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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 glands. 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 hypothyroidism.
Thyroid autoimmunity in children with alopecia areata references
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