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March 1996, Vol 150, No. 3 >
Article | March 1996

Natural Course of 'Subclinical' Hypothyroidism in Childhood and Adolescence FREE

Dan C. Moore, MD
Arch Pediatr Adolesc Med. 1996;150(3):293-297. doi:10.1001/archpedi.1996.02170280063012.
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Objectives:  To describe the natural course of "subclinical" hypothyroidism due to autoimmune thyroiditis in children and adolescents, and to determine whether, like euthyroid childhood autoimmune thyroiditis, it would also run a more benign course in this age group than in adults.

Design:  Case series.

Setting:  Pediatric endocrine clinic in a tertiary medical center.

Patients:  Eighteen patients (age range, 5 to 19 years) with juvenile autoimmune thyroiditis and an initially elevated serum thyrotropin (thyroid-stimulating hormone) concentration were followed up from documentation of the elevated serum thyrotropin concentration for a mean of 5.8 years. Eleven patients never received treatment, and seven were followed up after discontinuation of therapy.

Main Outcome Measures:  Changes in the serum thyrotropin and thyroxine concentrations and thyroid gland size, as well as signs and symptoms of hypothyroidism, were monitored throughout the observation period.

Results:  The mean duration of observation during which the patients did not receive any therapy was 47.3 months. At the end of the observation period, seven patients were euthyroid, 10 continued to have an elevated serum thyrotropin concentration with a normal serum thyroxine concentration, and one became hypothyroid.

Conclusions:  "Subclinical" juvenile hypothyroidism may be a benign and remitting process in many older children and adolescents. In view of the undefined risks of levothyroxine sodium therapy, it may be possible to follow up expectantly selected younger patients with a minimally elevated serum thyrotropin concentration, rather than to treat them empirically.(Arch Pediatr Adolesc Med. 1996;150:293-297)

