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Prevalence of Hashimoto's Thyroiditis Among Adolescents in Lviv Region

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Prevalence of Hashimoto's Thyroiditis Among Adolescents in Lviv Region Słupskie Prace Biologiczne 11 ••• 2014 PREVALENCE OF HASHIMOTO’S THYROIDITIS AMONG ADOLESCENTS IN LVIV REGION (UKRAINE) DURING YEARS 2000-2010 Olha Kasiyan 1 Halyna Tkachenko 2 Jan Łukaszewicz 3 Natalia Kurhaluk 2 1 Danylo Halytskyy Lviv National Medical University, Ukraine Department of Hygiene and Preventive Toxicology 2 Pomeranian University in Słupsk Institute of Biology and Environmental Protection Department of Zoology and Animal Physiology Arciszewski Str. 22b, 76-200 Słupsk e-mail: [email protected] 3 Adam Mickiewicz University Institute of Physical Geography and Environmental Planning Department of Hydrology and Water Management Dzięgielowa Str. 27, 61-680 Poznań ABSTRACT Incidence of autoimmune thyroid diseases (AITD) in Ukraine is currently higher than in past decades. In our previous study we demonstrated increase of AITD prevalence in Lviv region during 2000-2010 was mainly by the adult population in the greater urban area, less – among adults of rural areas (Kasiyan et al. 2009, 2010, 2013, 2014). Increase in the AITD prevalence among adults identified in 16 districts and 3 towns of Lviv region (Kasiyan et al. 2013). The aim of our study was the as- sessment of Hashimoto’s thyroiditis (HT) prevalence among adolescents (14-18 years old) in Lviv region (western Ukraine) during 2000-2010. For assessment of the HT prevalence among adolescents of different districts (reions) in Lviv region during years 2000-2010, the analysis of archival data from Lviv Regional Endocrinology Hospital was done. The research study covered by 20 districts (reions) of Lviv oblast, as well as six towns of Lviv region. For assessment of the relative risk (RR) of HT among adolescents of Lviv region, retrospective study was used. Decrease of HT prevalence among the adolescent population in Lviv region during years 2000- 2010 was observed. Increased HT prevalence among adolescents from towns during 2000-2004 years was found. The peak of disease prevalence was noted in 2000 and 2004. Among adolescents both in districts and towns, decrease of HT prevalence 77 from 2004 to 2010 was found. The decrease of HT prevalence among adolescents from rural areas during 2000-2004 years was observed, while its increase from 2004 to 2010 was noted. HT prevalence among adolescents was the highest in Brody, Turkivskyi, Sambir, Sokal, and Horodok districts during 2000-2010. Our results in- dicate the need to clarify the reasons for the increased HT prevalence among the population of Lviv region, the definition of the risk of thyroid pathology in each dis- trict of the region among the different age groups, which will propose measures to prevent further increase of HT incidence. Key words: Hashimoto’s thyroiditis, Lviv region, adolescents, relative risk INTRODUCTION Autoimmune thyroid diseases (AITD), including Graves’ disease (GD) and Hashimoto’s thyroiditis (HT), are the most common organ specific autoimmune dis- orders usually resulting in dysfunction (hyperfunction, hypofunction or both) of the thyroid gland (Trbojević and Djurica 2005). It is thought that autoimmune reactions against the thyroid can develop in various directions. In AIT, the immunological process is dominated be a lymphocyte mediated cell-damaging processes, leading to destruction of follicular cells; in Graves’ disease the immunological process is dominated by synthesis and release of antibodies that stimulate the TSH receptor (Nystrom et al. 2011). The pathophysiological background of the development of AITD has not been entirely clarified. It’s likely that some individuals have a predisposition which, in conjunction with triggering factors, starts the process. In addition to genetic factors, predisposing factors can include reduced immunological tolerance, which could have arisen during maturation of the immune competent cells in the thymus (Nystrom et al. 2011). Epidemiological data support strong genetic influences on the development of AITD (Hasham and Tomer 2012). The importance of genetic factors is supported by the increased prevalence of autoantibodies in relatives of affected patients, and because several members of one family can be affected by autoimmune thyroid disease. In some way, certain changes in the MHC/HLA system are thought to be associated with these diseases. Twin studies have, however, demonstrated a higher occurrence of the disease in siblings than can be explained by the HLA system alone (Nystrom et al. 2011). In addition to the MHC class II genes, there are now several other confirmed gene-loci associated with AITD, including immune-regulatory (CD40, CTLA-4, PTPN22, FOXP3, and CD25) and thyroid-specific genes (thy- roglobulin and TSHR) (Hasham and Tomer 2012). The pathogenetic mechanisms leading to the development of autoimmune dis- ease of the thyroid are based on several different factors (Schumm-Draeger 2004). It is well established that a complex interplay of diverse environmental and genetic susceptibility factors interact in predisposing an individual to AITD. Significant progress has been made in understanding of the genetic and environmental triggers contributing to AITD. The major environmental triggers of AITD include iodine, medications, infection, smoking, and possibly stress (Tomer and Huber 2009). 