May 1975

The Journal o f P E D I A T R I C S

675

Occurrence and natural history of chronic

lymphocytic thyroiditis in childhood
In a six-year survey o f 5,179 school children in Arizona, Utah, and Nevada 62 cases of chronic lymphocytic
thyroiditis were identified giving a prevalence of 1.2%. Thyroids were enlarged in 85%, firm in 60%, and had an
irregular or Iobulated surface in 75%. Antibodies to thyroglobulin were demonstrable in the serum at some time
during the course o f the disease in 76% by the tannedred blood cell technique and in 93% by
radioimmunoassay. Serum TSH concentrations were elevated in seven o f 15 subjects. Many o f the cases were
early or mild thyroiditis and, in most instances, subjects were asymptomatic and considered clinically euthyroid.
Two subjects were hypothyroid, and two appeared clinically hyperthyroid. Spontaneous resolution of thyroiditis
occurred in 15 of 32 individuals who received no treatment. Resolution occurred in 14 o f 30 children treated with
thyroid hormone supplement. The results suggest that lymphocytic thyroiditis in children may be present without
symptoms and in many is a self-limiting disorder from which complete recovery occurs spontaneously.

Marvin L. Rallison, M . D . , *
C l e v e l a n d , Ohio, F .

S a l t L a k e City, Utah, B r o w n M . D o b y n s , M . D . , P h . D . ,

Raymond Keating, M . D , , ~

Rochester, Minn.,

Joseph E. Rail, M.D., Ph.D., Bethesda, Md., and Frank H. Tyler, M.D.,
S a l t L a k e City, U t a h

CHRONIC LYMPHOCYTIC THYROIDITIS, or

Hashimoto struma, is suggested by insidious thyroidal
enlargement, variable consistency of the gland, a granular or pebbly surface, palpable lymph nodes in the immediate proximity of the gland, elevated serum antithyroglobulin antibody titer, wide difference between
From the Departments o f Pediatrics and Medicine,
University o f Utah College o f Medicine, Case Western
Reserve University, Mayo Clinic, and National Institute
o f Arthritis and Metabolic Diseases.
The material described in this paper is based on work
performed under a sttbcontract o f the Utah State Division
of Health pursuant to Contract No. CBE-R-70-0072 with
the Environmental Protection Agency. Additional support
for performance of laboratory tests was provided by the
National Institute o f Arthritis and Metabolic Diseases,
Contract No. NIH- 70-596. Studies performed at the
University o f Utah Medical Center were supported by
Clinical Research Center Grant RR-64.
*Reprintaddress:Departmentof Pediatrics, Universityof Utah,
Medical Center, Salt Lake City, Utah 84132.
?'Deceased.

values of protein-bound iodine and thyroxine iodine, irregular uptake of isotope on thyroid scan, and associated clinical hypo- or hyperthyroidism.
Although considered relatively u n c o m m o n at any age
in the past, thyroiditis* has recently been reported to be
a frequent cause of goiter in children L-5 and has been

See related article, p. 816.

Abbreviations used
TSH: thyroid-stimulating hormone
PBI: protein-bond iodine
T4I: thyroxine iodine
TRC: tanned red cell
presumed to be one of the causes of hypothyroidism in
adults. 6 Previous reports on thyroiditis in children have
been based on data from patients who presented for
medical attention with goiter or symptoms suggesting
*The term thyroiditis will hereafter be used to mean chronic lymphocytic thyroiditis.
VoL 86, No. 5, pp. 675-682

676

The Journal of Pediatrics

May 1975

Rallison et al.

