Can Anti-Thyroid Antibodies Influence the Outcome of Primary Chronic Immune Thrombocytopenia in Children?

Author(s): Paola Giordano, Maurizio Delvecchio, Giuseppe Lassandro, Federica Valente, Valentina Palladino, Mariangela Chiarito, Malgorzata Wasniewska, Maria F. Faienza*.

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
(Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders)

Volume 20 , Issue 3 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Background: Immune thrombocytopenia (ITP) is an acquired immune mediated disorder characterized by isolated thrombocytopenia. Pediatric ITP patients can develop autoantibodies such as anti-thyroglobulin (TG) and anti-thyroperoxidase (TPO), even in the absence of clinical signs of autoimmune disease.

Objective: The purpose of this article is to provide a review about: 1) the prevalence of positivity of anti-thyroid antibodies (TPO and TG) in pediatric patients with chronic ITP; 2) the role of autoimmune thyroiditis on the outcome of chronic ITP.

Methods: The authors individually completed a review of the literature for this article. Retrospective and prospective clinical studies with pediatric cohorts were considered.

Results: From the analysis of data, we found 4 papers which included studies only on pediatric population, and which corresponded to selected criteria. Pediatric ITP patients have been shown to have a statistically significant prevalence of anti-thyroid antibodies over healthy controls (11.6-36% versus 1.2-1.3%). No correlation has been found between the platelet count and the prevalence of positive anti-thyroid antibodies at any time of the follow up.

Conclusion: The results of our bibliographic research demonstrated that: a) pediatric patients with chronic ITP tend to have a statistically significant prevalence of anti-thyroid antibodies positivity respect to general pediatric population; b) there are no clear data about the role of autoimmune thyroiditis as prognostic factor for chronic course of ITP in pediatric age.

Keywords: Immune thrombocytopenia, thyroid, autoimmunity, children, anti-thyroglobulin, anti-thyroperoxidase.

