Skip to main content
SpringerLink
Log in
Book cover

Thyroid Diseases in Childhood pp 195–202Cite as

Subclinical Hypothyroidism

  • Chapter

Abstract

Subclinical hypothyroidism (SH) is defined as a serum TSH concentration above the statistically defined upper limit of the reference range when serum free T4 (fT4) concentration is within its reference range [1, 2]. As serum TSH concentration varies over time in healthy subjects, leading to occasional abnormal values, the measurement of serum TSH and fT4 should be repeated within 3–4 months. If elevated serum TSH concentrations are confirmed and fT4 levels are within the normal range, the diagnosis of SH is made. SH is also defined as isolated hyperthyrotropinemia, compensated hypothyroidism, preclinical hypothyroidism, mild thyroid failure, or mild hypothyroidism. The diagnosis of SH is mainly based on a biochemical evaluation because it has been observed that most patients exhibit few or no signs or symptoms of thyroid dysfunction. Many studies suggest that some patients do indeed have clinical or functional manifestations of mild thyroid failure that are more frequent than in age-matched controls [2].

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Surks MI, Ortiz E, Daniels GH et al (2004) Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 291:228–238

    Article  CAS  PubMed  Google Scholar 

  2. Cooper DS, Biondi B (2012) Subclinical thyroid disease. Lancet 379:1142–1154

    Article  PubMed  Google Scholar 

  3. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC (2000) The Colorado thyroid disease prevalence study. Arch Intern Med 160:526–534

    Article  CAS  PubMed  Google Scholar 

  4. Parle JV, Franklyn JA, Cross KW, Jones SC, Sheppard MC (1991) Prevalence and follow-up of abnormal thyrotropin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf) 34:77–83

    Article  CAS  Google Scholar 

  5. Hollowell JG, Staehling NW, Flanders WD et al (2002) Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 87:489–499

    Article  CAS  PubMed  Google Scholar 

  6. Vanderpump MP, Tunbridge WM, French JM et al (1995) The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey. Clin Endocrinol (Oxf) 43:55–69

    Article  CAS  Google Scholar 

  7. Paoli-Valeri M, Maman-Alvardo D, Jiménez-Lopez V et al (2003) Frequency of subclinical hypothyroidism among healthy children and those with neurological conditions in the state of Mérida, Venezuela. Invest Clin 44:209–218

    PubMed  Google Scholar 

  8. Wu T, Flowers JW, Tudiver F, Wilson JL, Punyasavatsut N (2006) Subclinical thyroid disorders and cognitive performance among adolescents in the United States. BMC Pediatr 6:12

    Article  PubMed Central  PubMed  Google Scholar 

  9. Arrigo T, Wasniewska M, Crisafulli G et al (2008) Subclinical hypothyroidism: the state of the art. J Endocrinol Invest 31:79–84

    Article  CAS  PubMed  Google Scholar 

  10. Cooper DS (2001) Clinical practice. Subclinical hypothyroidism. N Engl J Med 345:260–265

    Article  CAS  PubMed  Google Scholar 

  11. Pacifico L, Anania C, Ferraro F, Andreoli GM, Chiesa C (2012) Thyroid function in childhood obesity and metabolic comorbidity. Clin Chim Acta 413:396–405

    Article  CAS  PubMed  Google Scholar 

  12. Reinehr T (2010) Obesity and thyroid function. Mol Cell Endocrinol 316:165–171

    Article  CAS  PubMed  Google Scholar 

  13. Vanderpump MP, Tunbridge WM (2002) Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 12:839–847

    Article  PubMed  Google Scholar 

  14. Calaciura F, Motta RM, Miscio G et al (2002) Subclinical hypothyroidism in early childhood: a frequent outcome of transient neonatal hyperthyrotropinemia. J Clin Endocrinol Metab 87:3209–3214

    Article  CAS  PubMed  Google Scholar 

  15. Leonardi D, Polizzotti N, Carta A et al (2008) Longitudinal study of thyroid function in children with mild hyperthyrotropinemia at neonatal screening for congenital hypothyroidism. J Clin Endocrinol Metab 93:2679–2685

    Google Scholar 

  16. Rapa A, Monzani A, Moia S et al (2009) Subclinical hypothyroidism in children and adolescents: a wide range of clinical, biochemical, and genetic factors involved. J Clin Endocrinol Metab 94:2414–2420

    Article  CAS  PubMed  Google Scholar 

  17. Alberti L, Proverbio MC, Costagliola S et al (2002) Germline mutations of TSH receptor gene as cause of nonautoimmune subclinical hypothyroidism. J Clin Endocrinol Metab 87:2549–2555

    Article  CAS  PubMed  Google Scholar 

  18. Duprez L, Parma J, Van Sande J et al (1998) TSH receptor mutations and thyroid disease. Trends Endocrinol Metab 9:133–140