Table I. Occurrence of thyroiditis

1965-1968

Arizona
Male
Female
Both
Utah-Nevada
Male
Female
Both
Totals
Male
Female
Both

1969-1971 *

No.
examined

No. with
thyroiditis

No.
examined

1,051
1,089
2,140

8
10
18

370
330
700

1,367
1,324
2,691

9
26
35

2,418
2,413
4,831

17
36
53

Combined?~

No. with
thyroiditis

No.
examined

No. with
thyroiditis

RatesH, O00

1
2
3

1,120
1,151
2,27l

9
12
21

8
10
9

474
479
953

2
4
6

1,466
1,479
2,945

11
30
41

8
20
14

844
809
1,653

3
6
9

2,586
2,593
5,179

20
42
62

8
16
12

*of the 1,653 senior students examined in 1969-19711 1,305 had been previouslyexamined during 1965-1968.
"~Combinedcolumn represents number of separate children examined.

either hyper- or hypothyroidism. 1-9There is little information concerning the early stages, the actual prevalence, or the course of thyroiditis among children.
In a six-year survey of the thyroids of " n o r m a l "
schoolchildren, some of whom were presumed to be exposed to radioiodine(s) in fallout, 62 children with a
presumptive diagnosis of thyroiditis were identified. 1~
A n extensive sequence of observations of the children
with thyroiditis sheds light on the early development
and natural history of thyroiditis in children.
METHODS

OF STUDY

The children in this Study were identified during a

survey of 5,179 children in southwestern Utah, adjacent Nevada, and southeastern Arizona who were examined for thyroid abnormalities after exposure of children in Utah and Nevada to radioiodine(s) in fallout
from nuclear weapons testing in 1953.11 A n n u a l examinations from 1965-1968 included children from age
11 to 18; in the last 3 years (1969-1971), only high
school seniors from age 17 to 18 were examined. The
bases for population selection and the procedures for
screening and panel review have been described elsewhere.lO, 11
Protein-bound iodine, thyroxine iodine by column
chromatography, and inorganic iodide were measured
by a commercial laboratory.* The difference between
serum total iodine and the PBI was considered to be
serum iodide. Thyroid-stimulating hormone determina*Performed by Bio-ScienceLaboratories,Van Nuys, Calif.

tions using a radioimmunoassay were kindly done by

Dr. William Odell. Thyroglobulin antibodies were identified by two methods: the tanned red blood cell hemagglutination technique* and radioimmunoassay, a double-antibody technique utilizing thyroglobulin labeled

with 125I.t12
In 40 subjects the diagnosis of thyroiditis was based
on physical and clinical evidence derived from serial exa m i n a t i o n s a n d f r o m l a b o r a t o r y studies (PBI, T4I ,
serum iodide, and thyroglobulin antibodies) obtained
on sera collected during field examinations. In the remaining 22, studies were carried out in a hospital, using
radioactive iodine, technetium scans, and other laboratory studies of thyroid function as described in an
earlier report. 1~ In nine of these, thyroiditis was confirmed at surgical exploration, performed because o f
nodules in a population thought to be at risk.
RESULTS
The occurrence of thyroiditis among 5,179 schoolc h i l d r e n e x a m i n e d is p r e s e n t e d in T a b l e I by geographic location and by sex. Thyroiditis was twice as
c o m m o n among females as males (p ( 0 . 0 1 ) and one
and a half times more prevalent among children in
U t a h - N e v a d a than in Arizona (p (0.10). During the six
years of the study, thyroiditis was discovered in 31
children who had previously been examined and considered to be normal. There was a prevalence peak at 13
*Performed by Bio-ScienceLaboratories,Van Nuys, Calif.
tPerformed by Dr. Giovanni Salabe, Rome, Italy.

