Skip to main content
Top
Published in: Endocrine 2/2022

Open Access 02-06-2022 | Original Article

“Lymphocyte population in peripheral blood in children and adolescents with graves disease. Potential predictive tool for severity of the disease”

Authors: Gerdi Tuli, Jessica Munarin, Beatrice Mazzucco, Patrizia Matarazzo, Luisa de Sanctis

Published in: Endocrine | Issue 2/2022

Login to get access

Abstract

Purpose

To date, few data are available on the prognostic role of lymphocyte subsets in pediatric Graves’ Disease (GD). The aim of this retrospective study is to analyze the role of lymphocyte subtypes in predicting the severity of GD.

Methods

Data of 10 pediatric subjects aged <18 years with GD onset in the period November 2017–April 2021 were collected. The lymphocyte population was assessed at the onset of GD as well as hormonal and clinical data. The follow-up period was 2.4 ± 0.8 years.

Results

Pearson correlation coefficient between CD4+ /CD8+ ratio and fT3 levels and thyroid volume at diagnosis was 0.72 (p = 0.04) and 0.81 (p = 0.004) respectively; that between CD4+ /CD8+ ratio and the TRAb titer at diagnosis and after 6, 12 and 24 months was 0.89, 0.89, 0.73 and 0.77 respectively (p = 0.02, p = 0.01, p = 0.03 and 0.04). The correlation coefficient of anti-thyroid drug (ATD) dose after 6 and 12 months with CD4+ /CD8 ratio was 0.88 and 0.78 (p = 0.001 and p = 0.02 respectively). Patients with a higher CD4+ /CD8+ ratio at diagnosis displayed higher fT3 levels (28.73 ± 2.18 vs 13.48 ± 2.19 pmol/L, p = 0.03) and higher TRAb titers (28.9 ± 11.2 vs 4.88 ± 0.97, p = 0.01).

