ENDOCRINE DISORDERS IN CHILDHOOD AND ADOLESCENCE: Natural history of subclinical hypothyroidism in children and adolescents and potential effects of replacement therapy: a review
Open Access
- 1 January 2013
- journal article
- review article
- Published by Oxford University Press (OUP) in Acta Endocrinologica
- Vol. 168 (1), R1-R11
- https://doi.org/10.1530/eje-12-0656
Abstract
Objective: Subclinical hypothyroidism (SH) is quite common in children and adolescents. The natural history of this condition and the potential effects of replacement therapy need to be known to properly manage SH. The aim of this review is to analyze: i) the spontaneous evolution of SH, in terms of the rate of reversion to euthyroidism, the persistence of SH, or the progression to over hypothyroidism; and ii) the effects of replacement therapy, with respect to auxological data, thyroid volume, and neuropsychological functions.Methods: We systematically searched PubMed, Cochrane, and EMBASE (1990–2012) and identified 39 potentially relevant articles of which only 15 articles were suitable to be included.Results and conclusions: SH in children is a remitting process with a low risk of evolution toward overt hypothyroidism. Most of the subjects reverted to euthyroidism or remained SH, with a rate of evolution toward overt hypothyroidism ranging between 0 and 28.8%, being 50% in only one study (nine articles). The initial presence of goiter and elevated thyroglobulin antibodies, the presence of celiac disease, and a progressive increase in thyroperoxidase antibodies and TSH value predict a progression toward overt hypothyroidism. Replacement therapy is not justified in children with SH but with TSH 5–10 mIU/l, no goiter, and negative antithyroid antibodies. An increased growth velocity was observed in children treated with levothyroxine (l-T4; two articles). l-T4 reduced thyroid volume in 25–100% of children with SH and autoimmune thyroiditis (two studies). No effects on neuropsychological functions (one study) and posttreatment evolution of SH (one study) were reported.Keywords
This publication has 55 references indexed in Scilit:
- Thyroid function derangement and childhood obesity: an Italian experienceBMC Endocrine Disorders, 2010
- Thyroid Function in Obese Children and AdolescentsHormone Research in Paediatrics, 2010
- Extreme Longevity Is Associated with Increased Serum ThyrotropinJournal of Clinical Endocrinology & Metabolism, 2009
- Final Diagnosis in Children with Subclinical Hypothyroidism and Mutation Analysis of the Thyroid Peroxidase Gene (TPO)Journal of Pediatric Endocrinology and Metabolism, 2009
- Goitrous Autoimmune Thyroiditis in a Pediatric Population: A Longitudinal StudyPEDIATRICS, 2008
- Longitudinal Study of Thyroid Function in Children with Mild Hyperthyrotropinemia at Neonatal Screening for Congenital HypothyroidismJournal of Clinical Endocrinology & Metabolism, 2008
- The natural history of euthyroid Hashimoto’s thyroiditis in childrenThe Journal of Pediatrics, 2006
- Natural Course of Autoimmune Thyroiditis After Elimination of Iodine Deficiency in Northwestern GreeceThyroid®, 2006
- The Clinical Course of Hashimoto's Thyroiditis in Children and Adolescents: 6 Years Longitudinal Follow-upJournal of Pediatric Endocrinology and Metabolism, 2001
- Effect of thyroid hormone treatment on thyromegaly in children and adolescents with Hashimoto diseaseThe Journal of Pediatrics, 1994