Volume 86
Number 5

Chronic lymphocytic thyroid#is in childhood

677

Table II. PBI, T4I, and serum iodide in thyroiditis*

Number
Group

Utah-Nevada
Male
Female
Arizona
Male
Female
All thyroiditis
Normal control subjects

Mean SD
(txgldl)

PBI-T41
difference
Mean SD
(txg/dl)

Serum iodide
Mean SD
(/xg/dl)

r4i

Patients

Determinations

PBI
Mean SD
(~gldO

11
31

38
146

5,92 1.07
6.28 1.98

4.8 +--_0.86
4.53 1.15

1.74 _ 0.64
1.72 1.55

0.89 0.47
0.72 "4- 0.33

9
11
62
290

31
41
256
290

6.60
6.12
6.23
5.35

4.88 _+ 0.65
4.91 +_ 1.44
4.54 _ 1.01
4.36 +_ 0.73

1.25
1.21
1.62 _
1.01

1.37
1.17 _
0.91 +
0.83

1.54
1.53
1.68
0.90

0.96
0.34
1.17
0.73

0.87
0.78
0.60
0.53

*For each subject with multipledeterminations,mean values were used in tabulation.

to 14 years and another at 16 to 17 years.* The incidence of thyroiditis averaged five new cases of thyroiditis per y e a r per 1,000 c h i l d r e n e x a m i n e d d u r i n g
1965-1968 and 6.5 new cases per year per 1,000 among
the high school seniors.
Characteristics of thyroiditis. In 70% the thyroids
were moderately enlarged, in 15% greatly enlarged (up
to an estimated 90+ gm), and in 15% normal in size (but
suspected to contain nodules). Actual size drawings
were made of the thyroid at each examination so that
sequential comparisons were possible. The glands displayed increased firmness in 60% and were of soft or
normal consistency in 40%. The thyroid when first observed was described as smooth, granular, pebbly, or
bosselated in almost equal frequency. None were tender. There were palpable regional lymph nodes (particularly near the isthmus) in 21 of 62 subjects (33%).
Nearly half of the thyroids were considered to be nodulart at some time during the period of observation (26
of 62) and in 17 the nodularity was the reason for recognition of an abnormal thyroid.
Laboratory tests in thyroiditis, The mean values for
laboratory determinations by geographic location and
by sex among the 62 patients considered to have thyroiditis are listed in Table II, together with data collected from 290 control subjects chosen at random from
the same p o p u l a t i o n s . P r o t e i n - b o u n d iodine values
were significantly higher ( ( 0 . 0 1 ) and thyroxine values
nearly equal to those of the normal subjects. The difference between PBI and T4I , generally considered evidence of release of abnormal iodoproteins, was greater
*The latter peak may be attributablein part to the manner of sampiing.
?Nodularity is defined as any area of thickening or enlargement
which on palpation has a differentconsistencythan the remainderof
the gland.

T a b l e III. T h y r o g l o b u l i n a n t i b o d i e s by radioimmunoassay*
Subjects with
thyroiditis

Subjects with
normal thyroid

TRC
titer
(1:8

TRC
titer
>~1:8

TRC
titer
(1:8

TRC
titer
31:8

0.0-2.0
2.0-10.0
10.0

1
8
8

2
1
22

46
3
2

5
2
2

Totals

17

25

51

% binding
ofl251-Tg

42

60

*Performed by Dr. GiovanniSalabe, Rome, Italy.

than 2.0/xg/dl in ten of the 62 patients (16%). Among
the 290 subjects considered to be normal, the difference
was over 2.0 txg/dl in 6%. Serum iodide levels were significantly higher among children in Arizona than in
Utah-Nevada (for males p (0.01, for females p (0.05).
Thyroglobulin antibody titers by tanned RBC hemagglutination technique were obtained in all subjects with
thyroiditis and in 290 normal controls. The highest antibody titer measured for each child with thyroiditis*
compared to titers obtained from single observations in
children considered to be normal in the same population is depicted in Fig. 1. Forty-seven of 62 subjects
(76%) with thyroiditis had s e r u m a n t i b o d y titers of
more than 1:16. In 13 the titer was consistently less
than 1:8. Among 290 subjects without palpable thyroid
abnormality, 14 (4.7 %) had titers over 1:16.
*Sincein manychildrenantibodytiters wereobtainedbefore,during,
and after an episode of thyroiditis,the use of average or initial values
would be misleading.

