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Thyroid Disorders in Children and Adolescents: A Review
Patrick Hanley1, Katherine Lord1, Andrew J Bauer1
1The Thyroid Center, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Insights
Early diagnosis of thyroid disorders in children and adolescents is crucial for optimal development. Primary care physicians play a key role in identifying at-risk patients and initiating timely evaluation and treatment.
Area of Science:
- Pediatric Endocrinology
- Internal Medicine
- Public Health
Background:
- Normal thyroid function is essential for neurocognitive and physical development in children and adolescents.
- Thyroid disorders are prevalent and require prompt diagnosis and management.
- Early intervention is critical for optimizing growth and developmental outcomes.
Purpose of the Study:
- To provide a practical review of thyroid disorder presentation, evaluation, and treatment in primary care.
- To equip primary care physicians with the knowledge to manage common pediatric thyroid conditions.
- To guide the identification of patients requiring referral to pediatric endocrinologists.
Main Methods:
- Literature review of PubMed articles from 2010-2015, supplemented with earlier relevant publications.
- Focused on evidence-based management practices, consensus statements, and guidelines.
- Selected 83 publications relevant to the incidence, pathophysiology, evaluation, and treatment of pediatric hypothyroidism, hyperthyroidism, nodules, and cancer.
Main Results:
- Primary care physicians are often the first point of contact for pediatric thyroid disorders.
- Patients may be identified through newborn screening, caregiver concerns, or routine well-child visits.
- Knowledge of signs, symptoms, and evaluation approaches aids primary care physicians in initial assessment and referral decisions.
Conclusions:
- Early identification and treatment of thyroid disease in children and adolescents are vital for healthy growth and development.
- Primary care physicians are instrumental in recognizing at-risk individuals.
- Understanding risk factors, clinical signs, and laboratory interpretation facilitates accurate diagnosis and optimal patient outcomes through collaboration with specialists.
Importance:
Normal thyroid gland function is critical for early neurocognitive development, as well as for growth and development throughout childhood and adolescence. Thyroid disorders are common, and attention to physical examination findings, combined with selected laboratory and radiologic tools, aids in the early diagnosis and treatment.
Objective:
To provide a practical review of the presentation, evaluation, and treatment of thyroid disorders commonly encountered in a primary care practice.
Evidence Review:
We performed a literature review using the PubMed database. Results focused on reviews and articles published from January 1, 2010, through December 31, 2015. Articles published earlier than 2010 were included when appropriate for historical perspective. Our review emphasized evidence-based management practices for the clinician, as well as consensus statements and guidelines. A total of 479 articles for critical review were selected based on their relevance to the incidence, pathophysiology, laboratory evaluation, radiological assessment, and treatment of hypothyroidism, hyperthyroidism, thyroid nodules, and thyroid cancer in children and adolescents. Eighty-three publications were selected for inclusion in this article based on their relevance to these topics.
Findings:
The primary care physician is often the first health care professional responsible for initiating the evaluation of a thyroid disorder in children and adolescents. Patients may be referred secondary to an abnormal newborn screening, self-referred after a caregiver raises concern, or identified to be at risk of a thyroid disorder based on findings from a routine well-child visit. Irrespective of the path of referral, knowledge of the signs and symptoms of hypothyroidism, hyperthyroidism, and thyroid nodules, as well as the general approach to evaluation and management, will help the primary care physician complete an initial assessment and determine which patients would benefit from referral to a pediatric endocrinologist.
Conclusions And Relevance:
Early identification and treatment of thyroid disease in children and adolescents is critical to optimize growth and development. The primary care physician plays a critical role in identifying patients at risk. An understanding of risk factors, clinical signs and symptoms, and interpretation of screening laboratories ensures an efficient and accurate diagnosis of these common disorders. Regular communication between the primary care physician and the subspecialist is critical to optimize outcome because the majority of patients with thyroid disorders will require long-term to lifelong medical therapy and/or surveillance.
