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Diagnosis and Management of Pediatric Thyroid Diseases

Nov 29, 2016 11:15AM ● By MED Magazine
Primary congenital hypothyroidism (CH) in newborns occurs in approximately one in every 3,000 births. If left untreated it will result in mental impairment and growth retardation, which is why all states require that newborns be screened for it.

It is also the most common thyroid disease in children up to three years old in the Endocrine Clinic at Children’s Medical Center in Omaha, according to pediatric endocrinologist Kevin P. Corley, MD.

“All abnormal screenings merit follow-up,” he says. “If not treated early on in life, you could wind up with a child with severe mental retardation that was very preventable,”

Either thyroid stimulating hormone (TSH) or free T4 (thyroxine) tests or both can be used for CH screening but a study in the Journal of Clinical Research in Pediatric Endocrinology suggests that TSH screening is more specific for CH..

Free T4 screening is more sensitive in detecting newborns with rare hypothalamic pituitary-hypothyroidism. It is less specific, however, with a high frequency of false positives mainly in low birth weight and premature infants. Complicating the process further is the fact that normal ranges for free T4 and TSH are different in infants, children and adults.

“We look at factors including age and gestation to see what is normal for that particular newborn. The goal of newborn screening is to identify CH and have the child on therapy by 2 weeks of age,” says Children’s pediatric endocrinologist Marisa Fisher, MD.

Acquired hypothyroidism is the most common condition seen in the Endocrinology Clinic in children over three. This is most often caused by direct attack of the thyroid gland from the immune system, known as autoimmune or Hashimoto’s thyroiditis. Children with congenital syndromes, especially Down syndrome, children with type 1 diabetes, and children who have received radiation treatments for cancer are at greater risk for hypothyroidism.

Dr. Corley says management of hypothyroidism requires regular blood tests and treatment using the synthetic thyroid hormone Levothyroxine. “It’s a pill a day,” he says. “If the TSH elevation is major, then it is likely the child will be on medication for life.”

Pediatric hyperthyroidism or Graves’ disease, is much less common, and Dr. Corley says it should automatically prompt a referral to an endocrinologist.