Autoimmunerkrankungen der Schilddrüse im Kindes- und Jugendalter

Zusammenfassung

Die Autoimmunthyreopathie Hashimoto (HAT) kommt bei Kindern und Adoleszenten häufiger vor als der Morbus Basedow. Die klinischen Symp­tome der HAT sind oft unspezifisch, wobei die Betroffenen häufig eine Struma haben. Typischer-weise sind die Antikörper gegen die thyreoidale Peroxidase und gegen Thyreoglobulin erhöht. Die meisten Patienten sind euthyreot; etwa 20–40% sind hypothyreot. Die hyperthyreote Verlaufsform ist selten und in der Regel transient. Die latente und manifeste Hypothyreose werden mit L-T4 (Dosis: 2 µg/kg KG) behandelt, während die Therapie bei der euthyreoten Form kontrovers diskutiert wird. Das klinische Bild des manifesten Morbus Basedow dagegen ist eindeutig. Mittel der Wahl ist die thyreostatische Therapie mit Thiamazol oder Carbimazol. Sie muss regelmäßig überwacht und sollte initial 1 ½–2 Jahre durchgeführt werden. Danach sollte ein Auslassversuch erfolgen, da die Remissionsrate etwa bei 25% liegt. Operative Eingriffe bei Kindern und Jugendlichen mit Morbus Basedow sollten spezialisierten Zentren vorbehalten bleiben. Die Radioiodtherapie ist in Deutschland bei Kindern und Jugendlichen keine Therapieoption. Sie geht nicht mit einem erhöhten Malignitätsrisiko einher.

Abstract

In children, Hashimoto’s thyroiditis (HT) is more common than Graves’ disease. Goiter is relatively common in HT, but altogether the symptoms are nonspecific.

Antibodies against thyroidal peroxidase are increased in a high percentage. Most patients are euthyroid, but hypothyroidism appeared in approximately 20–40% of the patients. L-thyroxine (L-T4) in a dose of 2 µg/kg body weight is used for treatment of both subclinical and overt hypothyroidism, whereas the benefit of L-T4 treatment in euthyroid children is still a matter of debate. In contrast to HT, the clinical appearance of Graves’ disease is clear. Stimulating antibodies against the thyroid receptor are typically increased. The first-choice antithyroid drug therapy is thiamazole or carbimazole. It should be continued for 2 years. The long-term remission rate is 25% every 2 years. Surgical intervention in children and adolescents with Graves’ disease should be limited to specialized centres. Radioiodine therapy is not yet an option in Germany. However, it does not cause an increased risk of malignancy in children and adolescents.

Schlüsselwörter

Autoimmunthyreopathie - Hashimoto - Struma - Morbus Basedow - thyreostatische Therapie

Key words

autoimmune thyroiditis - hashimoto’s thyroiditis - goiter - L-Thyroxine - Graves’ disease - antithyroid drug therapy

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