Incidence of vitiligo in children with Graves' disease and Hashimoto's thyroiditis

A retrospective chart review was performed on 333 children who had been followed for thyroid disorders by endocrinologists at the Yale Pediatric Thyroid Center over the last 5 years for autoimmune thyroid disease. Demographical and clinical features of patients found to have thyroid disease and vitiligo were recorded. These studies were approved by the Yale Human Investigation Committee.Of the total 333 children and adolescents, 9 (2.7%) were noted to have vitiligo. Four patients (44%) had Graves' disease and 5 patients (66%) had Hashimoto's thyroiditis. For patients with Graves' disease and vitiligo, the average age of onset of thyroid disease was young at 4 ± 0.7 years, and the diagnosis of vitiligo usually preceded that of thyroid disease. For children with Hashimoto's thyroiditis and vitiligo, thyroid disease was diagnosed at an average age of 13.25 ± 2.8 years.In our population, 4.6% of children with Graves' disease and 2.0% of children with Hashimoto's thyroiditis had vitiligo. Interestingly, when vitiligo presents with Graves' disease, it occurs in younger rather than older children.The association between vitiligo and autoimmune thyroid disease, especially Hashimoto's thyroiditis, has been characterized in adults [1-3]. Studies indicate an autoimmune etiology for vitiligo, and genes have been identified that cause both vitiligo and autoimmune thyroid disease [1-11]. However, little data are available on the association of vitiligo and thyroid disease in children [1-3]. In addition, reported studies of vitiligo and thyroid disease are based on studies of children who were identified as having vitiligo and subsequently evaluated for the presence of thyroid function abnormalities [1-7].Graves' disease is an autoimmune condition with an estimated incidence of 1 in 10,000 children [12,13]. Graves' disease most commonly occurs in teenagers, and less than 5% of pediatric patients present at less than 5 years of age [14,15]. Hashimoto's thyroiditis is also an autoim