678

Rallison et aL

The Journal of Pediatrics

May197 5

I00THYROIDITIS 1 62
NORMAL CONTROLS 1---I 290

75(z)
uJ

~40-

,8 3020-

15"
I0"
5-

9':1:8

1:8

1:16

1:32 1:64 1:128 1:256 1:512 1:1024 1:2048 1:4096

HIGHEST TITER

Fig. 1. Human antithyroglobulin antibodies (tanned RBC hemagglutination technique [performed by Bio-Science
Laboratories]) in 62 subjects with thyroiditis and 290 normal controls. Only the highest measured titer is shown
when multiple values were available. The bar graph compares the percent of normal controls with various titer
levels with percent of subjects with thyroiditis who achieved various titer levels.

Thyroid antibodies were identified by radioimmunoassay in 93% of 42 children with thyroiditis and in
15% of 60 with normal thyroids (Table III). In all but
one of 17 subjects with thyroiditis,* whose TRC titer
was less than 1:8, thyroglobulin antibodies were demonstrable by radioimmunoassay. Four of the nine patients with a tissue diagnosis of thyroiditis did not have
a positive antibody titer by the TRC technique, but
were positive by radioimmunoassay.
Radioiodine uptake studies using 132It were performed in 20 subjects with thyroiditis. Uptake values in
thyroiditis were not significantly different from those
obtained in 33 children with nodularity or adolescent
goiter of the same age and geographic location (values
from normal children using 132I a r e not available). The
increase in thyroidal uptake following administration of
TSH in thyroiditis was not significantly different from
that seen in subjects with adolescent or nodular goiter.
The release of radioiodine from the thyroid after administration of perchlorate was greater than 10% in four of
the 20 patients tested with thyroiditis. A 40% discharge
was observed in one patient who was clinically hypothyroid.
Thyroid scans using 99mTct were made in 22 subjects
with thyroiditis. An irregular or mottled pattern of uptake throughout the gland suggested spotty areas of
functional tissue in 12 of 22 patients. In four additional
cases, this pattern was observed in one lobe. A discrete
*Based on presumptive clinical evidence 13 or tissue diagnosis.4
t132I (half-life 2.5 hr) was chosen for uptake studies and 99mTc (halflife 6 hr) was chosen for thyroid scans to minimize exposure to radiation.

area of decreased uptake was seen in three patients, and

a normal distribution occurred in three.
R a d i o i m m u n o a s s a y of T s H was performed on 19
samples from 15 children with thyroiditis. Values for
serum TSH, PBI, T4I , and thyroglobulin antibody titers
are listed in Table IV. Elevations of TSH above 10 m l U /
ml (normal 2 to 10 mlU/ml) were found in two clinically hypothyroid individuals and in four of 12 untreated subjects considered to be clinically euthyroid.
Elevations in two of five treated with thyroid supplement suggested the dose of supplement was insufficient. The elevated TSH levels could be generally correlated with diminished thyroxine levels confirming the
work of Greenberg and associates. 9 Elevated serum levels of TSH in clinically euthyroid subjects may represent subclinical hypothyroidism or they may signify
that extra TSH is required for the damaged thyroid to
maintain a normal secretion rate.
Thyroid status of patients studied. Fifty-four of the
62 subjects with thyroiditis were judged to be clinically
euthyroid (87%). Two subjects with thyroiditis presented with s y m p t o m s suggesting h y p e r t h y r o i d i s m
including nervousness, tremor, and tachycardia. Although PBI values were slightly elevated (8.4 and 8.8
/xg/dl), T4I values were normal (5.7 and 6.7/~g/dl),and
T 3 was normal in one (242/x/xg/dl).
Clinical hypothyroidism, accompanied by low PBI,
low T4I, and elevated TSH, was present in two subjects
at the time of initial examination. Although PBI or T4I
levels were not in the hypothyroid range, in four additional subjects clinical features such as lethargy, tiredness, dry skin, irregular menses, excessive body weight

