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

Vigone, Maria Cristina; Capalbo, Donatella; Weber, Giovanna; Salerno, Mariacarolina

doi:10.1210/js.2017-00471

Cited by 37 publications

(38 citation statements)

References 107 publications

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“…The data on the effects of specific therapy of IsHT with levothyroxine in children with SO is scarce [4]. A majority of the studies of levothyroxine supplementation conducted on non-obese children with IsHT, were not focused on changes in body weight or BMI [28]. One longitudinal study on comparative evaluation of 2-year therapy with levothyroxine versus no treatment in non-obese children with mild SCH, did not find any significant difference between the two groups in terms of BMI Z-scores [29].…”

Section: Discussionmentioning

confidence: 99%

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Levothyroxine supplementation for obesity-associated thyroid dysfunction in children: a prospective, randomized, case control study

Kumar

Dayal

Attri

et al. 2019

pedm

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Introduction: The specific treatment of thyroid dysfunction associated with simple obesity (SO) in children is controversial. Material and methods: Fifty-one children having SO (BMI ≥ 2 Z-score) aged 6-12 years with elevation of serum thyroid stimulating hormone (TSH) (4-10 mIU/l) with or without alterations in serum triiodothyronine (T3) or thyroxine (T4) were randomised to receive either routine weight management intervention (group 1, n = 25) or additional low dose levothyroxine (~0.5 μg/kg/day) (group 2, n = 26) and followed up at 3-month intervals for 6 months. Results: The mean BMI Z-scores decreased in both groups from baseline to 3 and 6-month time points (group 1, 3.69 ±1.31 to 3.24 ±1.45 to 2.84 ±1.46, p = 0.03 and group 2, 4.31 ±2.11 to 4.08 ±1.92 to 3.50 ±1.93, p = 0.02). However, the decrease was similar in the 2 groups (-0.80 ±0.77 vs-0.97 ±0.69, p = 0.19). All children had isolated hyperthyrotropinemia. The mean TSH levels decreased from baseline to endpoint in group 1 (5.51 ±1.0 to 4.14 ±1.0 to 4.04 ±1.1 mIU/l, mean change-1.44 ±1.20, p = 0.001) and in group 2 (5.89 ±1.10 to 5.89 ±1.10 to 3.89 ±1.48 mIU/l, mean change-1.93 ±1.15, p = 0.001). The decrease in TSH levels was also similar in the 2 groups (p = 0.69). TSH normalized in 48% and 57.6% in group 1 and group 2 respectively. The decrease in total cholesterol and triglycerides was also similar in the 2 groups. Conclusions: Addition of levothyroxine to weight management interventions has no beneficial effect on BMI reduction as well as parameters of lipid and thyroid profiles, and should not be prescribed to children with obesity associated thyroid dysfunction.

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Section: Discussionmentioning

confidence: 99%

“…The usual dose of levothyroxine in children with SCH is 2 μg/kg/day [28,29]. We chose a low dose of levothyroxine in view of our general observation of a mild IsHT in children with SO and observations by others that even a small dose in these patients might occasionally cause mild hyperthyroidism [16,28].…”

Section: Discussionmentioning

confidence: 99%

Levothyroxine supplementation for obesity-associated thyroid dysfunction in children: a prospective, randomized, case control study

Kumar

Dayal

Attri

et al. 2019

pedm

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“…Therefore, TSH and free T4 levels should be regularly monitored in patients with persistently high-grade proteinuria (Table 2) [178,179]. For those children with TSH levels > 10 mU/l and low free T4, we recommend treating with levothyroxine (T4) [180]. In asymptomatic children with TSH elevations of 4.5-10 mU/l and normal free T4, thyroid function can be monitored periodically and the indication for treatment re-evaluated [177,180,181].…”

Section: Evidence and Rationalementioning

confidence: 99%

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-resistant nephrotic syndrome

et al. 2020

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Idiopathic nephrotic syndrome newly affects 1-3 per 100,000 children per year. Approximately 85% of cases show complete remission of proteinuria following glucocorticoid treatment. Patients who do not achieve complete remission within 4-6 weeks of glucocorticoid treatment have steroid-resistant nephrotic syndrome (SRNS). In 10-30% of steroid-resistant patients, mutations in podocyte-associated genes can be detected, whereas an undefined circulating factor of immune origin is assumed in the remaining ones. Diagnosis and management of SRNS is a great challenge due to its heterogeneous etiology, frequent lack of remission by further immunosuppressive treatment, and severe complications including the development of end-stage kidney disease and recurrence after renal transplantation. A team of experts including pediatric nephrologists and renal geneticists from the International Pediatric Nephrology Association (IPNA), a renal pathologist, and an adult nephrologist have now developed comprehensive clinical practice recommendations on the diagnosis and management of SRNS in children. The team performed a systematic literature review on 9 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, formulated recommendations and formally graded them at a consensus meeting, with input from patient representatives and a dietician acting as external advisors and a voting panel of pediatric nephrologists. Research recommendations are also given.

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“…A treatment for SH is lacking, except for the supplementation of thyroxine when TSH rises above 10 mU/L, with some exceptions (e.g., goiter or clear symptoms of hypothyroidism) [15,16]. A meta-analysis in adults with SH studied the benefits of thyroid supplementation and its effect on thyroid related symptoms.…”

Section: Introductionmentioning

confidence: 99%

A Lifestyle (Dietary) Intervention Reduces Tiredness in Children with Subclinical Hypothyroidism, a Randomized Controlled Trial

Gaag

Palen

Schaap

et al. 2020

IJERPH

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Purpose: Subclinical hypothyroidism (SH) in children and adults is a subject for discussion in terms of whether to treat it or not with respect to the short-term clinical implications and consequences of SH and in the long term. If treatment with thyroxine supplementation is not indicated, no other treatment is available. We investigated whether a lifestyle (dietary) intervention improves or normalizes SH or decreases the presence of Thyroid Stimulating Hormone (TSH) and/or tiredness. Methods: We randomized children aged 1–12 years with SH to the control group (standard care = no treatment) or intervention group (dietary intervention). The dietary intervention consisted of green vegetables, beef, whole milk and butter for 6 months. The rest of the diet remained unchanged. We measured TSH, FreeT4, Lipid profile, Body Mass Index (BMI) and Pediatric Quality of Life (PedQL) multidimensional fatigue scale scores. Results: In total, 62 children were included. After 6 months, TSH decreased in both groups without a significant difference between the groups (p = 0.98). PedQL fatigue scores for sleep (p = 0.032) and total fatigue scores (p = 0.039) improved significantly in the intervention group, compared to the control group. No unfavorable effects occurred in the lipid profile or BMI. Conclusion: The lifestyle (dietary) intervention did not normalize SH and TSH levels, but it significantly reduced tiredness. These results suggest that children’s well-being can be improved without medication.

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

Cited by 37 publications

References 107 publications

Levothyroxine supplementation for obesity-associated thyroid dysfunction in children: a prospective, randomized, case control study

Levothyroxine supplementation for obesity-associated thyroid dysfunction in children: a prospective, randomized, case control study

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-resistant nephrotic syndrome

A Lifestyle (Dietary) Intervention Reduces Tiredness in Children with Subclinical Hypothyroidism, a Randomized Controlled Trial

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