Pediatric Hypothyroidism: Diagnosis and Treatment

Abstract

Thyroid hormone has important physiologic functions in nearly every organ system. The critical role of thyroid hormone in growth and in physical and neurologic development lends particular importance to the prompt diagnosis and appropriate treatment of hypothyroidism in infants and children. Congenital hypothyroidism is common and has potentially devastating neurologic consequences. While the approach to diagnosis and treatment of severe congenital hypothyroidism is well established, data continue to emerge about the genetic causes, clinical significance, and prognosis of the milder forms of congenital hypothyroidism that are increasingly being diagnosed by newborn screening. Similarly, the diagnosis and treatment of severe acquired hypothyroidism is straightforward and clearly of clinical benefit, but uncertainty remains about the optimal management of mild subclinical hypothyroidism. This review summarizes current knowledge of the causes, clinical manifestations, diagnosis, treatment, and prognosis of hypothyroidism in infants and children, with a focus on recent developments and areas of uncertainty in this field.

Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?

“…Finally, cough suppressants and nutritional supplements containing iodine may also cause thyroid dysfunction [77]. …”

Hashimoto Thyroiditis and Dyslipidemia in Childhood: A Review

“…Like other autoimmune diseases, AIT is multifactorial disease caused by complex interplay of genetic (1,(19)(20)(21)(22)(23)(24)(25)(26), environmental (21,(27)(28)(29), and hormonal factors (19,21,30), that provoke the inappropriate immune response against thyroid gland. HT is mainly mediated by cellular immune response directed toward thyroid autoantigens, leading to inflammation, fibrosis, and impaired function of thyroid gland (4,26). The first step in pathogenesis is believed to be activation of autoreactive CD4+ T cells i.e., T helper (Th) cells specific for thyroid autoantigens.…”

“…Also, as a consequence of improved sensitivity and specificity of the methods for TSH determination, the upper reference limit for TSH decreased over time. Finally, it should not be neglected that thyroid hormones circulate bound to plasma proteins, and their biological action is exerted by the fraction (0.02-0.1%) of unbound or "free" form (4). Hence, the direct fT4 assays may be inaccurate in patients with severe systemic illness or abnormalities of protein binding, so caution is needed when interpreting such tests in this setting (4).…”

“…Presentation of the disease is rare before the age of 3 years, but there are described cases in infancy, too (1). Female strong preponderance has been reported with female to male ratio up to 3.4:1 (1-3), with high prevalence in patients with Down and Turner syndrome (4). Clinical manifestations of AIT in childhood are extremely diverse, ranging from completely normal, asymptomatic state, to pronounced symptoms of severe thyroid dysfunction.…”

Harder than just hitting a bulls-eye: treatment for hypothyroidism in children might have more than just one target

“…Clinical hypothyroidism, is known to include an assortment of signs and symptoms that do not have an established direct relationship with LT4 dose or TSH levels. Specifically, in the pediatric population, there are no concrete measures that can definitively attribute slowed growth and development to hypothyroidism rather than organic disorders [2]. Of note, hypothyroidism symptoms may also be underreported by pediatric patients who lack the capacity to thoroughly communicate them.…”