Evaluation of Thyroid Dysfunction in Children: Screening Approaches and Referral Triggers to Endocrinology

Area of Science:

• Pediatric Endocrinology
• Clinical Chemistry
• Diagnostic Screening

Background:

• Thyroid diseases are prevalent pediatric endocrinological disorders.
• Abnormal thyroid function tests (TFTs) in children often lead to referrals to specialists.
• Accurate diagnosis is essential for appropriate management and to avoid unnecessary specialist consultations.

Purpose of the Study:

• To determine the actual prevalence of thyroid dysfunction in children referred for abnormal TFTs.
• To evaluate the diagnostic utility of thyroid-stimulating hormone (TSH) and free thyroxine (fT4) in this pediatric population.
• To establish optimal screening and referral guidelines for pediatric thyroid disorders.

Main Methods:

• Retrospective analysis of 204 children referred to pediatric endocrinology.
• Evaluation of clinical characteristics and TFT results (TSH, fT4) at initial and follow-up visits.
• Comparison of initial screening results with final diagnoses of thyroid dysfunction.

Main Results:

• Nearly half (49.5%) of referred children did not have thyroid dysfunction after specialist evaluation.
• Thyroid-stimulating hormone (TSH) alone was sufficient for initial screening.
• Among children with initially low TSH, 80% lacked thyroid dysfunction; 57.6% with high TSH had dysfunction.
• Persistently high TSH at follow-up increased the risk of thyroid dysfunction 19.4-fold.

Conclusions:

• Thyroid-stimulating hormone (TSH) is a reliable sole screening marker for pediatric thyroid dysfunction.
• Initial abnormal TSH levels warrant repeat TSH and free thyroxine (fT4) testing after 4-12 weeks before pediatric endocrinology referral.
• This approach can reduce unnecessary referrals and optimize resource utilization in pediatric endocrinology.