    Article  CAS  PubMed  Google Scholar 

  19. Tonacchera M, Di Cosmo C, De Marco G et al (2007) Identification of TSH receptor mutations in three families with resistance to TSH. Clin Endocrinol (Oxf) 67:712–718

    Article  CAS  Google Scholar 

  20. Clifton-Bligh RJ, Gregory JW, Ludgate M et al (1997) Two novel mutations in the thyrotropin (TSH) receptor gene in a child with resistance to TSH. J Clin Endocrinol Metab 82:1094–1100

    CAS  PubMed  Google Scholar 

  21. Camilot M, Teofoli F, Gandini A et al (2005) Thyrotropin receptor gene mutations and TSH resistance: variable expressivity in the heterozygotes. Clin Endocrinol (Oxf) 63:146–151

    Article  CAS  Google Scholar 

  22. De Marco G, Agretti P, Montanelli L et al (2011) Identification and functional analysis of novel dual oxidase 2 (DUOX2) mutations in children with congenital or subclinical hypothyroidism. J Clin Endocrinol Metab 96:E1335–E1339

    Article  PubMed  Google Scholar 

  23. Grandone A, Perrone L, Cirillo G et al (2012) Impact of phosphodiesterase 8B gene rs4704397 variation on thyroid homeostasis in childhood obesity. Eur J Endocrinol 166:255–260

    Article  CAS  PubMed  Google Scholar 

  24. Peeters RP, van der Deure WM, Visser TJ (2006) Genetic variation in thyroid hormone pathway genes; polymorphisms in the TSH receptor and the iodothyronine deiodinases. Eur J Endocrinol 155:655–662

    Article  CAS  PubMed  Google Scholar 

  25. Turkkahraman D, Alper OM, Aydin F et al (2009) Final diagnosis in children with subclinical hypothyroidism and mutation analysis of the thyroid peroxidase gene (TPO). J Pediatr Endocrinol Metab 22:845–851

    Article  CAS  PubMed  Google Scholar 

  26. Aijaz NJ, Flaherty EM, Preston T et al (2006) Neurocognitive function in children with compensated hypothyroidism: lack of short term effects on or off thyroxin. BMC Endocr Disord 6:2

    Article  PubMed Central  PubMed  Google Scholar 

  27. Monzani A, Prodam F, Rapa A et al (2012) Endocrine disorders in childhood and adolescence. Natural history of subclinical hypothyroidism in children and adolescents and potential effects of replacement therapy: a review. Eur J Endocrinol 168:R1–R11

    Article  PubMed  Google Scholar 

  28. Cerbone M, Bravaccio C, Capalbo D et al (2011) Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism. Eur J Endocrinol 164:591–597

    Article  CAS  PubMed  Google Scholar 

  29. Marcocci C, Vitti P, Cetani F et al (1991) Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism. J Clin Endocrinol Metab 72:209–213

    Article  CAS  PubMed  Google Scholar 

  30. Bona G, Prodam F, Monzani A (2013) Subclinical hypothyroidism in children: natural history and when to treat. J Clin Res Pediatr Endocrinol 5:23–28

    PubMed Central  PubMed  Google Scholar 

  31. Gopalakrishnan S, Chugh PK, Chhillar M et al (2008) Goitrous autoimmune thyroiditis in a pediatric population: a longitudinal study. Pediatrics 122:670–674

    Article  Google Scholar 

  32. Zois C, Stavrou I, Svarna E, Seferiadis K, Tsatsoulis A (2006) Natural course of autoimmune thyroiditis after elimination of iodine deficiency in northwestern Greece. Thyroid 16:289–293

    Article  CAS  PubMed  Google Scholar 

  33. Radetti G, Gottardi E, Bona G et al (2006) The natural history of euthyroid Hashimoto’s thyroiditis in children. J Pediatr 149:827–832

    Article  PubMed  Google Scholar 

  34. Wasniewska M, Salerno M, Cassio A et al (2009) Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence. Eur J Endocrinol 160:417–421

    Article  CAS  PubMed  Google Scholar 

  35. Moore DC (1996) Natural course of ‘subclinical’ hypothyroidism in childhood and adolescence. Arch Pediatr Adolesc Med 150:293–297

    Article  CAS  PubMed  Google Scholar 

  36. Jaruratanasirikul S, Leethanaporn K, Khuntigij P, Sriplung H (2001) The clinical course of Hashimoto’s thyroiditis in children and adolescents: 6 years longitudinal follow-up. J Pediatr Endocrinol Metab 14:177–184

    Article  CAS  PubMed  Google Scholar 

  37. Lazar L, Frumkin RB, Battat E et al (2009) Natural history of thyroid function tests over 5 years in a large pediatric cohort. J Clin Endocrinol Metab 94:1678–1682

    Article  CAS  PubMed  Google Scholar 

  38. Radetti G, Maselli M, Buzi F et al (2012) The natural history of the normal/mild elevated TSH serum levels in children and adolescents with Hashimoto’s thyroiditis and isolated hyperthyrotropinaemia: a 3-year follow-up. Clin Endocrinol 76:394–398