Volume 86
Number 5

Chronic lymphocytic thyroiditis in childhood

679

Table IV. Serum TSH assay in thyroiditis*

Thyroid
antibody titer
(TRC)
~1:16

Subject

TSH
(mlU/ml)
2-10

PBI
(Ixg/dl)
4.0-8.0

T41
(izg/dl)
3.0-ZO

1
2a
2b
3
4
5
6
7.
8
9a
9b
10
11
12
!3a
13b
14a

3.3
25.0
2.5
2.5
6.3
4.3
12.0
9.5
4.7
145
19
165
7.4
7.7
2.6
13.6
19.3

5.7
8.0
6.4
9.0
6.0
5.6
5.8
7.7
6.8
3.7
3.0
7.2
6.2
10.1
5.5
5.4

6.0
7.4
8.0
6.7
4.4
5.5
3.3
5.5
5.0
1.0
11.3
2.5
6.2
4.4
8.1
5.5
3.1

.1:8
1:128
1:32
1:8
1:64
1:8
1:64
1:8
1:8
1:2048
1:512
1:8
1:32
1:64
1:64
1:256
1:8

Euthyroid
Euthyroid
Euthyroid
Euthyroid
Euthyroid
Euthyroid
Euthyroid
Euthyroid
Euthyroid
Hypothyroid
Euthyroid (pregnant)
Hypothyroid
Euthyroid
Euthyroid
Euthyroid
Euthyroid
Euthyroid

|4b
15

36.0
6.1

4.3
6.5

2.7
3.9

1:8
1:64

Euthyroid
Euthyroid

Clinical
status

Treatment
at time of
assay

None
None
T4, 0.2 rag/day
T4, 0.2 rag/day
None
None
None
None
None
None
T4, 0.3 mg/day
None
None
None
T4, 0.3 rag/day
None
Dessicated thyroid,
1 grain/day
None
None

*Performed courtesy of Dr. William Odell.

(which improved with thyroid supplementation), or apparent retardation of growth suggested hypothyroidism.
Serum concentrations of TSH were elevated in one and
normal in one.
No progression to hypothyroidism was observed clinically or demonstrated by laboratory determinations in
32 patients observed for an average of three years without thyroid supplement. Treatment with thyroxine in
3 0 subjects obscured the natural course of the disease;
however, later discontinuation of supplement in four
subjects for a period of two years did not result in clinical hypothyroidism.
Clinical course of thyroiditis. In 31 of the 62 subjects
with thyroiditis, the thyroid had previously been examined and considered to be normal, thus permitting
an estimation of the approximate date of onset of the
process. In 17 of these 31, elevation of antibody titer
was present at the time of discovery of a palpable thyroid abnormality. In 11 of the 31, enlargement preceded
the elevation of antibody titer, and in three, an elevated
antibody titer was discovered accidentally when random samples of serum were obtained from children
considered normal. The gland later developed evidence
of disease.
Diminution in the size of the gland in those who rec e i v e d s u p p l e m e n t a l t h e r a p y with t h y r o i d h o r m o n e

compared to those who received no therapy is presented in Fig. 2. Of 32 who received no treatment, the
thyroid returned spontaneously to normal size in 15; it
remained unchanged in 12, and increased slightly in 5.
Thirty children considered to have progressing or severe disease received supplemental hormone therapy.
At the conclusion of the study, the thyroids of 14 of the
30 had decreased to normal size.
Changes in thyroglobulin serum antibody titer during
the course of the disease are presented in Fig. 3. In the
30 patients who received thyroid supplement, the medication was prompted by an increase in antibody titer
usually accompanied by thyroid enlargement. At the
conclusion of the study, the titers had fallen to normal
in 23 of 62 and in 18 the thyroid had become normal in
size and consistency as well.
Consideration of possible etiologic factors. Adenoviruses or other respiratory viruses have been implicated in thyroiditis because of positive serologic determ i n a t i o n s ) 3 but the viruses have not been recovered
f r o m t h y r o i d tissue. 14, 15 In this study, serologic examinations for m u m p s and adenovirus were performed
in ten subjects considered to have thyroiditis.* Only two
*Courtesy of Dr. Eli Gold, Case Western Reserve University, Cleveland, Ohio.

