treatment.TRAb was an important reference index in the diagnosis of GD and identified GD from HT.2. If TRAb level of GD at diagnosis was higher, it was not easy to get relief;But initial TRAb level was lower, the younger, smaller thyroid enlargement indicated to get relief more easily.3. In addition,both the level of TRAb decreased after ATD treatment and FT4,TSH returned to normal needed shorter time indicated to get relief more easily.TRAb can be used as an indication to withdrawal ATD in children GD.A higher TPOAb level and bigger thyroid enlargement at diagnosis indicated that thyroid function was easy to fluctuate during 2-3years treatment with LT4.4. TSAb could be used as a sensitive and specific index for diagnosis of GD children.There was important value in identifying GD and HT. serum TSAb had a high accuracy in the diagnosis of GD children;The cut-off point of TSAb for GD was OD405=0.547,Sensitive coefficient was 0.897,Specificity coefficient was 0.899.TSB-Ab had relative accuracy in the diagnosis of children with HT;The cut-off point of TSAb for HT was OD405=0.481,Sensitive coefficient was 0.763,Specificity coefficient was 0.772.Therefore,TSAb and TSBAb were measured respectively might have more clinical value in diagnosis, differential diagnosis and treatment follow-up of children with autoimmune thyroid disease. |
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