    Article  CAS  Google Scholar 

  39. Aversa T, Valenzise M, Corrias A et al (2015) Underlying Hashimoto’s thyroiditis negatively affects the evolution of subclinical hypothyroidism in children irrespective of other concomitant risk factors. Thyroid 25:183–187

    Article  CAS  PubMed  Google Scholar 

  40. Althaus BU, Staub JJ, Ryff-De Leche A, Oberhansli A, Stahelin HB (1988) LDL/HDL-changes in subclinical hypothyroidism: possible risk factors for coronary heart disease. Clin Endocrinol 28:157–163

    Article  CAS  Google Scholar 

  41. Nanchen D, Gussekloo J, Westendorp RG et al (2012) Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. J Clin Endocrinol Metab 97:852–861

    Article  CAS  PubMed  Google Scholar 

  42. Hak AE, Pols HA, Visser TJ et al (2000) Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 132:270–278

    Article  CAS  PubMed  Google Scholar 

  43. Rodondi N, den Elzen WP, Bauer DC et al (2010) Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 304:1365–1374

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Haggerty JJ Jr, Stern RA, Mason GA et al (1993) Subclinical hypothyroidism: a modifiable risk factor for depression? Am J Psychiatry 150:508–510

    Article  PubMed  Google Scholar 

  45. Diekman T, Lansberg PJ, Kastelein JJ, Wiersinga WM (1995) Prevalence and correction of hypothyroidism in a large cohort of patients referred for dyslipidemia. Arch Intern Med 155:1490–1495

    Article  CAS  PubMed  Google Scholar 

  46. Staub JJ, Althaus BU, Engler H et al (1992) Spectrum of subclinical and overt hypothyroidism: effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues. Am J Med 92:631–642

    Article  CAS  PubMed  Google Scholar 

  47. Muller B, Tsakiris DA, Roth CB et al (2001) Haemostatic profile in hypothyroidism as potential risk factor for vascular or thrombotic disease. Eur J Clin Invest 31:131–137

    Article  CAS  PubMed  Google Scholar 

  48. Faber J, Galloe AM (1994) Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J Endocrinol 130:350–356

    Article  CAS  PubMed  Google Scholar 

  49. Sawin CT, Geller A, Wolf PA et al (1994) Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 331:1249–1252

    Article  CAS  PubMed  Google Scholar 

  50. Atzmon G, Barzilai N, Hollowell JG, Surks MI, Gabriely I (2009) Extreme longevity is associated with increased serum thyrotropin. J Clin Endocrinol Metab 94:1251–1254

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  51. Rozing MP, Houwing-Duistermaat JJ, Slagboom PE et al (2010) Familial longevity is associated with decreased thyroid function. J Clin Endocrinol Metab 95:4979–4984

    Article  CAS  PubMed  Google Scholar 

  52. Gharib H, Tuttle RM, Baskin HJ et al (2005) Consensus statement: subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association and the Endocrine Society. J Clin Endocrinol Metab 90:581–585

    Article  CAS  PubMed  Google Scholar 

  53. Cetinkaya E, Aslan A, Vidinlisan S, Ocal G (2003) Height improvement by L-thyroxine treatment in subclinical hypothyroidism. Pediatr Int 45:534–537

    Article  CAS  PubMed  Google Scholar 

  54. Chase HP, Garg SK, Cockerham RS, Wilcox WD, Walravens PA (1990) Thyroid hormone replacement and growth of children with subclinical hypothyroidism and diabetes. Diabet Med 7:299–303

    Article  CAS  PubMed  Google Scholar 

  55. Svensson J, Ericsson UB, Nilsson P et al (2006) Levothyroxine treatment reduces thyroid size in children and adolescents with chronic autoimmune thyroiditis. J Clin Endocrinol Metab 91:1729–1734

    Article  CAS  PubMed  Google Scholar 

  56. Johner SA, Thamm M, Stehle P et al (2014) Interrelations between thyrotropin levels and iodine status in thyroid-healthy children. Thyroid 24:1071–1079

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy

    Alice Monzani, Flavia Prodam, Simonetta Bellone & Gianni Bona

Authors
  1. Alice Monzani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Flavia Prodam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simonetta Bellone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianni Bona
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianni Bona .

Editor information

Editors and Affiliations

  1. Novara, Italy

    Gianni Bona

  2. Messina, Italy

    Filippo De Luca

  3. Division of Pediatrics, Piedemonte Hospital, Novara, Italy

    Alice Monzani

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Monzani, A., Prodam, F., Bellone, S., Bona, G. (2015). Subclinical Hypothyroidism. In: Bona, G., De Luca, F., Monzani, A. (eds) Thyroid Diseases in Childhood. Springer, Cham. https://doi.org/10.1007/978-3-319-19213-0_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19213-0_17

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19212-3

  • Online ISBN: 978-3-319-19213-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation