Pediatric sleep apnea caused by Hashimoto's thyroiditis

DOI Open Access
  • Uemura Saeko
    Department of Otolaryngology, Jichi Medical University
  • Shimada Mari
    Department of Otolaryngology, Jichi Medical University
  • Ito Makoto
    Department of Pediatric Otolaryngology, Jichi Children's Medical Center
  • Nishino Hiroshi
    Department of Otolaryngology, Jichi Medical University

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Other Title
  • 睡眠時無呼吸を契機に発見された小児橋本病症例

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Abstract

 We describe rare pediatric sleep apnea caused by Hashimoto's thyroiditis. A girl aged 4 years and 8 months was referred to our hospital due to nocturnal awakening due to stifling and nasal congestion. The primary care doctor identified sleep apnea. A physical examination revealed adenoidal hypertrophy and allergic rhinitis, but tonsillar hypertrophy was not significant. She was obese, short for her age and appeared tired with low activity levels. Hormonal assessment and blood testing for the short stature revealed Hashimoto's thyroiditis. Levothyroxine sodium was administered, which improved the nocturnal awakening after two weeks, and snoring, nasal congestion and thyroid function after three months. Sixteen months of medication resulted in a decrease in the Apnea Hypopnea index (AHI) from 50.8 to 8.5 and an improved desaturation rate (rate of O2 saturation ≤90%) from 20% to 1.28%. A medical history of a growth disorder accompanied by other signs and symptoms are important for a diagnosis of hypothyroidism in pediatric sleep apnea because pediatric patients are usually unable to effectively describe their symptoms.

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