Conclusion

CD4+/CD8+ ratio appears as a promising predictive tool to be considered together with other prognostic factors to better manage pediatric GD. These preliminary data need to be confirmed over a longer follow-up period and in larger cohorts.
Literature
1.
go back to reference K. Torimoto, Y. Okada, A. Kurozumi, M. Narisawa, T. Arao, Y. Tanaka, Clinical Features of Patients with Basedow’s Disease and High Serum IgG4 Levels. Intern. Med. 56, 1009–1013 (2017)CrossRef K. Torimoto, Y. Okada, A. Kurozumi, M. Narisawa, T. Arao, Y. Tanaka, Clinical Features of Patients with Basedow’s Disease and High Serum IgG4 Levels. Intern. Med. 56, 1009–1013 (2017)CrossRef
2.
go back to reference D.S. Ross, H.B. Burch, D.S. Cooper, M.C. Greenlee, P. Laurberg, A.L. Maia, S.A. Rivkees, M. Samuels, J.A. Sosa, M.N. Stan, M.A. Walter, 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 26, 1343–1421 (2016)CrossRef D.S. Ross, H.B. Burch, D.S. Cooper, M.C. Greenlee, P. Laurberg, A.L. Maia, S.A. Rivkees, M. Samuels, J.A. Sosa, M.N. Stan, M.A. Walter, 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 26, 1343–1421 (2016)CrossRef
3.
go back to reference C.F. Mooij, T.D. Cheetham, F.A. Verburg, A. Eckstein, S.H. Pearce, J. Léger, A.S.P. van Trotsenburg, 2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease. Eur. Thyroid J. 11, e210073 (2022)CrossRef C.F. Mooij, T.D. Cheetham, F.A. Verburg, A. Eckstein, S.H. Pearce, J. Léger, A.S.P. van Trotsenburg, 2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease. Eur. Thyroid J. 11, e210073 (2022)CrossRef
4.
go back to reference S. Rabon, A.M. Burton, P.C. White, Graves’ disease in children: long-term outcomes of medical therapy. Clin. Endocrinol. (Oxf.) 85, 632–635 (2016)CrossRef S. Rabon, A.M. Burton, P.C. White, Graves’ disease in children: long-term outcomes of medical therapy. Clin. Endocrinol. (Oxf.) 85, 632–635 (2016)CrossRef
5.
go back to reference H. O Ohye, A. Minagawa, J.Y. Noh, K. Mukasa, Y. Kunii, N. Watanabe, M. Matsumoto, M. Suzuki, A. Yoshihara, K. Ito, K. Ito, Antithyroid drug treatment for graves’ disease in children: a long-term retrospective study at a single institution. Thyroid 24, 200–207 (2014)CrossRef H. O Ohye, A. Minagawa, J.Y. Noh, K. Mukasa, Y. Kunii, N. Watanabe, M. Matsumoto, M. Suzuki, A. Yoshihara, K. Ito, K. Ito, Antithyroid drug treatment for graves’ disease in children: a long-term retrospective study at a single institution. Thyroid 24, 200–207 (2014)CrossRef
6.
go back to reference H. Sato, K. Minamitani, M. Minagawa, I. Kazukawa, S. Sugihara, K. Wataki, S. Konda, H. Inomata, K. Sanayama, Y. Kohno, N. Sasaki, Clinical features at diagnosis and responses to antithyroid drugs in younger children with Graves’ disease compared with adolescent patients. J. Pediatr. Endocrinol. Metab. 27, 677–683 (2014)CrossRef H. Sato, K. Minamitani, M. Minagawa, I. Kazukawa, S. Sugihara, K. Wataki, S. Konda, H. Inomata, K. Sanayama, Y. Kohno, N. Sasaki, Clinical features at diagnosis and responses to antithyroid drugs in younger children with Graves’ disease compared with adolescent patients. J. Pediatr. Endocrinol. Metab. 27, 677–683 (2014)CrossRef
7.
go back to reference T. Cheetham, R. Bliss, Treatment options in the young patient with Graves’ disease. Clin. Endocrinol. (Oxf.) 85, 161–164 (2016)CrossRef T. Cheetham, R. Bliss, Treatment options in the young patient with Graves’ disease. Clin. Endocrinol. (Oxf.) 85, 161–164 (2016)CrossRef
8.
go back to reference J. Léger, J.C. Carel, Management of endocrine disease: arguments for the prolonged use of antithyroid drugs in children with Graves’ disease. Eur. J. Endocrinol. 177(2), R59–R67 (2017)CrossRef J. Léger, J.C. Carel, Management of endocrine disease: arguments for the prolonged use of antithyroid drugs in children with Graves’ disease. Eur. J. Endocrinol. 177(2), R59–R67 (2017)CrossRef
9.
go back to reference J. Léger, I. Oliver, D. Rodrigue, A.S. Lambert, R. Coutant, Graves’ disease in children. Ann. Endocrinol. (Paris) 79, 647–655 (2018)CrossRef J. Léger, I. Oliver, D. Rodrigue, A.S. Lambert, R. Coutant, Graves’ disease in children. Ann. Endocrinol. (Paris) 79, 647–655 (2018)CrossRef
10.
go back to reference R. Gastaldi, E. Poggi, A. Mussa, G. Weber, M.C. Vigone, M. Salerno, M. Delvecchio, E. Peroni, A. Pistorio, A. Corrias, Graves disease in children: thyroid-stimulating hormone receptor antibodies as remission markers. J. Pediatr. 164, 1189–1194 (2014)CrossRef R. Gastaldi, E. Poggi, A. Mussa, G. Weber, M.C. Vigone, M. Salerno, M. Delvecchio, E. Peroni, A. Pistorio, A. Corrias, Graves disease in children: thyroid-stimulating hormone receptor antibodies as remission markers. J. Pediatr. 164, 1189–1194 (2014)CrossRef
11.
go back to reference S.A. Rivkees, Controversies in the management of Graves’ disease in children. J. Endocrinol. Investig. 39, 1247–1257 (2016)CrossRef S.A. Rivkees, Controversies in the management of Graves’ disease in children. J. Endocrinol. Investig. 39, 1247–1257 (2016)CrossRef
12.
