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Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
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Referrals for Elevated Thyroid Stimulating Hormone to Pediatric Endocrinologists.

Sarah Gammons1, Brent K Presley1, Perrin C White1

  • 1Division of Pediatric Endocrinology, UT Southwestern Medical Center, Dallas, Texas.

Journal of the Endocrine Society
|October 23, 2019
PubMed
Summary

Thyroid-stimulating hormone (TSH) levels alone are not sufficient to diagnose pediatric hypothyroidism. Referral to pediatric endocrinologists should be based on clinical concern, not just mildly elevated TSH levels.

Keywords:
autoantibodieslevothyroxinereceiver operating characteristic curvesubclinical hypothyroidism

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Area of Science:

  • Pediatric Endocrinology
  • Thyroid Function Testing
  • Clinical Diagnostics

Background:

  • Thyroid-stimulating hormone (TSH) testing is crucial for diagnosing hypothyroidism in children.
  • Reproducibility of TSH levels and prediction of treatment decisions require further investigation.

Purpose of the Study:

  • To assess the reproducibility of TSH testing in pediatric patients.
  • To identify TSH thresholds predicting autoantibodies and levothyroxine treatment initiation/continuation.

Main Methods:

  • Retrospective analysis of 325 children (1-18 years) with suspected hypothyroidism.
  • Used receiver operating characteristic (ROC) analysis to evaluate TSH predictive ability for treatment decisions, autoantibodies, and TSH reproducibility.

Main Results:

  • An initial TSH of 11 mIU/L predicted a repeat TSH ≥11 with 90% sensitivity and specificity.
  • TSH predicted autoantibodies (AUC 0.711) and treatment decisions (AUC 0.878) with optimal cutoffs at 8.8 and 8.2 mIU/L, respectively.
  • Combined TSH, antibody status, and examination findings best predicted treatment (AUC 0.930).

Conclusions:

  • Mildly elevated TSH levels alone do not warrant referral to pediatric endocrinologists.
  • Clinical suspicion and other factors are essential for guiding referral and treatment decisions in pediatric hypothyroidism.