Subclinical hyperthyroidism in children

Kotb Abbass Metwalley; Hekma Saad Farghaly

doi:10.1515/jpem-2022-0534

Article

Subclinical hyperthyroidism in children

Kotb Abbass Metwalley and Hekma Saad Farghaly

Published/Copyright: December 6, 2022

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 4

Abstract

Subclinical hyperthyroidism (SH) is defined as serum thyroid-stimulating hormone (TSH) below the lower limit of the reference range in the presence of normal free T4 and free T3 levels. Depending on the degree of TSH suppression, SH could be defined as mild (TSH, 0.1–0.45 mU/L) or severe (TSH<0.1 mU/L). Patients with SH are often asymptomatic when symptoms are present, they are similar to the symptoms in patients with overt hyperthyroidism, although they are usually milder. The management of the SH is uncertain and should be individualized. We present this review after an extensive literature search and long-standing clinical experience. This review provides the prevalence, causes, clinical presentation, investigation, and therapeutic approach of SH in children.

Keywords: anti-thyroid drugs; Graves’ disease; Hashimoto’s thyroiditis; subclinical hyperthyroidism; thyroid-stimulating hormone

Corresponding author: Kotb Abbass Metwalley, MD, Department of Pediatrics, Pediatric Endocrinology Unit , Faculty of Medicine, Assiut University, 71111 Assiut, Egypt, E-mail: kotb72@gmail.com

Funding source: No fund

Funding source: No Fund

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: Not applicable.

References

1. Bahn Chair, RS, Burch, HB, Cooper, DS, Garber, JR, Greenlee, MC, Klein, I, et al.. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011;21:593–646. https://doi.org/10.1089/thy.2010.0417.Search in Google Scholar PubMed

2. Mitchell, AL, Pearce, SH. How should we treat patients with low serum thyrotropin concentrations? Clin Endocrinol (Oxf) 2010;72:292–6. https://doi.org/10.1111/j.1365-2265.2009.03694.x.Search in Google Scholar PubMed

3. Donangelo, I, Suh, SY. Subclinical hyperthyroidism: when to consider treatment. Am Fam Physician 2017;95:710–6.Search in Google Scholar

4. Santos Palacios, S, Pascual-Corrales, E, Galofre, JC. Management of subclinical hyperthyroidism. Int J Endocrinol Metabol 2012;10:490–6. https://doi.org/10.5812/ijem.3447.Search in Google Scholar PubMed PubMed Central

5. Canaris, GJ, Manowitz, NR, Mayor, G, Ridgway, EC. The colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526–34. https://doi.org/10.1001/archinte.160.4.526.Search in Google Scholar PubMed

6. Burch, HB, Cooper, DS. Management of Graves disease: a review. JAMA 2015;314:2544–54. https://doi.org/10.1001/jama.2015.16535.Search in Google Scholar PubMed

7. Léger, J. Graves’ disease in children. Paediatr thyroidol 2014;26:171–82. https://doi.org/10.1159/000363163.Search in Google Scholar PubMed

8. Metwalley, KA, Farghaly, HS, Raafat, DM, Ismail, AM, Saied, GM. Soluble CD40 ligand levels in children with newly diagnosed Graves’ disease. J Clin Res Pediatr Endocrinol 2020;12:197–201. https://doi.org/10.4274/jcrpe.galenos.2019.2019.0108.Search in Google Scholar PubMed PubMed Central

9. Bartalena, L, Masiello, E, Magri, F, Veronesi, G, Bianconi, E, Zerbini, F, et al.. The phenotype of newly diagnosed Graves’ disease in Italy in recent years is milder than in the past: results of a large observational longitudinal study. J Endocrinol Invest 2016;39:1445–51. https://doi.org/10.1007/s40618-016-0516-7.Search in Google Scholar PubMed

10. Aversa, T, Valenzise, M, Corrias, A, Salerno, M, Mussa, A, Capalbo, D, et al.. Subclinical hyperthyroidism when presenting as initial manifestation of juvenile Hashimoto’s thyroiditis: first report on its natural history. J Endocrinol Invest 2014;37:303–8. https://doi.org/10.1007/s40618-014-0054-0.Search in Google Scholar PubMed

11. Wasniewska, M, Corrias, A, Salerno, M, Lombardo, F, Aversa, T, Mussa, A, et al.. Outcomes of children with hashitoxicosis. Horm Res Paediatr 2012;77:36–40. https://doi.org/10.1159/000334640.Search in Google Scholar PubMed

12. Golombek, SG. Nonthyroidal illness syndrome and euthyroid sick syndrome in intensive care patients. Semin Perinatol 2008;32:413–8. https://doi.org/10.1053/j.semperi.2008.09.010.Search in Google Scholar PubMed

