Atopic dermatitis in children and the thyroid gland

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.

event_note June 13, 2022

account_box Dr. Peter B Milburn

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