Abstract
A recent study in children suggested that levothyroxine requirements are higher in congenital than in acquired hypothyroidism but did not match for severity of disease. Here, we studied only children with congenital or acquired hypothyroidism who had an undetectable fT4 at diagnosis. There were eight girls with congenital hypothyroidism due to athyreosis and eight girls with acquired hypothyroidism due to autoimmune thyroid disease. The median levothyroxine dose received at the most recent visit when serum TSH was <5.0 mU/L (at a median age of 7.86 and 14.29 years, respectively) was 3.2 mcg/kg/day in the former and 2.4 mcg/kg/day in the latter (N.S.). Combining both groups, the levothyroxine requirement decreased by 0.5 mcg/kg/day for every 4-year period.
Conclusion: When strictly matched for severity of disease, levothyroxine requirements are similar in school-age children with congenital or acquired hypothyroidism and decrease with age. Thus, in congenital hypothyroidism treated early with high-dose levothyroxine, pituitary resistance to thyroxine feedback does not appear to be present at school age.
What is known: • Pediatric studies unmatched for severity have suggested that levothyroxine requirements are higher in congenital than in acquired hypothyroidism. |
What is new: • When strictly matched for severity, levothyroxine requirements are similar in children with congenital or acquired hypothyroidism and decrease with age. |
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Abbreviations
- AH:
-
Acquired hypothyroidism
- CH:
-
Congenital hypothyroidism
- l-T4 :
-
Levothyroxine
- TSH:
-
Thyroid stimulating hormone
- fT4 :
-
Free thyroxine
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Acknowledgments
The authors are supported by a grant from the Canadian Institutes of Health Research (MOP-130390 to JD) and by private donations to the Girafonds/Fondation du Centre Hospitalier Universitaire Sainte-Justine (to JD and GVV). JD is chercheur-boursier clinicien junior 2 of the Fonds de Recherche du Québec-Santé.
Authors’ contributions
M.P. conceived the study, carried it out, and wrote the manuscript under the joint supervision of J.D. and G.VV. All three have read and approved the submitted version.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The need for informed consent for this retrospective analysis of routinely obtained clinical data was waived by the Head of Medical and Academic Affairs of the Sainte-Justine Hospital.
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Communicated by Beat Steinmann
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Perlsteyn, M., Deladoëy, J. & Van Vliet, G. Similar age-dependent levothyroxine requirements of schoolchildren with congenital or acquired hypothyroidism. Eur J Pediatr 175, 869–872 (2016). https://doi.org/10.1007/s00431-016-2701-2
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DOI: https://doi.org/10.1007/s00431-016-2701-2