Del Vecchio, G.C.; De Santis, A.; Giordano, P.; Amendola, G.; Baronci, C.; Del Principe, D.; Nobili, B.; Jankovic, M.; Ramenghi, U.; Russo, G.; Zecca, M.; De Mattia, D. Management of acute childhood idiopathic thrombocytopenic purpura according to AIEOP consensus guidelines: Assessment of Italian experience. Acta Haematol., 2008, 119(1), 1-7.
[] [PMID: 18176072]
De Mattia, D.; Del Vecchio, G.C.; Russo, G.; De Santis, A.; Ramenghi, U.; Notarangelo, L.; Jankovic, M.; Molinari, A.C.; Zecca, M.; Nobili, B.; Giordano, P. Management of chronic childhood immune thrombocytopenic purpura: AIEOP consensus guidelines. Acta Haematol., 2010, 123(2), 96-109.
[] [PMID: 20029174]
Rodeghiero, F.; Michel, M.; Gernsheimer, T.; Ruggeri, M.; Blanchette, V.; Bussel, J.B.; Cines, D.B.; Cooper, N.; Godeau, B.; Greinacher, A.; Imbach, P.; Khellaf, M.; Klaassen, R.J.; Kühne, T.; Liebman, H.; Mazzucconi, M.G.; Newland, A.; Pabinger, I.; Tosetto, A.; Stasi, R. Standardization of bleeding assessment in immune thrombocytopenia: Report from the International Working Group. Blood, 2013, 121(14), 2596-2606.
[] [PMID: 23361904]
Del Vecchio, G.C.; De Santis, A.; Accettura, L.; De Mattia, D.; Giordano, P. Chronic immune thrombocytopenia in childhood. Blood Coagul. Fibrinolysis, 2014, 25(4), 297-299.
[] [PMID: 24492401]
Rodeghiero, F.; Stasi, R.; Gernsheimer, T.; Michel, M.; Provan, D.; Arnold, D.M.; Bussel, J.B.; Cines, D.B.; Chong, B.H.; Cooper, N.; Godeau, B.; Lechner, K.; Mazzucconi, M.G.; McMillan, R.; Sanz, M.A.; Imbach, P.; Blanchette, V.; Kühne, T.; Ruggeri, M.; George, J.N. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: Report from an international working group. Blood, 2009, 113(11), 2386-2393.
[] [PMID: 19005182]
Giordano, P.; Cascioli, S.; Lassandro, G.; Marcellini, V.; Cardinale, F.; Valente, F.; Locatelli, F.; Carsetti, R. B-cell hyperfunction in children with immune thrombocytopenic purpura persists after splenectomy. Pediatr. Res., 2016, 79(2), 262-270.
[] [PMID: 26492283]
Pratt, E.L.; Tarantino, M.D.; Wagner, D.; Hirsch Pescovitz, O.; Bowyer, S.; Shapiro, A.D. Prevalence of elevated antithyroid antibodies and antinuclear antibodies in children with immune thrombocytopenic purpura. Am. J. Hematol., 2005, 79(3), 175-179.
[] [PMID: 15981229]
Rodeghiero, F.; Carli, G. Beyond immune thrombocytopenia: The evolving role of thrombopoietin receptor agonists. Ann. Hematol., 2017, 96(9), 1421-1434.
[] [PMID: 28275823]
Zimmerman, S.A.; Ware, R.E. Clinical significance of the antinuclear antibody test in selected children with idiopathic thrombocytopenic purpura. J. Pediatr. Hematol. Oncol., 1997, 19(4), 297-303.
[] [PMID: 9256827]
Altintas, A.; Ozel, A.; Okur, N.; Okur, N.; Cil, T.; Pasa, S.; Ayyildiz, O. Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura. J. Thromb. Thrombolysis, 2007, 24(2), 163-168.
[] [PMID: 17436144]
Bay, A.; Coskun, E.; Leblebisatan, G.; Karaoglu, O.; Keskin, M.; Yavuz, S.; Yilmaz, F.; Dai, A.; Coskun, M.Y. Prevalence and clinical significance of antithyroid antibodies in children with immune thrombocytopenic purpura. Pediatr. Hematol. Oncol., 2013, 30(8), 698-704.
[] [PMID: 23301695]
Mousa, S.O.L.; Soliman, G.T.; Saedii, A.A.; Hameed, E.N. The effect of anti-thyroid antibodies positivity on children with primary immune thrombocytopenia. Pediatr. Hematol. Oncol., 2017, 34(5), 298-307.
[] [PMID: 29190168]
Giordano, P.; Urbano, F.; Lassandro, G.; Bianchi, F.P.; Tolva, A.; Saracco, P.; Russo, G.; Notarangelo, L.D.; Gabelli, M.; Cesaro, S.; Wasniewska, M.; Faienza, M.F. Role of antithyroid autoimmunity as a predictive biomarker of chronic immune thrombocytopenia. Pediatr. Blood Cancer, 2019, 66(1)e27452
[] [PMID: 30270575]
Ruggeri, R.M.; Trimarchi, F.; Giuffrida, G.; Certo, R.; Cama, E.; Campennì, A.; Alibrandi, A.; De Luca, F.; Wasniewska, M. Autoimmune comorbidities in Hashimoto’s thyroiditis: Different patterns of association in adulthood and childhood/adolescence. Eur. J. Endocrinol., 2017, 176(2), 133-141.
[] [PMID: 27913607]
Aversa, T.; Salerno, M.; Radetti, G.; Faienza, M.F.; Iughetti, L.; Corrias, A.; Predieri, B.; Mussa, A.; Mirabelli, S.; De Luca, F.; Wasniewska, M. Peculiarities of presentation and evolution over time of Hashimoto’s thyroiditis in children and adolescents with Down’s syndrome. Hormones (Athens), 2015, 14(3), 410-416.
[] [PMID: 26188225]
Aversa, T.; Messina, M.F.; Mazzanti, L.; Salerno, M.; Mussa, A.; Faienza, M.F.; Scarano, E.; De Luca, F.; Wasniewska, M. The association with Turner syndrome significantly affects the course of Hashimoto’s thyroiditis in children, irrespective of karyotype. Endocrine, 2015, 50(3), 777-782.
[] [PMID: 25542186]
Crisafulli, G.; Gallizzi, R.; Aversa, T.; Salzano, G.; Valenzise, M.; Wasniewska, M.; De Luca, F.; Zirilli, G. Thyroid function test evolution in children with Hashimoto’s thyroiditis is closely conditioned by the biochemical picture at diagnosis. Ital. J. Pediatr., 2018, 44(1), 22.
[] [PMID: 29415743]

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2020
Page: [351 - 355]
Pages: 5
DOI: 10.2174/1871530319666190905161347
Price: $65

Article Metrics

PDF: 14
PRC: 1