go back to reference E.R. Okawa, F.D. Grant, J.R. Smith, Pediatric Graves’ disease: decisions regarding therapy. Curr. Opin. Pediatr. 27, 442–447 (2015)CrossRef E.R. Okawa, F.D. Grant, J.R. Smith, Pediatric Graves’ disease: decisions regarding therapy. Curr. Opin. Pediatr. 27, 442–447 (2015)CrossRef
13.
go back to reference P.B. Kaplowitz, P. Vaidyanathan, Update on pediatric hyperthyroidism. Curr. Opin. Endocrinol. Diabetes Obes. 27, 70–76 (2020)CrossRef P.B. Kaplowitz, P. Vaidyanathan, Update on pediatric hyperthyroidism. Curr. Opin. Endocrinol. Diabetes Obes. 27, 70–76 (2020)CrossRef
14.
go back to reference A. Kuś, M. Radziszewski, A. Glina, K. Szymański, B. Jurecka-Lubieniecka, E. Pawlak- Adamska, D. Kula, N. Wawrusiewicz-Kurylonek, J. Kuś, P. Miśkiewicz, R. Płoski, M. Bolanowski, J. Daroszewski, B. Jarząb, A. Bossowski, T. Bednarczuk, Paediatric- onset and adult-onset Graves’ disease share multiple genetic risk factors. Clin. Endocrinol. (Oxf.) 90, 320–327 (2019)CrossRef A. Kuś, M. Radziszewski, A. Glina, K. Szymański, B. Jurecka-Lubieniecka, E. Pawlak- Adamska, D. Kula, N. Wawrusiewicz-Kurylonek, J. Kuś, P. Miśkiewicz, R. Płoski, M. Bolanowski, J. Daroszewski, B. Jarząb, A. Bossowski, T. Bednarczuk, Paediatric- onset and adult-onset Graves’ disease share multiple genetic risk factors. Clin. Endocrinol. (Oxf.) 90, 320–327 (2019)CrossRef
15.
go back to reference I. Ben-Skowronek, L. Szewczyk, B. Kulik-Rechberger, E. Korobowicz, The differences in T and B cell subsets in thyroid of children with Graves’ disease and Hashimoto’s thyroiditis. World J. Pediatr. 9, 245–250 (2013)CrossRef I. Ben-Skowronek, L. Szewczyk, B. Kulik-Rechberger, E. Korobowicz, The differences in T and B cell subsets in thyroid of children with Graves’ disease and Hashimoto’s thyroiditis. World J. Pediatr. 9, 245–250 (2013)CrossRef
16.
go back to reference T. Chen, L. Chen, H. Song, X. Chen, R. Xie, Q. Xia, D. Zhang, H. Wu, H. Sun, X. Wang, F. Wang, Clinical relevance of T lymphocyte subsets in pediatric Graves’ disease. J. Pediatr. Endocrinol. Metab. 33, 1425–1430 (2020)CrossRef T. Chen, L. Chen, H. Song, X. Chen, R. Xie, Q. Xia, D. Zhang, H. Wu, H. Sun, X. Wang, F. Wang, Clinical relevance of T lymphocyte subsets in pediatric Graves’ disease. J. Pediatr. Endocrinol. Metab. 33, 1425–1430 (2020)CrossRef
17.
go back to reference B.S. Iwona, S.S. Jadwiga, K. Elzbieta, S. Leszek, Lymphocytes in peripheral blood and thyroid tissue in children with Graves’ disease. World J. Pediatr. 4, 274–282 (2008)CrossRef B.S. Iwona, S.S. Jadwiga, K. Elzbieta, S. Leszek, Lymphocytes in peripheral blood and thyroid tissue in children with Graves’ disease. World J. Pediatr. 4, 274–282 (2008)CrossRef
18.
go back to reference K. Van der Weerd, P.M. Van Hagen, B. Schrijver, D.J. Kwekkeboom, W.W. De Herder, M.R. Ten Broek, P.T. Postema, J.J. Van Dongen, F.J. Staal, W.A. Dik, The peripheral blood compartment in patients with Graves’ disease: activated T lymphocytes and increased transitional and pre-naive mature B lymphocytes. Clin. Exp. Immunol. 174, 256–264 (2013)CrossRef K. Van der Weerd, P.M. Van Hagen, B. Schrijver, D.J. Kwekkeboom, W.W. De Herder, M.R. Ten Broek, P.T. Postema, J.J. Van Dongen, F.J. Staal, W.A. Dik, The peripheral blood compartment in patients with Graves’ disease: activated T lymphocytes and increased transitional and pre-naive mature B lymphocytes. Clin. Exp. Immunol. 174, 256–264 (2013)CrossRef
19.
go back to reference P. Vitti, E. Martino, F. Aghini-Lombardi, T. Rago, L. Antonangeli, D. Maccherini, P. Nanni, A. Loviselli, A. Balestrieri, G. Araneo, Thyroid volume measurement by ultrasound in children as a tool for the assessment of mild iodine deficiency. J. Clin. Endocrinol. Metab. 79, 600–603 (1994)PubMed P. Vitti, E. Martino, F. Aghini-Lombardi, T. Rago, L. Antonangeli, D. Maccherini, P. Nanni, A. Loviselli, A. Balestrieri, G. Araneo, Thyroid volume measurement by ultrasound in children as a tool for the assessment of mild iodine deficiency. J. Clin. Endocrinol. Metab. 79, 600–603 (1994)PubMed
20.
go back to reference J.M. van Lieshout, C.F. Mooij, A.S.P. van Trotsenburg, N. Zwaveling-Soonawala, Methimazole-induced remission rates in pediatric Graves’ disease: a systematic review. Eur. J. Endocrinol. 185, 219–229 (2021)CrossRef J.M. van Lieshout, C.F. Mooij, A.S.P. van Trotsenburg, N. Zwaveling-Soonawala, Methimazole-induced remission rates in pediatric Graves’ disease: a systematic review. Eur. J. Endocrinol. 185, 219–229 (2021)CrossRef
Metadata
Title
“Lymphocyte population in peripheral blood in children and adolescents with graves disease. Potential predictive tool for severity of the disease”
Authors
Gerdi Tuli
Jessica Munarin
Beatrice Mazzucco
Patrizia Matarazzo
Luisa de Sanctis
Publication date
02-06-2022
Publisher
Springer US
Published in
Endocrine / Issue 2/2022
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-022-03088-7

Other articles of this Issue 2/2022

Endocrine 2/2022 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.