Hypothyroidism & JRA

[Guest guest]

Prevalence and Aetiology of Hypothyroidism in the Young

>From Archives of Disease in Childhood Sept 2000 (Volume 83, Number 9)

http://www.medscape.com/medscape/features/JournalScan/nurses/2000/js-nur0107.htm\

l

While prevalence rates of congenital hypothyroidism are well known,

there has been less documentation of rates of acquired hypothyroidism.

These few studies, all conducted in selected smaller populations, have

placed the incidence at 0.04% and 0.06%. This study attempted to

quantify the number of individuals from 0-22 years of age who have

clinical hypothyroidism by examining the population receiving thyroxine,

a product whose only indication is hypothyroidism.

The study population was made up of all residents under the age of 22

living in a large region of Scotland. This is relatively easy to

accomplish in a country like Scotland where all individuals are assigned

a unique community health number. There were over 103,000 patients

identified, 140 of whom were receiving thyroxine. This translates to a

0.135% prevalence rate, 2 to 3 times that of all other previous

estimates.

Male:female ratio in this population was 1:2.8. Acquired primary

hypothyroidism accounted for just under 50% of the cases, with the

majority of these cases due to an autoimmune process commonly known as

Hashimoto's thyroiditis. However, in 14% of primary cases, an etiology

was not known. Acquired hypothyroidism was also noted to occur secondary

to Graves' disease, primary thyroid cancers, and treatment for other

malignancies.

Of the 140 patients, 7.1% had a comorbidity, the most common being Type

I diabetes mellitus (DM), which was found in 3.5% of the sample. Another

fairly common comorbidity was juvenile rheumatoid arthritis (JRA), found

in 2.1% of the sample. Down's syndrome was noted in 1.5% of the

population, confirming an already recognized association between these 2

conditions.

While the significantly higher prevalence rate may be unique to the

population studied, it should be noted that the rates found in adults in

this study were comparable with those of previous studies in other parts

of the world, making a regional difference less likely. The significant

proportion of children with an autoimmune basis for their disease

reflects a growing worldwide trend toward higher prevalence rates of all

autoimmune disease. It is of interest to note that the 2 diseases with

the highest comorbid rates, Type I DM and JRA, are also known to have an

autoimmune etiology. The authors were so impressed with this association

that they suggest it may be of value to routinely screen for thyroid

autoantibodies in patients with JRA.

The conclusion that there is a rising prevalence of autoimmune thyroid

disease in children is inescapable, and the authors recommend further

study to quantify this important finding.

[Guest guest]

I have a friend who had thyroid cancer, and she spends quite a bit of time researching it. According to her reading, their is a correlation between auto-immune disorders and the thyroid. We had a long discussion on it the evening before Abbie had an appt with a ped. endocrinologist. She said to make sure that her thyroid was tested. I had never thought of it, but when the nurse was taking Abbie's history, she mentioned thyroid twice. I would never have caught it before our conversation, so I made sure to note that it had never been tested as far as I knew and requested that it be tested. So that's my little bit of input. No results on any tests yet by the way. She is out of her office over the holidays. Other interesting info was that estrogen levels were as important as growth hormone levels. She said that estrogen was a key player in bone density (which I knew), and that it was necessary even before or at puberty.

Christy

[Guest guest]

> Prevalence and Aetiology of Hypothyroidism in the Young

> >From Archives of Disease in Childhood Sept 2000 (Volume 83,

Number 9)

>

http://www.medscape.com/medscape/features/JournalScan/nurses/2000/js-

nur0107.html

Thanks everyone for your comments on naprosyn and kidney infections.

I came across this, one of Georgina's many research gems (thanks,

Georgina!) in the archives, and wonder whether people on the list

have seen any causal relationship between hypothyroidism and JRA.

Hypothyroidism runs in our family, so I'm guessing our 3-1/2 yr old

who has JRA probably also has that. Would love to hear your

opinions/experiences/insights on this.

We are still early in the JRA diagnosis (1+ yr) so we're trying to

sort out what's going on, and JRA doesn't explain it all.

Kasey

[Guest guest]

hi Christy

you mentioning the estrogen has me now

had Hesions for years and the cream they gave me was estrogen cream

to use on her i never did cause on the tube it had side effects but every

time she had the hesion i was given the estrogen cream her thyroid has been

checked though and so far its ok my mom had thyroid problems

Robbin

[Guest guest]

I got Abbies test results from the endocrinologist today. Everything looked good. Her predicted final height is within the lower normal rate, but "that is all contingent on her continued steroid use." So while it is nice to know that thyroid and estrogen were fine, it is frustrating to know that there is no answer on growth hormone. I am supposed to talk to her rheumy about it in 2 weeks, and then let the endocrinologist know what we decide. I feel so frustrated right now. We are once again on the verge of venturing into the unknown with this thing. What is the next drug we turn to?...What will that do with the prednisone (to which Abbie is getting more and more resistant)?...and finally, the last spiral is growth hormone or not growth hormone, which is dependent on steroid use, which is dependent on new meds and how well they work. (I better stop, I'm even confusing myself. lol) Oh well, thanks as usual for letting me vent.

The good news in all of this is that our prescription plan will cover enbrel, remicaide, and kinaret. So we'll see.

