Thyroid autoimmunity in children with alopecia areata
It is a well known fact that alopecia areata can be associated with the development
of other autoimmune disorders. In particular people with alopecia areata can
develop autoimmune thyroiditis [aT]. Other than autoimmune thyroiditis, alopecia
areata patients can also be affected by myasthenia gravis, vitiligo, diabetes
mellitus type 1, pernicious anemia [caused due to lack of an intrinsic factor
that is responsible for the absorption of Vitamin B 12] and lupus erythematosus
[a chronic inflammatory collagen disease affecting the connective tissue].
Since autoimmune thyroiditis is prevalent in children and adolescents,
a study of the thyroid gland and associated problems were studied
in alopecia areata affected children. 46 children [23 boys and
23 girls] with different age onset of alopecia areata were the
candidates. Of these children in the age group of 3-18 years,
41 had a family history of alopecia areata. They were all evaluated
for the size of the thyroid gland and its vital parameters, regional
lymphadenopathy, rate of heart beat, pressure of arterial blood
flow, sin humidity and changes in nail characters.
The working of the thyroid gland was studied using a fluoroimmunologic
assay [FIA] to find out the levels of thyroid stimulating hormone
[TSH] which stimulates the thyroid gland to secrete other hormones
and the thyroid hormones triiodothyronine [T3] and thyroxine [T4].
Six children with alopecia areata showed high levels of TSH but
normal levels of thyroxine while the rest of the children showed
normal TSH and thyroid hormones.
12 children were tested using thyrotropin releasing hormone
[TRH] and the amount of TSH was determined immediately and after
20 and 60 mins of introducing TRH respectively. 10 children responded
to TRH normally while 2 had hypothyroidism like symptoms.
Using the microhemaglutination method, antithyroglobulin [TAT]
and antimicrosomal antibodies [MAT] were determined. Out of 43
children who underwent this test, 17 were positive for TAT and
14 for MAT. Higher titer values correspond to an intimate association
of autoimmune thyroiditis with alopecia areata.
38 children underwent ultrasound examination of the thyroid
gland of which 20 children were normal, 13 had probabilities of
autoimmune thyroiditis and 5 had typical autoimmune thyroiditis.
26 alopecia areata children and 28 controls took tests for checking
cellular and humoral immunity. The study included common T lymphocytes,
helpers and inducers, suppressors, activated T lymphocytes, natural
killer cells, cells with natural killer and natural killer like
properties, B lymphocytes and immunoglobulins. There was significant
increase in the number of activated T lymphocytes. This report
is consistent with other reports confirming the infiltration of
lymphocytes in the epithelium of hair follicles and increased
activity of T lymphocytes in the peripheral blood cells.
All the children in this study were from Bulgaria where nearly
half the region is deficient in iodine. Many of them had family
history of diabetes mellitus, goiter, thyrotoxicosis [hyperthyroidism],
alopecia areata, vitiligo, hypothyroidism and Addison’s
syndrome [a glandular disorder caused by failure of function of
cortex of the adrenal gland resulting in anemia and brownish skin].
Some had dry skin and the nails showed pits and furrows, a character
typical of alopecia areata, and the tooth enamel was also apparently
defective. Some had enlarged thyroid glands and the texture ranged
from soft to firm with the surface of the gland being smooth,
lobulated or granular. A few patients also had lymphadenopathy
[abnormal enlargement of lymph nodes].
Out of the 46 children studied nearly half the number had autoimmune
thyroiditis which was diagnosed based on goiter, ultrasound studies,
hypothyroidism and thyroid antibody studies. Only 6 of them did
not show any abnormal enlargement or other problems of the thyroid
It was noted that the sex of the child had no relation to the
onset of alopecia areata as previously suggested and most of the
alopecia areata onset was before the age of 5. Since most of the
patients showed some thyroid related disorder, there seems to
be a definite correlation between alopecia areata and autoimmune
thyroiditis. Hence frequent assessment of thyroid functioning
may help alopecia areata patients, particularly children who develop
alopecia areata, prevent the onset of autoimmune thyroiditis and
Thyroid autoimmunity in children with alopecia areata references
- Kurtev A, Iliev E. Thyroid autoimmunity
in children and adolescents with alopecia areata. Int J Dermatol.