Hashimoto’s thyroiditis (HT) is an organ-specific autoimmune disease with an incidence of 0.3–1.5 per 1,000 people. It is characterized by lymphocytic infiltration that destroys thyroid follicular structures, leading to hypothyroidism. Children with hypothyroidism may require lifelong oral synthetic hormone therapy (levothyroxine) to maintain normal hormone levels. The decline in learning ability among children with hypothyroidism has long been overlooked; this issue is closely linked to
rapid mood swings, depression, and anxiety associated with the disease.
Hashimoto’s thyroiditis is associated with psychopathological disorders
Hashimoto’s thyroiditis (HT) leads to hypothyroidism in approximately 20–30% of patients, a condition that is particularly common in children. Hypothyroidism is associated with psychopathological disorders—such as depression and anxiety—and even poor health-related quality of life (HRQoL). Furthermore, patients with hypothyroidism often report residual symptoms even after undergoing levothyroxine replacement therapy and achieving a euthyroid state. These residual symptoms include rapid mood swings, depression (manifesting as fatigue, tearfulness, sleep disturbances, and loss of appetite), anxiety, and even impaired memory and learning abilities. Indeed, a high prevalence of psychopathological disorders has been demonstrated in children with HT, highlighting the importance of personality traits and coping strategies in these patients; they stand to benefit significantly from clinical psychological counseling and support.
Somatic anxiety in children with Hashimoto’s thyroiditis is positively correlated with thyroid autoantibody status
Studies indicate a positive correlation between somatic anxiety in children with HT and their thyroid autoantibody status—assessed via TgAb and TPOAb levels, which provide serological evidence of autoimmune thyroiditis. Thyroid autoimmunity may be a high-risk factor for anxiety disorders, as psychopathological disorders and autoimmune responses are hypothesized to stem from shared abnormalities within the immuno-endocrine system. From a psychosomatic perspective, even when Hashimoto’s thyroiditis (HT) patients undergo levothyroxine replacement therapy, residual symptoms may arise from somatization in response to physical and psychological stressors. Indeed, stress is considered an environmental factor capable of directly or indirectly influencing the immune system via the nervous and endocrine systems. Consequently, anxiety experienced at a somatic level can induce immunomodulation, thereby triggering or exacerbating autoimmune diseases, particularly in genetically predisposed individuals.
Sleep disorders and memory decline in children are associated with hypothyroidism
Studies indicate a link between sleep disorders in children—such as insomnia and excessive dreaming—and thyroid hormone levels. Researchers have employed various methods to assess these sleep disorders, ranging from specialized self-report questionnaires to objective measures like polysomnography.
Selenium deficiency increases the risk and accelerates the progression of Hashimoto’s thyroiditis in children
Recent data from China suggest that selenium deficiency increases the risk and accelerates the progression of Hashimoto’s thyroiditis by impairing antioxidant defense mechanisms, thereby promoting the production of thyroid autoantibodies and inflammation. Selenium has long been recognized as a nutrient with multiple roles, yet it has a narrow therapeutic and toxicity range. Extended treatment trials are being conducted on euthyroid children with Hashimoto’s thyroiditis who test positive for TPO antibodies (TPOAb) to determine if seroconversion occurs and whether this is associated with selenium levels, disease duration, or gender. Although the clinical benefits of combining levothyroxine with selenium supplementation in pediatric patients remain unclear, it is hypothesized that selenium supplementation may mitigate inflammatory processes, alleviate symptoms, and slow the progression of Hashimoto’s thyroiditis.