ESPE Abstracts (2019) 92 P2-297

Evaluation of Elevated Serum Thyroid-Stimulating Hormone (TSH) in Children and Adolescents: A Single-Center Study in Uruguay

Mariana Risso, Gimena Echeverría, Beatriz Mendoza


Pereira Rossell children University Hospital, Montevideo, Uruguay


Introduction: Primary hypothyroidism is the most frequent thyroid disease in children, and elevation of serum TSH is a common presenting complaint (pc) in the pediatric endocrinology outpatient clinic. Subclinical hypothyroidism (sHT) predominates in relation to overt hypothyroidism (cHT). The benefit of Levothyroxine is controversial specially when serum TSH levels are less than 10 uUI/ml.

Objectives: To evaluate the prevalence of children with elevated serum TSH referred to our center in a period of 6 months (January to June 2016). Analyze patient characteristics, biochemical diagnosis and treatment with Levothyroxine.

Methods: A retrospective, cross-sectional study was performed based on review of the charts of children between 2 and 15 years with elevated serum TSH in the pediatric endocrinology outpatient clinic at the Pereira Rossel Hospital, Montevideo Uruguay. Final population was 72 children. Data collected was: age, gender, anthropometry: height and body mass index (BMI), goiter, neurodevelopment, main reason of request serum TSH. Biochemical values of: TSH, free thyroxine (fT4), anti-thyroid autoantibodies (anti-Tab), second thyroid profile and treatment with Levothyroxine.

Results: Fifty percent of the pc were because of elevated serum TSH and the main reason of request was the obesity. No significant difference was between sex, and age of presentation was 7 years. Seventy-five children had normal neurodevelopment. Almost half of the patient had overweight or obesity (15% and 33% respectively) and no one of this associated impaired growth. Biochemical diagnosis was made with the fist thyroid profile: 11% cHT and 88.9% sHT. The second profile was made in 47% of the sHT and the serum TSH level normalized in 13.6%. There was a statistically significant decrease between the first and second TSH value (P = 0.01). The prevalence of sHT was 22.3% due to a correct diagnosis. All of the cHT and sHT with TSH ≥ 10 uUI/ml received treatment with Levotiroxine. Fifty eight percent of the sHT with serum TSH levels < 10 uUI/ml were treated but only 48% of them had a confirmatory profile.

Conclusions: half of the children referred to our center had elevated serum TSH. Obesity was the main cause of solicitude serum TSH and sHT was the most prevalent diagnosis. In most of the cases the diagnosis was not made correctly leading to an over diagnosis and over treatment.

Keywords: Subclinical hypothyroidism, obesity, children, Levothyroxine.

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