Disfunção tireoidiana e doença autoimune da tireoide em pacientes com Síndrome de Down

Abstract

Introduction: Children with Down Syndrome (DS) are at increased risk for multiple health problems, including thyroid dysfunction (TD). Even with the evolution of diagnostic techniques and clinical approach, the design of screening and management of thyroid dysfunction in patients with DS still presents challenges. Expanding the knowledge of the particularities of these individuals can lead to a more adequate design of screening, diagnosis and treatment strategies, improving health care. Objective: To verify the epidemiological profile of thyroid dysfunction, laboratory alterations and their associations with demographic and clinical variables in patients with Down Syndrome. Method: Observational, retrospective study, carried out in a public university hospital. 177 patients from 0 to 25 years of age with DS were included. The variables analyzed were: age, gender, presence and classification of TD, treatment and association with antithyroid and extrathyroidal autoimmunity, genotype, heart disease, anthropometric data and family history of thyroid disease. Results: The prevalence of TD was 88.7% and most of the alterations were diagnosed in the first 6 months of life (48%). In patients younger than 3 years, TD predominated in males. There was no association between TD and the variables evaluated, except genotype. The most prevalent dysfunction was subclinical hypothyroidism with thyroid-stimulating hormone (TSH) between 4.2-10 μIU / mL, found in 120 of 157 patients with TD. Of these, 54 remained under clinical observation and 83.3% normalized the exams. Conclusions: In patients with DS, there is a high prevalence of TD. Mild and isolated elevations of TSH predominate and possibly represent transient hyperthyrotropinemia. Due to the large percentage of patients diagnosed before 6 months of life, it seems to be necessary to adopt screening between 1 and 6 months of life. Careful interpretation of thyroid function especially in the first years of life and adoption of screening and treatment protocols can facilitate management and contribute to the prognosis of patients with DS.