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Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
Published on: February 9, 2024
Pattern and Predictors of Thyroid Dysfunction among Pediatric Endocrine Referrals at the Tertiary Care Center of
Mona Sood1, Moomin Hussain Bhat2, Shariq R Masoodi2
1Department of Endocrinology, RNT Medical College, Udaipur, Rajasthan, India.
Insights
Subclinical hypothyroidism (SCH) is the most common pediatric thyroid disorder. Autoimmunity and family history are key factors in treating SCH and congenital hypothyroidism (CH) in children.
Area of Science:
- Pediatric Endocrinology
- Thyroidology
- Autoimmune Diseases
Background:
- The postiodization era shows increased diagnoses of pediatric thyroid disorders, particularly autoimmune conditions and subclinical hypothyroidism (SCH).
- Understanding the clinical spectrum and management of these disorders in children is crucial for optimal outcomes.
Purpose of the Study:
- To analyze the clinical characteristics of thyroid disorders in referred children.
- To identify factors influencing treatment decisions and evaluate patient outcomes.
- To assess the prevalence of different thyroid abnormalities in pediatric patients.
Main Methods:
- An observational, longitudinal study of treatment-naïve children (<18 years) with suspected thyroid disorders.
- Data collection included anthropometry, thyroid function tests (TSH, TT4, TT3), autoantibodies (anti-TPO, anti-TG), family history, and clinical symptoms.
- Management was guided by clinical judgment, with follow-up at 6 weeks, then quarterly for one year.
Main Results:
- Subclinical hypothyroidism (SCH) was the most frequent diagnosis (39%), followed by overt hypothyroidism (OH) (33%), congenital hypothyroidism (CH) (18%), and overt thyrotoxicosis (5%).
- 85.5% of subjects received treatment, with 81% achieving adequate management.
- Pubertal age, female sex, and autoimmunity were significant factors in OH. Anti-TPO positivity predicted treatment in SCH. Positive family history influenced treatment initiation in non-treated SCH.
Conclusions:
- While SCH management guidelines are evolving, autoimmunity and family history are critical for treatment decisions.
- Delayed presentation of CH highlights the need for active newborn screening to prevent developmental issues.
- The study underscores the importance of comprehensive evaluation for pediatric thyroid disorders.
Abstract:
Postiodization era has experienced a change in pediatric thyroid disorders with autoimmune disorders and subclinical hypothyroidism (SCH) now more frequently diagnosed. The aims of this study were to evaluate the clinical spectrum of thyroid disorders among children referred to us, to ascertain characteristics that influence treatment, and to follow them for various outcome measures. An observational longitudinal study where all treatment-naïve children (<18 years) with suspected thyroid disorders were recruited. Data collected were anthropometry, serum TSH, TT4, TT3, antithyroid autoantibodies, family history, and clinical symptoms. The management was based on the clinical judgment of the endocrinologist with the first follow-up at six weeks and subsequent visits three monthly for one year. A total of 241 subjects aged 28 days to 17 years were included. Overall, SCH was the most common abnormality (39%) detected among subjects, followed by overt hypothyroidism (OH) (33%), congenital hypothyroidism (CH) (18%), and overt thyrotoxicosis (5%). A total of 85.5% (n = 204) of subjects were treated and in follow-up, 81% of them were found to be adequately managed. Comparative analysis of OH and SCH revealed pubertal age, female predominance, and the presence of autoimmunity (positive anti-TPO and anti-TG Ab) statically significant variables in the OH group. A major independent predictor of treatment in treated SCH (72/96) in comparison with nontreated SCH (24/96) was anti-TPO positivity (P = 0.029). Eight of 24 nontreated SCH were eventually treated in follow-up and positive family history was observed as a significant variable among them (P < 0.05). Subjects with CH presented at a mean age of 6 months (28 days to 2 years). However, guidelines for the management of SCH are still evolving, autoimmunity and positive family history should be considered as decisive factors while initializing treatment. Delayed presentation of CH in our study warrants active surveillance of children at birth for thyroid disorders for their mental well-being.
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