Managing Hypothyroidism in Pediatric Patients

Abstract

Received: July 19, 2018 Published Online: September 12, 2018 Citation: US Endocrinology, 2018;14(2):51–3. Corresponding Author: Stephen H LaFranchi, Department of Pediatrics [CDRCP], Oregon Health & Science University, 707 SW Gaines St, Portland, Oregon, US. E: lafrancs@ohsu.edu T his interview explores current controversies in the management of hypothyroidism in children. Newborn screening programs have allowed early detection and treatment of babies with congenital hypothyroidism, but some programs do not detect cases with delayed thyroidstimulating hormone (TSH) elevation and most do not detect congenital central hypothyroidism. Lack of harmonization of TSH cut-offs means that some programs do not detect milder cases of congenital hypothyroidism. Detection of such mild cases is controversial as most patients have transient hypothyroidism and the benefit of treatment is not proven. The most common disorder of thyroid function in children is subclinical hypothyroidism—many of these cases represent TSH assay artifacts or are associated with obesity, but some will progress to overt hypothyroidism. Some patients/parents are not happy with levothyroxine treatment alone, which raises the consideration of combination thyroxine and triiodothyronine (T4 and T3) treatment. Further research, including randomized clinical trials, is required to resolve these issues.