78 Moreover, the contribution that each factor makes varies from patient to patient, and as yet there are no clear genotype-phenotype correlations (Diseases... 2007). Children not only encounter a somewhat different range of environmental factors to adults, but also have overall a lower chance of encountering aetiological agents simply because of their shorter period of exposure. In turn, this has led to the sug- gestion that genetic factors are likely to play a larger role in childhood thyroid auto- immunity than in adults, while environmental factors would have an increasing role in adults as they age. Despite possible ascertainment artefacts, initial studies have certainly shown that children and adolescents with autoimmune thyroiditis have strik- ingly strong family histories of thyroid and other autoimmune disease, including those in the non-organ-specific category (Diseases... 2007). HT is the most common cause of thyroid diseases in children and adolescents and it is also the most common cause of acquired hypothyroidism with or without goiter. Iodine and iodine containing drugs can precipitate HT in susceptible popula- tions. There is an infiltration of lymphocytes and plasma cells between the follicles followed by their atrophy. The clinical course is variable and spontaneous remission may occur in adolescence. Goiter, menstrual disorders, short stature, constipation, nervousness and exophthalmos have been reported as the most recurrent clinical fea- tures of HT (Lorini et al. 2003). In younger people, hypothyroidism requiring treatment is reported to occur in about 1-1.5/1,000 individuals. Autoimmune thyroiditis is the most common cause of hypothyroidism. This disease is more uncommon in children and adolescents than in adults. The disease can be diagnosed in small children but is uncommon before puberty and increased thereafter with age. Autoimmune thyroiditis is more common in girls than boys but the gender difference is less pronounced than in adults (Szymborska and Staroszczyk 2000). Probably the most frequent clinical presentation of thyroid autoimmunity in children and adolescents is with a small asymptomatic goitre typically appearing around 11 to 12 years of age and compris- ing a mild lymphocytic thyroiditis. Patients are usually euthyroid (Diseases... 2007). Clinical observations indicate that autoimmune thyroiditis in children and adolescents is typically less severe than in adults, with lower levels of autoanti- bodies and a more fluctuating course which includes spontaneous recovery (Dis- eases... 2007). A careful follow-up of children exposed to fallout after the Chernobyl nuclear re- actor accident found a significantly higher frequency of thyroid antibodies in chil- dren aged 7–14 years compared to unexposed controls (81 vs. 17%) and ultrasono- graphic abnormalities compatible with lymphocytic thyroiditis were also increased (Vykhovanets et al. 1997). The dose of 131 I that the children had been exposed to correlated with thyroid antibody levels, up to a thyroid gland dose of 4Gy (Dis- eases... 2007). Incidence of AITD in Ukraine is currently higher than in past decades. In our pre- vious study we demonstrated increase of AITD prevalence in Lviv region during 2000-2010 was mainly by the adult population in the greater urban area, less – among adults of rural areas (Kasiyan et al. 2009, 2010, 2013, 2014). Increase in the AIT prevalence among adults identified in 16 districts and 3 towns of Lviv region (Kasiyan 79 et al. 2013). The aim of our study was the assessment of HT prevalence among adoles- cents (14-18 years old) in Lviv region (western Ukraine) during 2000-2010. MATERIALS AND METHODS For assessment of the HT prevalence among adolescents of different districts (reions) in Lviv region during years 2000-2010, the analysis of archival data from Lviv Regional Endocrinology Hospital was done. The research study covered by 20 districts (reions) of Lviv Oblast (Brody, Busk, Horodok, Drohobych, Zhydachivskyi, Zhovkivskyi, Zolochivskyi, Kamianka-Buzka, Mykolaiv, Mostyska, Peremyshliany, Pustomyty, Radekhiv, Sambir, Skole, Sokal, Starosambirskyi, Stryiskyi, Turkivskyi, and Yavorivskyi Districts), as well as six towns of Lviv region (Lviv, Boryslav, Dro- hobych, Stryi, Truskavets, Chervonograd). For assessment of the relative
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