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Learning Lessons From Patients: Attitude Is Everything

When I was in the 8th grade and honored at the “A” team honor roll breakfast, the speech was one that I never forgot: “Attitude is Everything.” Essentially, having a good education and good grades give you the tools to be successful, but having a great attitude toward any challenges ASSURES that you will arrive at that success.

Being a pediatrician AND an endocrinologist, I am blessed to work with many graceful children and their families who face medical endocrine challenges with great attitudes.  I can recall numerous examples but will share one of my favorites: A now 11-year-old vibrant female with hashimotos thyroiditis who was diagnosed at 5 years old. Initially, she required frequent lab checks for medication adjustment (~5-6) which then decreased to ~2-3 annually thereafter for further medication dosing adjustments of synthroid replacement as she outgrew prior lower doses.

Her attitude towards her lab draws has always stuck with me because surprisingly she actually looked forward to them AND to her endo visits! She and her mother would always go out to eat and spend special quality time together whenever she had to have a lab draw. They would always choose Mexican food for these special outings, and in fact would limit all Mexican food intake, making it that much more special.

Hashimotos thyroiditis in children is responsible for the majority of cases of acquired hypothyroidism. In hashimotos thyroiditis, there is formation of unsuppressed clones of thymus-dependent lymphocytic infiltration of the gland. B lymphocytes, either through interaction with T lymphocytes or because of stimulation linked to the damaged thyroid cells, produce anti-thyroid antibodies (antithyroid-peroxidase antibody, antithyroglobulin antibody) that are characteristic of the disorder and a cornerstone of the diagnosis.

Hashimotos thyroiditis can be associated with other polyendocrine disorders (Type 1 Autoimmune Polyendocrinopathy Syndrome) which includes disorders of vitiligo, autoimmune alopecia, hypoparathyroidism, primary Addison’s disease, mucocutaneous candidiasis, autoimmune liver disease, and pernicious anemia. It can also be associated with Type 2 Schmidt’s Syndrome which includes hashimotos hypothyroidism in addition to graves hyperthyroidism, type 1 diabetes, and primary Addison’s disease as well as candidiasis. Although thyroid carcinoma in hashimotos thyroiditis and multinodular goiters is rare, it has indeed been described thus close monitoring of any large nodules (>1cm) must occur which is particularly true during childhood.

Continual monitoring for other endocrinopathies will always be important for this young girl, thus more special outings and Mexican food are in her future. However with her great attitude, success in life is already hers, no matter what the lab results.

– Jennifer Shine Dyer, M.D., M.P.H.

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