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Subclinical hypothyroidism in childhood, treatment or only follow-up?
Marta Murillo-Vallés1, Santiago Martinez1, Cristina Aguilar-Riera2
1Endocrinology Unit. Pediatrics Section, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain.
Insights
Subclinical hypothyroidism in children often resolves spontaneously. Key predictors for progression include elevated baseline thyroid-stimulating hormone (TSH), female sex, and thyroid autoimmunity.
Area of Science:
- Pediatric Endocrinology
- Thyroid Disorders
- Clinical Medicine
Background:
- Subclinical hypothyroidism (SH) is characterized by elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (fT4) levels.
- Management of SH in children presents challenges, necessitating further research into its clinical course.
- This study evaluated clinical and laboratory findings in pediatric SH patients at a tertiary hospital.
Purpose of the Study:
- To assess the clinical and laboratory characteristics of children diagnosed with subclinical hypothyroidism.
- To investigate the natural clinical course and predictors of progression in pediatric SH.
- To inform management strategies for subclinical hypothyroidism in pediatric populations.
Main Methods:
- Retrospective study of 65 children (2-18 years) with SH.
- Patients were categorized based on TSH normalization, persistent mild elevation, or progression to overt hypothyroidism.
- Follow-up duration was a median of 9 months, with specific criteria for thyroxine therapy initiation.
Main Results:
- 89% of patients showed spontaneous TSH normalization or stable levels without treatment.
- Less than 11% progressed to overt hypothyroidism (Group 3).
- Predictors for progression included higher baseline TSH, female sex, and presence of thyroid autoimmunity (anti-TPO antibodies).
Conclusions:
- Baseline TSH, female sex, and thyroid autoimmunity are significant predictors of SH evolution in children.
- A substantial majority of pediatric SH cases do not progress to overt hypothyroidism.
- These findings aid in stratifying risk and guiding monitoring of pediatric subclinical hypothyroidism.
Background:
Subclinical hypothyroidism (SH) is defined as serum levels of thyroid-stimulating hormone (TSH) above the upper limit with normal concentrations of free T4 (fT4). Its management remains challenging. The aim of the study was to evaluate clinical and laboratory findings as well as the clinical course of children with SH followed in a third level hospital. Sixty-five patients aged between 2 and 18 years old were retrospectively studied.
Methods:
The patients were followed for a median period of 9 months (range 6 months to 24 months). Those who normalized TSH levels were discharged (Group 1). If TSH persisted mildly elevated (5-10μUI/mL) with normal fT4 and negative TPOAb/TgAb, they were classified as Group 2 and followed semi-annually without treatment. Those patients whose TSH raised ≥10μUI/mL or who maintained TSH 5-10μUI/mL and positive TPOAb/TgAb were considered suitable for thyroxin therapy (Group 3, G3).
Results:
In 89% of our patients, TSH concentrations spontaneously reverted to normality or remained stable without treatment (Groups 1 and 2), whereas less than 11% progressed to clinical hypothyroidism (Group 3). Baseline TSH was significantly lower in group 1 than in group 3. In group 3 the prevalence of female sex (71%) was higher and TPO antibodies were present in 85% of patients. The risk of developing overt hypothyroidism in patients with positive anti-thyroid antibodies respect to those who normalized TSH was 45 (95%CI 6.5-312.5).
Conclusion:
Baseline TSH, female sex and the presence of thyroid autoimmunity were the best predictors of the evolution to SH over time.
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