Subclinical but significant? updated review of pediatric hypothyroidism

Objectives: The aims of this review are to describe the rates of diagnosis of true thyroid disease (and subsequent treatment) in children with an elevated TSH referred to pediatric endocrinology, risk factors associated with elevated TSH secondary to thyroid disease, and TSH threshold level associated with thyroid disease. Methods: To accomplish these aims, our team searched through four databases to curate 211 articles regarding TSH values in healthy children ages 1–18 years without an underlying risk for hypothyroidism. Results: Five studies met our criteria and were analyzed to create the conclusions about rates of hypothyroidism requiring treatment (6.3–59 %), risk factors to developing hypothyroidism (TSH>10 mIU/L, goiter, and anti-thyroid antibodies), and high-risk TSH value (9.6 mIU/L when averaged among four studies). Conclusions: The results are helpful in guiding practitioners about when to repeat TSH value before considering referral to endocrinology, when to refer, and when to anticipate the need of thyroid hormone replacement.