[Acquired childhood and juvenile subclinical hypothyroidism with or without goitre]

Primary acquired childhood and juvenile hypothyroidism is mainly due to chronic thyroiditis or to the after effects of cervical radiotherapy for cancer. In the presence of clinically evocative signs, with a palpable goitre or firm thyroid, hypothyroidism is searched for. However, cases of childhood and juvenile hypothyroidism without goitre have been described.

We retrospectively studied childhood and juvenile sub-clinical hypothyroidism in those in whom antithyroid antibodies had been searched for and thyroid ultrasonographic examination had been performed.

In this age group, we studied 34 cases of subclinical hypothyroidism (plasma TSH: 3.6-20 microIU/ml, normal free thyroxin level). In a first group (17 girls/1 boy, mean age: 14.4 years), 50% of patients had an abnormal palpable thyroid and 100% have auto-immunity markers. In the other group (7 girls/9 boys, mean age: 12.0 years), there was no goitre and no auto-immunity marker had been found. The clinical signs that prompted consultation were identical in the two groups and, if no goitre existed, measurement of TSH levels established the diagnosis of the onset of hypothyroidism.

It seems that second group patients constituted an unusual entity: predominance of boys, thyroid usually small and lack of auto-immunity markers.