680

Rallison et al.

The Journal of Pediatrics

May1975

5-

=it...-Rx STARTED

"-"

~ 'x" ~""'~'"~ ~

I
I

I
I

~t

I
I

I-

. . . . UNTREATED PATIENTS32
THYROXINE-TREATED PATIENTS30

I
2
TIME-YEARS

Fig. 2. The mean size of goiter in 62 subjects with thyroiditis is shown to decrease with time in both treated and
untreated subjects. Data derived from sequential actual-size drawings (l=normal size thyroid).
2.0--

DIAGNOSIS----~ ' ' ~

(~

UNTREATEDPATIENTS32 - - TREATED PATIENTS 30

bd

~-

Rx STARTED~

Id_
0
0

0.5ILl

I
TIME -YEARS

Fig. 3. The mean negative log of antithyroglobulin titers is plotted against time in years for the 62 subjects with
thyroiditis. A decrease in titer is observed for both treated and untreated subjects.
had significant titers to adenovirus and two had slight
elevation of m u m p s titer. In 30 normal subjects, m u m p s
titer was found elevated in two, b u t adenovirus titers
were not significant in any. Cultures for parainfluenza,
mumps, and adenovirus in primary Rhesus monkey
kidney and human fetal diploid lung were carried out
with thyroid tissue and blood from four individuals with
thyroiditi s, but no viral organisms were found.
Since thyroiditis is said to be produced in certain experimental animals by iodine administration 16 and the
iodine intake in Utah and in Arizona was different, this
possibility was considered as an etiologic factor. However, there was no significant difference in the prevalence of thyroiditis in the two areas (p ( 0 . 1 0 ) . Ex-

posure to radioiodine in fallout was also considered, but

there was no higher incidence of thyroiditis among
those exposed than unexposed. 1~
DISCUSSION
The true incidence of thyroiditis in children has been
unknown, although its increasing occurrence has been
recognized.i, 17 In recent years, reports suggest that it is
the cause of nontoxic goiters in one-third to two-thirds
of all children referred to thyroid clinics} -8 The cases of
thyroiditis reported here were from a different population. Almost all were asymptomatic and found only by a
meticulous thyroida! screening procedure in a population of normal adolescents rather than individuals seek-