REFERENCES

1 +
Hay ID.  Thyroiditis: a clinical update . Mayo Clin Proc . 1985;;60:836-843.
2 +
Rapoport B.  Pathophysiology of Hashimoto's thyroiditis and hypothyroidism . Annu Rev Med . 1991;;42:91-96.
3 +
Bachrach LK, Foley TP.  Thyroiditis in children . Pediatr Rev . 1989;;11:184-191.
4 +
Rallison ML, Dobyns BM, Keating FR, Rail JE, Tyler FH.  Occurrence and natural history of chronic lymphocytic thyroiditis in childhood . J Pediatr . 1975;;86: 675-682.
5 +
Sklar CA, Qazi R, David R.  Juvenile autoimmune thyroiditis . AJDC . 1986;;140: 877-880.
6 +
Maenpaa J, Raatikka M, Rasanan J, Taskinen E, Wager O.  Natural course of juvenile autoimmune thyroiditis . J Pediatr . 1985;;107:898-904.
7 +
Tunbridge WMG, Brewis M, French J, et al.  Natural history of autoimmune thyroiditis . BMJ . 1981;;282:258-262.
8 +
Gordin A, Lamberg B-A.  Spontaneous hypothyroidism in symptomless autoimmune thyroiditis: a long-term follow-up study . Clin Endocrinol (Oxf) . 1981;; 15:537-543.
9 +
Gruneiro de Papendieck L, lorcansky S, Rivarola MA, Bergada C.  Variations in clinical, hormonal and serological expressions of chronic lymphocytic thyroiditis (CLT) in children and adolescents . Clin Endocrinol (Oxf) . 1982;;16:19-28.
10 +
Hayashi Y, Tamai H, Fukata S, et al.  A long term clinical, immunological, and histological follow-up study of patients with goitrous chronic lymphocytic thyroiditis . J Clin Endocrinol Metab . 1985;:61:1172-1178.
11 +
Kabadi UM.  'Subclinical hypothyroidism': natural course of the syndrome during a prolonged follow-up study . Arch Intern Med . 1993;;153:957-961.
12 +
Takasu N, Yamada T, Katakura M, Yamauchi K, Shimizu Y, Ishizuki Y.  Evidence for thyrotropin (TSH)-blocking activity in goitrous Hashimoto's thyroiditis with assays measuring inhibition of TSH receptor binding and TSH-stimulated thyroid adenosine 3′,5′-monophosphate responses/cell growth by immunoglobulins . J Clin Endocrinol Metab . 1987;;65:239-245.
13 +
Rallison ML, Dobyns BM, Meikle AW, Bishop M, Lyon JL, Stevens W.  Natural history of thyroid abnormalities: prevalence, incidence, and regression of thyroid diseases in adolescents and young adults . Am J Med . 1991;;91:363-370.
14 +
Hegedus L, Hansen LM, Feldt-Rasmussen U, Hansen BM, Hoier-Madsen M.  Influence of thyroxine treatment on thyroid size and anti–thyroid peroxidase antibodies in Hashimoto's thyroiditis . Clin Endocrinol (Oxf) . 1991;;35:235-238.
15 +
Staub J-J, Althaus BU, Engler H, et al.  Spectrum of subclinical and overt hypothyroidism: effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues . Am J Med . 1992;;92:631-642.
16 +
Ridgway EC, Cooper DS, Walker H, Rodbard D, Maloof F.  Peripheral responses to thyroid hormone before and after L-thyroxine therapy in patients with subclinical hypothyroidism . J Clin Endocrinol Metab . 1981;;53:1238-1242.
17 +
Cooper DS, Halpern R, Wood LC, Levin AA, Ridgway EC.  L-Thyroxine therapy in subclinical hypothyroidism . Ann Intern Med . 1984;;101:18-24.
18 +
Nystrom E, Caidahl K, Fager G, Wikkelso C, Lundberg P-A, Lindstet G.  A double-blind cross-over 12-month study of L-thyroxine treatment of women with 'subclinical' hypothyroidism . Clin Endocrinol (Oxf) . 1988;;29:63-74.
19 +
Bogner U, Arntz H-R, Peters H, Schleusner H.  Subclinical hypothyroidism and hyperlipoproteinemia: indiscriminate L-thyroxine treatment not justified . Acta Endocrinol (Copenh) . 1993;;128:202-206.
20 +
Rother KI, Zimmerman D, Schwenk WF.  Effect of thyroid hormone treatment on thyromegaly in children and adolescents with Hashimoto disease . J Pediatr . 1994;;124:599-601.
21 +
Ross DS.  Subclinical hyperthyroidism: possible danger of overzealous thyroxine replacement therapy . Mayo Clin Proc . 1988;;63:1223-1229.
22 +
Ross DS.  Monitoring L-thyroxine therapy: lessons from the effects of L-thyroxine on bone density . Am J Med . 1991;;91:1-4.
23 +
Paul TL, Kerrigan J, Kelly AM, Braverman LE, Baran DT.  Long-term L-thyroxine is associated with decreased hip bone density in premenopausal women . JAMA . 1988;:259:3137-3141.
24 +
Kung AWC, Pun KK.  Bone mineral density in premenopausal women receiving long-term physiological doses of levothyroxine . JAMA . 1991;;265:2688-2691.
25 +
Rovet JF, Daneman D, Bailey JD.  Psychologic and psychoeducational consequences of thyroxine therapy for juvenile acquired hypothyroidism . J Pediatr . 1993;:122:543-549.

