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Evaluation and management of the child with hypothyroidism

  • Alexander K. C. LeungEmail author
  • Alexander A. C. Leung
Review Article

Abstract

Background

Thyroid hormones are critical for early neurocognitive development as well as growth and development throughout childhood. Prompt recognition and treatment of hypothyroidism is, therefore, of utmost importance to optimize physical and neurodevelopmental outcomes.

Data sources

A PubMed search was completed in Clinical Queries using the key terms “hypothyroidism”.

Results

Hypothyroidism may be present at birth (congenital hypothyroidism) or develop later in life (acquired hypothyroidism). Thyroid dysgenesis and dyshormonogenesis account for approximately 85% and 15% of permanent cases of congenital primary hypothyroidism, respectively. More than 95% of infants with congenital hypothyroidism have few, if any, clinical manifestations of hypothyroidism. Newborn screening programs allow early detection of congenital hypothyroidism. In developed countries, Hashimoto thyroiditis is the most common cause of goiter and acquired hypothyroidism in children and adolescents. Globally, iodine deficiency associated with goiter is the most common cause of hypothyroidism. Central hypothyroidism is uncommon and may be associated with other congenital syndromes and deficiencies of other pituitary hormones. Familiarity of the clinical features would allow prompt diagnosis and institution of treatment.

Conclusions

To optimize neurocognitive outcome in infants with congenital hypothyroidism, treatment with levothyroxine should be started as soon as possible, preferably within the first 2 weeks of life. Children with acquired hypothyroidism should also be treated early to ensure normal growth and development as well as cognitive outcome. The target is to keep serum TSH < 5 mIU/L and to maintain serum free T4 or total T4 within the upper half of the age-specific reference range, with elimination of all symptoms and signs of hypothyroidism.

Keywords

Dysgenesis Dyshormonogenesis Hashimoto thyroiditis Hypothyroidism Iodine deficiency Levothyroxine Mental retardation Stunted growth 

Notes

Author contributions

AKCL wrote the first draft of the manuscript, as well as a statement of whether an honorarium, grant, or other form of payment was given to anyone to produce the manuscript. AACL contributed to drafting and revising the manuscript. We have seen and approved the final version submitted for publication and take full responsibility for the manuscript.

Funding

None.

Compliance with ethical standards

Ethical approval

Not required.

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2019

Authors and Affiliations

  1. 1.Department of PediatricsThe University of Calgary, and The Alberta Children’s HospitalCalgaryCanada
  2. 2.Department of Medicine, The University of CalgaryCalgaryCanada

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