Evaluation and Follow-up of Clinically Euthyroid Children with Normal Free T4 and Suppressed TSH
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Priya Vaidyanathan
ABSTRACT
Aim: Although subnormal TSH between 0.1-0.4 mIU/L is fairly common and benign, suppression of TSH to < 0.1mIU/L with normal free T4 is less common and more worrisome. We have conducted a retrospective chart review of a collection of such cases and have summarized the features and outcome on follow up.
Methods: We studied 23 consecutive patients referred from 2005-07 to our pediatric endocrine clinic with TSH < 0.1 mIU/L and free T4 in the range of 0.8-2 ng/dl. We collected historical, clinical and laboratory data, and analyzed their outcome.
Results: The natural evolutions of these subjects were separated into 4 groups. Group 1, 14 subjects, (61%) became euthyroid within a mean of 3.7 months. Group 2, 4 subjects, (17%) became hypothyroid within a mean of 2.8 months. Group 3, 2 subjects (9%) progressed to overt hyperthyroidism. Group 4, 3 subjects (13%) had persistently suppressed TSH, 8-14 months after initial testing, of which one had a multinodular goiter and had a thyroidectomy. Elevated thyroid peroxidase antibody (TPO) was seen in 54.5% of those tested.
Conclusion: Only 2/23 in our series became overtly hyperthyroid. Substantial number of subjects had a short period of transient TSH suppression that resolved spontaneously. Markers suggestive of autoimmune thyroid disease were consistently seen in group 2 and less so in others. It is prudent to observe such cases in the short term with serial follow up TSH, free T4 and T3, and to reserve further testing and treatment for those who become symptomatic or do not resolve.
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Articles in the same Issue
- A Warning Sign from the Thyroid
- Variable Associations of Klinefelter Syndrome in Children
- Diabetes Insipidus in a Young Child
- Evaluation and Follow-up of Clinically Euthyroid Children with Normal Free T4 and Suppressed TSH
- Bicalutamide plus Anastrozole for the Treatment of Gonadotropin-Independent Precocious Puberty in Boys with Testotoxicosis: A Phase II, Open-Label Pilot Study (BATT)
- Endocannabinoid (EC) Receptor, CB1, and EC Enzymes' Expression in Primary Adipocyte Cultures of Lean and Obese Pre-pubertal Children in Relation to Adiponectin and Insulin
- The Relationship of Insulin Secretion and GAD65 Antibody Levels at Diagnosis on Glycemic Control in Type 2 Diabetes
- Morning Cortisol is Not Associated with Truncal Fatness or Resting Blood Pressure in Children: Cross-Sectional and 1-2 Year Follow-Up Analyses
- Decreased Plasma Apelin Levels in Pubertal Obese Children
- Adolescent Acromegaly: Clinical Parameters and Treatment Outcome
- Left Ventricular Diastolic Dysfunction in Adolescents with Type 1 Diabetes Reflects the Long- but Not Short- Term Metabolic Control
- Effects of a Structured Exercise Program on Insulin Resistance, Inflammatory Markers and Physical Fitness in Obese Korean Children
- Case Series of Neonatal Hypocalcemia due to Pseudohypoparathyroidism
- A Case of Antenatal Bartter Syndrome with Sensorineural Deafness
- Association of SUMO4 M55V Polymorphism with Type 1 Diabetes in Chinese Children
- Mayer-Rokintansky-Kuster-Hauser Syndrome Associated with Atrial Septal Defect, Partial Anomalous Pulmonary Venous Connection and Unilateral Kidney – An Unusual Triad of Anomalies
