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Juvenile Hypothyroidism: A Clinical Perspective from Eastern India
Moutusi Raychaudhuri1, Debmalya Sanyal2
1Department of Pediatric Endocrinology Unit, Institute of Child Health, Kolkata, West Bengal, India.
Insights
Juvenile hypothyroidism (JH) affects growth and development. This study found goiter is the most common sign, with overt hypothyroidism more prevalent in females and associated with short stature.
Area of Science:
- Pediatric Endocrinology
- Thyroid Disorders
- Internal Medicine
Background:
- Juvenile hypothyroidism (JH) can negatively impact child development.
- Data on acquired JH in India is limited.
- This study aimed to characterize JH in a referral clinic in eastern India.
Purpose of the Study:
- To assess the clinical, biochemical, and ultrasonographic profile of juvenile hypothyroidism.
- To differentiate between overt (OH) and subclinical (SCH) juvenile hypothyroidism.
- To identify common presentations and associated conditions in JH.
Main Methods:
- Retrospective evaluation of 100 pediatric patients (<18 years) with acquired JH.
- Data collected included patient history, clinical examination, biochemical tests, and thyroid ultrasonography.
- Patients were categorized into overt (OH) and subclinical (SCH) hypothyroidism groups.
Main Results:
- 74% had overt hypothyroidism (OH), 26% subclinical (SCH); 66% were female.
- Goiter was the most common presentation (58%). Short stature (<3rd percentile) was significantly higher in OH (28%) vs SCH (4%).
- Thyroid peroxidase antibody (TPOAb) positivity was higher in OH (64%) vs SCH (15%). Associated conditions included T1DM (5%) and Down syndrome (7%).
Conclusions:
- JH exhibits female preponderance and higher TPOAb positivity in OH.
- Goiter is the most frequent sign, with short stature more common in overt cases.
- Screening for JH is recommended in patients with T1DM or Down syndrome, and vice versa.
Introduction:
Juvenile hypothyroidism (JH) can have deleterious effects on growth, pubertal development, and scholastic performance of children. In India, there is a paucity of data on acquired hypothyroidism in children, in contrast to congenital hypothyroidism. Our objective was to assess the profile of JH in a referral clinic from eastern India.
Materials And Methods:
For this study, 100 patients with documented acquired hypothyroidism (subclinical and overt) (aged <18 years), from eastern India, were evaluated retrospectively. Evaluation included history as well as clinical, biochemical, and ultrasonography parameters.
Results:
Out of the 100 participants, 74% had overt hypothyroidism (OH), while 26% had subclinical hypothyroidism (SCH). The majority of the participants were females (66%). The mean age at detection was 8.95 ± 3.96 years in the SCH group and 8.38 ± 3.29 years in the OH group. A family history of thyroid disorder and/or goiter was present in 35% of the patients. Goiter was the most common presentation in both SCH and OH, with overall prevalence of 58%. Height below 3rd percentile was significantly higher (28%) in OH group compared to 4% in SCH group. Five percent of OH subjects were obese. Worsening school performance was reported in only 9% of subjects. Only 4% (all males) presented with delayed puberty, while one female (1%) presented with precocious puberty. Sixty-four percent of OH group were TPOAb positive compared to only 15% in SCH group. Five percent of our study population had type-1 diabetes mellitus (T1DM) and 7% had Down syndrome (DS).
Conclusion:
In our study, JH showed significantly higher female preponderance and TPOAb positivity in OH group, in comparison to SCH group. Family history of thyroid disorder and/or goiter was present in a significant proportion of patients. Goiter was the most common presentation of JH. Height deceleration, weight gain, and fatigue were the other common presentations. Prevalence of short stature was significantly higher in OH group. Interestingly, in contrast to prevalent notion, only 5% of OH were obese and worsening school performance was observed to be rare. Puberty disorders (both delayed and precocious) may occur in JH as seen here. Because of strong association, those with T1DM or DS should be screened for JH and vice versa in TIDM.
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