It is known that one of the “target organs” for thyroid
hormones is the skin. On the other hand, atopic dermatitis is a representative
of allergic diseases, in which inflammatory changes due to the body’s
immunopathological response to exogenous antigens also affect the skin. The
existing problems in the treatment and rehabilitation of children with atopic
dermatitis, the high prevalence of thyroid gland (thyroid) pathology among the
children of Transbaikalia in areas with the most pronounced degree of iodine
deficiency, and the lack of a systematic study of this issue indicated the
relevance of this study.
The functional state of the thyroid gland was studied in 14 children with
localized forms of atopic dermatitis in the acute stage, who made up the
experimental group, and in 13 children who did not have allergic diseases, who
made up the comparison group. All children lived in one of the northern regions
of Transbaikalia, which belongs to the territories with moderate iodine
deficiency (median iodine 42-45 µg/l).
An analysis of hereditary burden showed that allergic diseases occurred in 21%
of cases, none of the relatives of the children in the experimental group had
thyroid diseases. Ultrasound scanning testified to the absence of an increase
in the volume and structural disorders of the thyroid gland in children of both
groups, however, palpable enlargement of the thyroid gland occurred in 21% of
children with atopic dermatitis.
When analyzing the functional state of the thyroid gland in children, depending
on the disease with atopic dermatitis, differences in the level of
thyroid-stimulating hormone (TSH) were established. An increase in serum TSH
concentration above the normative limits occurred in 21% of children with
atopic dermatitis. In addition, they also showed a positive qualitative
reaction for antibodies to thyroid peroxidase with normal levels of antibodies
to thyroglobulin . These are children who previously had a palpable increase in
the thyroid gland. The fractions of total and free thyroxine (T4) and
triiodothyronine (T3) in these patients did not go beyond the laboratory norm,
which led to the conclusion that 21% of children with atopic dermatitis had
subclinical hypothyroidism. In children of the control group, all the studied
hormones were within the normal range. Comparative analysis of the average
values of thyroid hormones indicated a statistically significant increase in
the level of TSH in children with atopic dermatitis (p<0.001) relative to
the corresponding values in the control group.
Thus, a conclusion was made about moderately pronounced disorders of the
hormonal thyroid status in children with exacerbation of atopic dermatitis,
which consisted in a relative increase in mean TSH values and the presence of
subclinical hypothyroidism in 1/5 of the examined children. The presence of a
set of clinical and laboratory signs that we identified in 21% of children in
the experimental group, namely palpation enlargement of the thyroid gland, a
positive reaction of antibody formation to thyroid peroxidase and subclinical
hypothyroidism allows us to make a well-founded assumption about the early
stage of development of autoimmune thyroiditis in them, especially since subclinical
hypothyroidism most often accompanies this thyroid disease.
The issues of therapeutic tactics in subclinical hypothyroidism still remain
the object of numerous scientific debates. Various examination algorithms are
proposed, followed by a decision on the appropriateness of substitution
therapy. However, it is well known from practice that hypothyroidism,
especially acquired, can proceed for a long time under the guise of dermatitis,
naturally, without giving dynamics against the background of ongoing therapy.
And on the other hand, the correct diagnosis of the disease and treatment with
L-thyroxine lead to a fairly rapid relief of the skin syndrome.