Cantas Orsdemir, Sena, MD

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PRACTICAL PEARLS: Thyroid Screening  INTRODUCTION  Autoimmune thyroiditis is the most common cause of acquired hypothyroidism in children.   Clinical features of moderate to severe hypothyroidism are insidious in onset and include growth failure, goiter, fatigue, cold intolerance, constipation, sleep disturbance, and even obstructive sleep apnea; subclinical and mild hypothyroidism are usually asymptomatic.   Obesity is NOT a sign of hypothyroidism; however, mild weight gain (<10% of the BW) despite decreased appetite is characteristic of severe hypothyroidism.   Review articles:  http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/content/thyroid-testing-when-worry-not-often-and-when-reassure-0http://www.ncbi.nlm.nih.gov/pubmed/20628588   INITIAL EVALUATION AND MANAGEMENT BY PRIMARY CARE   Signs and symptoms, especially goiter and poor linear growth are strong indicators for screening lab work.  Screening should include TSH with reflex free T4; a thyroid ultrasound is NOT indicated unless a nodule is present.  If TSH is <6, then hypothyroidism has been ruled out.   A TSH of 6-10 suggests subclinical hypothyroidism, which is common and often resolves, so repeat TSH in 6 months with thyroid anti-microsomal antibody   If TSH >10, consider referral  WHEN TO REFER  TSH >10 for thyroid hormone replacement HOW TO REFER  (413) 794-KIDS   WHAT TO EXPECT FROM BAYSTATE CHILDREN’S HOSPITAL VISIT   Thorough history and examination  Initiation of treatment with follow-up  Counseling and education for the patient and family   Author:     Sena Cantas Orsdemir, MD      Pediatric Endocrinology      February 2016 Contact:    Baystatechildrenshospital@baystatehealth.org  

Practical Pearl:  Thyroid Screening - Feb. 2016

https://scholarlycommons.libraryinfo.bhs.org/cgi/viewcontent.cgi?article=1021&amp;context=pedipearl

Practical Pearl: Thyroid Screening - Feb. 2016

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