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References

1 +
Hay ID.  Thyroiditis: a clinical update . Mayo Clin Proc . 1985;;60:836-843.
2 +
Rapoport B.  Pathophysiology of Hashimoto's thyroiditis and hypothyroidism . Annu Rev Med . 1991;;42:91-96.
3 +
Bachrach LK, Foley TP.  Thyroiditis in children . Pediatr Rev . 1989;;11:184-191.
4 +
Rallison ML, Dobyns BM, Keating FR, Rail JE, Tyler FH.  Occurrence and natural history of chronic lymphocytic thyroiditis in childhood . J Pediatr . 1975;;86: 675-682.
5 +
Sklar CA, Qazi R, David R.  Juvenile autoimmune thyroiditis . AJDC . 1986;;140: 877-880.
6 +
Maenpaa J, Raatikka M, Rasanan J, Taskinen E, Wager O.  Natural course of juvenile autoimmune thyroiditis . J Pediatr . 1985;;107:898-904.
7 +
Tunbridge WMG, Brewis M, French J, et al.  Natural history of autoimmune thyroiditis . BMJ . 1981;;282:258-262.
8 +
Gordin A, Lamberg B-A.  Spontaneous hypothyroidism in symptomless autoimmune thyroiditis: a long-term follow-up study . Clin Endocrinol (Oxf) . 1981;; 15:537-543.
9 +
Gruneiro de Papendieck L, lorcansky S, Rivarola MA, Bergada C.  Variations in clinical, hormonal and serological expressions of chronic lymphocytic thyroiditis (CLT) in children and adolescents . Clin Endocrinol (Oxf) . 1982;;16:19-28.
10 +
Hayashi Y, Tamai H, Fukata S, et al.  A long term clinical, immunological, and histological follow-up study of patients with goitrous chronic lymphocytic thyroiditis . J Clin Endocrinol Metab . 1985;:61:1172-1178.
11 +
Kabadi UM.  'Subclinical hypothyroidism': natural course of the syndrome during a prolonged follow-up study . Arch Intern Med . 1993;;153:957-961.
12 +
Takasu N, Yamada T, Katakura M, Yamauchi K, Shimizu Y, Ishizuki Y.  Evidence for thyrotropin (TSH)-blocking activity in goitrous Hashimoto's thyroiditis with assays measuring inhibition of TSH receptor binding and TSH-stimulated thyroid adenosine 3′,5′-monophosphate responses/cell growth by immunoglobulins . J Clin Endocrinol Metab . 1987;;65:239-245.
13 +
Rallison ML, Dobyns BM, Meikle AW, Bishop M, Lyon JL, Stevens W.  Natural history of thyroid abnormalities: prevalence, incidence, and regression of thyroid diseases in adolescents and young adults . Am J Med . 1991;;91:363-370.
14 +
Hegedus L, Hansen LM, Feldt-Rasmussen U, Hansen BM, Hoier-Madsen M.  Influence of thyroxine treatment on thyroid size and anti–thyroid peroxidase antibodies in Hashimoto's thyroiditis . Clin Endocrinol (Oxf) . 1991;;35:235-238.
15 +
Staub J-J, Althaus BU, Engler H, et al.  Spectrum of subclinical and overt hypothyroidism: effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues . Am J Med . 1992;;92:631-642.
16 +
Ridgway EC, Cooper DS, Walker H, Rodbard D, Maloof F.  Peripheral responses to thyroid hormone before and after L-thyroxine therapy in patients with subclinical hypothyroidism . J Clin Endocrinol Metab . 1981;;53:1238-1242.
17 +
Cooper DS, Halpern R, Wood LC, Levin AA, Ridgway EC.  L-Thyroxine therapy in subclinical hypothyroidism . Ann Intern Med . 1984;;101:18-24.
18 +
Nystrom E, Caidahl K, Fager G, Wikkelso C, Lundberg P-A, Lindstet G.  A double-blind cross-over 12-month study of L-thyroxine treatment of women with 'subclinical' hypothyroidism . Clin Endocrinol (Oxf) . 1988;;29:63-74.
19 +
Bogner U, Arntz H-R, Peters H, Schleusner H.  Subclinical hypothyroidism and hyperlipoproteinemia: indiscriminate L-thyroxine treatment not justified . Acta Endocrinol (Copenh) . 1993;;128:202-206.
20 +
Rother KI, Zimmerman D, Schwenk WF.  Effect of thyroid hormone treatment on thyromegaly in children and adolescents with Hashimoto disease . J Pediatr . 1994;;124:599-601.
21 +
Ross DS.  Subclinical hyperthyroidism: possible danger of overzealous thyroxine replacement therapy . Mayo Clin Proc . 1988;;63:1223-1229.
22 +
Ross DS.  Monitoring L-thyroxine therapy: lessons from the effects of L-thyroxine on bone density . Am J Med . 1991;;91:1-4.
23 +
Paul TL, Kerrigan J, Kelly AM, Braverman LE, Baran DT.  Long-term L-thyroxine is associated with decreased hip bone density in premenopausal women . JAMA . 1988;:259:3137-3141.
24 +
Kung AWC, Pun KK.  Bone mineral density in premenopausal women receiving long-term physiological doses of levothyroxine . JAMA . 1991;;265:2688-2691.
25 +
Rovet JF, Daneman D, Bailey JD.  Psychologic and psychoeducational consequences of thyroxine therapy for juvenile acquired hypothyroidism . J Pediatr . 1993;:122:543-549.

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