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Subclinical but significant? Updated review of pediatric hypothyroidism
Felicia Cooper1, Gabriela Guadalupe Rios1, Andrea Rivera-Sepulveda1
1Department of Pediatrics, Nemours Children's Health, Orlando, FL, USA.
Insights
Pediatric endocrinology referrals for elevated thyroid-stimulating hormone (TSH) show significant rates of true thyroid disease (6.3-59%). Key risk factors include high TSH levels, goiter, and antibodies, guiding timely diagnosis and treatment.
Area of Science:
- Pediatric Endocrinology
- Thyroidology
Background:
- Elevated thyroid-stimulating hormone (TSH) in children warrants careful evaluation.
- Distinguishing true thyroid disease from transient elevations is crucial for appropriate management.
Purpose of the Study:
- To determine the diagnostic rates of thyroid disease in children with elevated TSH referred to pediatric endocrinology.
- To identify risk factors associated with elevated TSH due to thyroid disease.
- To establish a TSH threshold indicative of thyroid disease.
Main Methods:
- A systematic review of 211 articles from four databases was conducted.
- Studies focused on TSH values in healthy children aged 1-18 years without pre-existing hypothyroidism risk factors.
- Five studies met the inclusion criteria for analysis.
Main Results:
- The rate of hypothyroidism requiring treatment ranged from 6.3% to 59%.
- Risk factors for hypothyroidism included TSH > 10 mIU/L, goiter, and anti-thyroid antibodies.
- An average high-risk TSH threshold of 9.6 mIU/L was identified across four studies.
Conclusions:
- Findings aid practitioners in deciding when to recheck TSH levels before referral.
- Guidance is provided on appropriate referral timing to pediatric endocrinology.
- The results help anticipate the need for thyroid hormone replacement therapy.
Objectives:
The aims of this review are to describe the rates of diagnosis of true thyroid disease (and subsequent treatment) in children with an elevated TSH referred to pediatric endocrinology, risk factors associated with elevated TSH secondary to thyroid disease, and TSH threshold level associated with thyroid disease.
Methods:
To accomplish these aims, our team searched through four databases to curate 211 articles regarding TSH values in healthy children ages 1-18 years without an underlying risk for hypothyroidism.
Results:
Five studies met our criteria and were analyzed to create the conclusions about rates of hypothyroidism requiring treatment (6.3-59 %), risk factors to developing hypothyroidism (TSH>10 mIU/L, goiter, and anti-thyroid antibodies), and high-risk TSH value (9.6 mIU/L when averaged among four studies).
Conclusions:
The results are helpful in guiding practitioners about when to repeat TSH value before considering referral to endocrinology, when to refer, and when to anticipate the need of thyroid hormone replacement.
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