Volume 86
Number 5

ing medical advice. Although a tissue diagnosis was not

made in some of the patients, the presumptive diagnoses b a s e d on r e p e a t e d p h y s i c a l e x a m i n a t i o n s a n d
laboratory evidence seemed reasonably reliable. In retr o s p e c t t h e e v i d e n c e suggests t h a t s o m e a d d i t i o n a l
cases of thyroiditis may have been overlooked because
of the subtle character of the disease.
Because of the opportunity for repeated physical examinations and completion of laboratory data in this
study, thyroiditis could be observed during development and subsidence reflecting a wide spectrum of
findings which included early and mild thyroiditis. Although firm consistency and irregular surface resulting
from compensatory hypertrophy are characteristic of
long-standing thyroiditis and were present in over half
of the subjects, many cases were identified early and
the thyro!ds at that time were soft or of normal consistency with a smooth surface on palpation.
Characteristic laboratory features were found with
less frequency than have been reported. A difference
between PBI and T4I of over 2 ~g/dl has been reported
in the majority of children with thyroiditis seeking medical a t t e n t i o n ~9, 18, 19; s e r u m c o n c e n t r a t i o n s o f TSH
have been reported to be elevated in 60 to 75% 4, 9;
thyroid uptake of radioactive iodine has usually been
elevated1-9,18,19; defective binding of inorganic iodide is
reported to be present in roughly half the children, 9,18,
20 and a failure of the thyroid to respond to TSH is common.2, 18 In this study a wider than normal difference
between PBI and T4I was seen in 20%; TSH elevations
in 47% of those tested; the uptake of radioiodine was
usually in the accepted normal range; only 20% had defective binding of inorganic iodide and a poor response
to TSH was seen in only 30%, presumably because
many of the cases composing this series were early or
mild cases.
Identification of serum antibodies to thyroglobulin
has usually been considered desirable for the diagnosis
of thyroiditis, b u t antibodies have been found with
v a r i a b l e f r e q u e n c y d e p e n d i n g on t h e m e t h o d o l o g y
used.l-9, 19 Negative TRC titers to thyroglobulin have
been reported in many cases of thyroiditis proved by
tissue diagnosis.2, 3,19 Use of multiple laboratory determinations has improved the serologic identification of
thyroiditis.5,2! In this study, 76% of the 62 subjects with
thyroiditis had a serum antithyroglobulin titer over 1:16
b y the T R C t e c h n i q u e . H o w e v e r , in 17 s u b j e c t s in
whom the determination was negative, antibody to thyroglobulin by radioimmunoassay was positive in all b u t
one. Radioimmunoassay demonstrated antibodies in all
of four subjects with a tissue diagnosis of thyroiditis b u t
a negative tanned red blood cell test. Elevated serum

Chronic lymphocytic thyroiditis in childhood

681

thyroglobulin antibody titers have been reported to occur infrequently in normal children, 2~ but among 290
children in this study considered to have no thyroid abnormality, 14 (4.7%) had serum antibody titers over
1:16 to thyroglobulin by the TRC technique and nine of
60 (15%) had significant thyroglobulin antibodies by
radioimmunoassay. Thyroglobulin antibodies in individuals with a p p a r e n t l y n o r m a l t h y r o i d s m a y be a
p h e n o m e n o n of aging since antibodies are seen with
moderate frequency in adults, or it may represent early
or subclinical thyroiditis23 in which case the true prevalence of thyroiditis may be considerably underestimated.
Spontaneous recovery from thyroiditis has been repeatedly observed in individual cases by the authors
a n d c l e a r l y d e m o n s t r a t e d in this u n i q u e p o p u l a t i o n .
Thyroids which failed to regress with supplemental thyroxine or those already found to be hypothyroid may
represent an advanced stage of the disease which may
ultimately result in hypothyroidism in later life as suggested by others. 6, 24 In this study, complete resolution
of the thyroid to normal size, loss of firmness or pebbliness, and decrease in the serum antibody titer to normal
were seen in half of the children who received no
medication and in nearly half of those given thyroxine
supplement. In seven of nine subjects in w h o m tissue
examination showed moderate invasion and replacem e n t of thyroid tissue with lyrnphocytes, resolution to
normal was observed although most of the diseased
gland was not removed when the pathologic process
was recognized at operation. Thyroiditis in children appears often to be a spontaneously reversible process.
REFERENCES

1. Hahn HB, Hayles AB, and Woolner LB: Lymphocytic

thyroiditis in children, J pEDIATR66:73, 1965.
2. Leboeuf G, and Ducharme JR: Thyroiditis in children, diagnosis and management, Pediatr Clin North Am 13:19,
1966.
3. Ling SM, Kaplan SA, Weitzman JJ, Reed GB, Costin G,
and Landing BH: Euthyroid goiters in children: Correlation of needle biopsy with other clinical findings in chronic lymphocytic thyroiditis and simple goiter, Pediatrics
44:695, 1969.
4. Hung W, Chandra R, August GP, and Altman PR: Clinical, laboratory, and histologic observations in euthyroid
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