Christy

[Guest guest]

Dear Kasey, I'm not sure about any causal relationship of hypothyroid and JRA but I know that I've had both problems since early ages. I am constantly striving for the perfect numbers lol be they sed rates or T3's T4's or tsh 's the later being the throid and thyroid hormone tests. I'm 40 now and the older I get the more exasperated I seem to become .....I've was told for years that my hypothyroid and JRA were unrelated ( straight from Endocrinologist and Rhuematologist mouth's) ...alot they know or care to share sometimes ..... I recently got ahold of a PDR physician's desk reference and one of the indications for JRA is Hypothroid hmmmm..... I swear I have it in black and white !!!! But by research on my own I had long sense known there was a connection probably because in our FACES group the majority have hypothyroid as well as a form or two of arthritis. A simple blood test will reviel thyroid problems and even if it turns out to be in normal ranges if you see increased problems such as constipation, extra weight gain or loss, hair falling out, very dry skin,low temperature, less apetite, fatigue, muscle aches, do the testing again. It's truely hard to tell if your tired because of the JRA or thyroid , same thing with the aches and pains. I hope this helped some , If you'd like to know more just email me :):):):)Tree:):):):):) Treesap0@... F.A.C.E.S. Co-Leader Facing Arthritis With Compassion, Encouragement and Support Louisville Kentucky Re: Hypothyroidism & JRA > Prevalence and Aetiology of Hypothyroidism in the Young> >From Archives of Disease in Childhood Sept 2000 (Volume 83,Number 9)>http://www.medscape.com/medscape/features/JournalScan/nurses/2000/js-nur0107.htmlThanks everyone for your comments on naprosyn and kidney infections.I came across this, one of Georgina's many research gems (thanks,Georgina!) in the archives, and wonder whether people on the listhave seen any causal relationship between hypothyroidism and JRA.Hypothyroidism runs in our family, so I'm guessing our 3-1/2 yr old who has JRA probably also has that. Would love to hear youropinions/experiences/insights on this.We are still early in the JRA diagnosis (1+ yr) so we're trying tosort out what's going on, and JRA doesn't explain it all.Kasey

[Guest guest]

Hi Christy,

Great news, about your insurance covering all those meds. At least that's one less problem to worry about. It sounds like things went okay at the endocrinologists', too. That's good. If Abbie's still within the normal range, even if it's on the low side, I'd still be optimistic about that. See what the doctor says and then check with your insurance carrier about growth hormone. If they'll cover it for an extended period, it might be worthwhile. Most of what I've read about kids with JRA using it seems to say that the increase in growth lasts only as long as continued therapy. Your insurance does sound pretty great though, so maybe they'll cover it? When you said that Abbie's getting more resistant to prednisone, how do you mean? Even though it's probably not the best way to go about it, we were always able to fall back on the steroids and always got a great response, really quickly.

Well, take care,

Georgina

I got Abbies test results from the endocrinologist today. Everything looked good. Her predicted final height is within the lower normal rate, but "that is all contingent on her continued steroid use." So while it is nice to know that thyroid and estrogen were fine, it is frustrating to know that there is no answer on growth hormone. I am supposed to talk to her rheumy about it in 2 weeks, and then let the endocrinologist know what we decide. I feel so frustrated right now. We are once again on the verge of venturing into the unknown with this thing. What is the next drug we turn to?...What will that do with the prednisone (to which Abbie is getting more and more resistant)?...and finally, the last spiral is growth hormone or not growth hormone, which is dependent on steroid use, which is dependent on new meds and how well they work. (I better stop, I'm even confusing myself. lol) Oh well, thanks as usual for letting me vent.The good news in all of this is that our prescription plan will cover enbrel, remicaide, and kinaret. So we'll see.Christy

[Guest guest]

Hi Georgina,

I hope that the holidays went well at your house. We had a nice quiet Christmas for a change. No flying all over the country to see everyone, and no one came here. Quite a nice change.

What I meant about the prednisone is that it takes so much more than it used to to achieve the same results. If a year ago it took 20 mg to ease through a bad period, it now takes 30. So it is not as affective as it used to be.

Abbie goes to the rheumy next week, so we will see. She is doing fairly well right now. She is back down to 20 and 10 on the prednisone. Still having breakthrough symptoms, but they are all pain and swelling related; haven't seen any rash or fever in months. She does have a really annoying cough though. We all had a sinus infection/upper respiratory thing for a while, but she is not getting rid of the cough. I have thought about taking her back to the pediatrician, but she is out of the office for a while, and I hate to break in someone new. lol If it gets worse I guess I'll have to.

Take care,

Christy

[Guest guest]

Hi Christy,

We had a few close friends of the family join us for the holidays. It was really nice this year. Christmas, and New Years Eve. Everything did seem somewhat more relaxed than it used to. We did basically the same sorts of things but it was less hectic. I think, due to everything that's been going on in the world, we really understand better just how fortunate we are and we were very happy that we were able to be together and enjoy one another's company. I'm glad the holidays were happy for your family, too : )

Okay. I understand now, about the prednisone. That never happened for . The last time Josh was sick (as were we all) it took longer for him to feel better, too. He's finally over it. I hope Abbie's cough gets better soon, too.

Aloha,

Georgina

Hi Georgina,I hope that the holidays went well at your house. We had a nice quiet Christmas for a change. No flying all over the country to see everyone, and no one came here. Quite a nice change.What I meant about the prednisone is that it takes so much more than it used to to achieve the same results. If a year ago it took 20 mg to ease through a bad period, it now takes 30. So it is not as affective as it used to be.Abbie goes to the rheumy next week, so we will see. She is doing fairly well right now. She is back down to 20 and 10 on the prednisone. Still having breakthrough symptoms, but they are all pain and swelling related; haven't seen any rash or fever in months. She does have a really annoying cough though. We all had a sinus infection/upper respiratory thing for a while, but she is not getting rid of the cough. I have thought about taking her back to the pediatrician, but she is out of the office for a while, and I hate to break in someone new. lol If it gets worse I guess I'll have to.Take care,Christy