Endocrine Abstracts

Aim: The purpose of this review is to outline the key elements that should be taken into account when making a determination regarding the prescription of L-Thyroxine for a pediatric patient diagnosed with subclinical hypothyroidism (SH).

Methods: A systematic review of the literature was conducted to evaluate the current evidence regarding the management of subclinical hypothyroidism in children.

Results: For children who exhibit progressive thyroid deterioration due to underlying Hashimoto’s thyroiditis, it is advisable to recommend therapy, especially if they present with goiters, hypothyroid symptoms, or have coexisting conditions such as Turner syndrome, Down’s syndrome, or other autoimmune disorders. Furthermore, children with proatherogenic metabolic abnormalities may also benefit from treatment. Conversely, in cases of idiopathic or mild subclinical hypothyroidism (SH) without goiter, hypothyroid symptoms, or positive thyroid autoantibodies, treatment is not recommended. In the absence of intervention, regular monitoring of clinical status and thyroid function tests is necessary to identify children who may require treatment. Children with persistently mild elevations in thyroid-stimulating hormone (TSH) levels who are not receiving L-Thyroxine should undergo biochemical monitoring of thyroid function and reassessment of their clinical status every six months. The monitoring interval can be extended after two years of stable thyroid function tests

Conclusions: This review offers valuable insights into the management of subclinical hypothyroidism in pediatric patients, emphasizing the need for personalized treatment decisions based on clinical presentation, laboratory results, and underlying conditions. The study suggests that in children with chronic kidney disease (CKD), a TSH cutoff of 10 u/L may be appropriate for initiating thyroxine replacement therapy. Additionally, the review highlights the importance of recommending replacement treatment for children with subclinical hypothyroidism who have underlying Hashimoto’s thyroiditis, progressive thyroid deterioration, goiters, hypothyroid symptoms, associated conditions like Turner syndrome or Down’s syndrome or proatherogenic metabolic abnormalities. On the other hand, for children with idiopathic or mild subclinical hypothyroidism, treatment is not recommended, and regular monitoring of thyroid function and clinical status is advised to identify those who may eventually benefit from therapy. Further research is required to validate the optimal management approach for subclinical hypothyroidism in children.