13. Nishikawa, M, Toyoda, N, Nomura, E. Drug-induced thyroid dysfunction. Nihon Rinsho 2012;70:1958–64.Search in Google Scholar

14. Al-Fifi, S, Rodd, C. Multinodular goiter in children. J Pediatr Endocrinol Metab 2001;14:749–56. https://doi.org/10.1515/jpem.2001.14.6.749.Search in Google Scholar PubMed

15. Engkakul, P, Mahachoklertwattana, P, Poomthavorn, P. De Quervain thyroiditis in a young boy following hand-foot-mouth disease. Eur J Pediatr 2011;170:527–9. https://doi.org/10.1007/s00431-010-1305-5.Search in Google Scholar PubMed

16. Stasiak, M, Lewiński, A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord 2021;22:1027–39. https://doi.org/10.1007/s11154-021-09648-y.Search in Google Scholar PubMed PubMed Central

17. Duprez, L, Parma, J, Van Sande, J, Allgeier, A, Leclère, J, Schvartz, C, et al.. Germline mutations in the thyrotropin receptor gene cause non–autoimmune autosomal dominant hyperthyroidism. Nat Genet 1994;7:396–401. https://doi.org/10.1038/ng0794-396.Search in Google Scholar PubMed

18. Tessaris, D, Corrias, A, Matarazzo, P, De Sanctis, L, Wasniewska, M, Messina, MF, et al.. Thyroid abnormalities in children and adolescents with McCune-Albright syndrome. Horm Res Paediatr 2012;78:151–7. https://doi.org/10.1159/000342641.Search in Google Scholar PubMed

19. Khare, A, Bhutani, P, Chauhan, S. Autonomous functioning thyroid nodule in a four-year-old male child treated with radioiodine (I-131). World J Nucl Med 2013;12:65–6. https://doi.org/10.4103/1450-1147.136695.Search in Google Scholar PubMed PubMed Central

20. Beck-Peccoz, P, Rodari, G, Giavoli, C, Lania, A. Central hypothyroidism – a neglected thyroid disorder. Nat Rev Endocrinol 2017;13:588–98. https://doi.org/10.1038/nrendo.2017.47.Search in Google Scholar PubMed

21. Biondi, B, Palmieri, EA, Klain, M, Schlumberger, M, Filetti, S, Lombardi, G. Subclinical hyperthyroidism: clinical features and treatment options. Eur J Endocrinol 2005;152:1–9. https://doi.org/10.1530/eje.1.01809.Search in Google Scholar PubMed

22. Biondi, B, Palmieri, EA, Fazio, S, Cosco, C, Nocera, M, Saccà, L, et al.. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J Clin Endocrinol Metab 2000;85:4701–5. https://doi.org/10.1210/jc.85.12.4701.Search in Google Scholar

23. Surks, MI, Ortiz, E, Daniels, GH, Sawin, CT, Col, NF, Cobin, RH, et al.. Subclinical thyroid disease. Scientific review and guidelines for diagnosis and management. J Am Med Assoc 2004;291:228–38.10.1001/jama.291.2.228Search in Google Scholar PubMed

24. Cheruvu, S, Alverson, BK, Quintos, JB. Femoral fracture as a rare presentation of prepubertal graves disease. J Pediatr 2013;162:429–30. https://doi.org/10.1016/j.jpeds.2012.10.036.Search in Google Scholar PubMed

25. Subramonian, D, Wu, YJ, Amed, S, Sanatani, S. Hyperthyroidism with atrial fibrillation in children: a case report and review of the literature. Front Endocrinol 2021;20:689497. https://doi.org/10.3389/fendo.2021.689497.Search in Google Scholar PubMed PubMed Central

26. Cooper, DS. Approach to the patient with subclinical hyperthyroidism. J Clin Endocrinol Metab 2007;92:3–9. https://doi.org/10.1210/jc.2006-2472.Search in Google Scholar PubMed

27. Lee, R, So, Y, Song, YS, Lee, WW. Evaluation of hot nodules of thyroid gland using Tc-99m pertechnetate: a novel approach using quantitative single-photon emission computed tomography/computed tomography. Nucl Med Mol Imaging 2018;52:468–72. https://doi.org/10.1007/s13139-018-0554-5.Search in Google Scholar PubMed PubMed Central

28. Kravets, I. Hyperthyroidism: diagnosis and treatment. Am Fam Physician 2016;93:363–70.Search in Google Scholar

Received: 2022-10-19

Accepted: 2022-11-21

Published Online: 2022-12-06

Published in Print: 2023-04-25

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Articles in the same Issue

https://doi.org/10.1515/jpem-2022-0534

Keywords for this article

anti-thyroid drugs; Graves’ disease; Hashimoto’s thyroiditis; subclinical hyperthyroidism; thyroid-stimulating hormone