The Natural Course of Subclinical Hypothyroidism in Children and Adolescents: A Comprehensive Review

Nada Alaaraj; Ashraf Soliman; Fawzia Alyafei; Noor Hamed; Shayma Ahmed; Ashraf Adel; Amal Sabt

Introduction: Subclinical hypothyroidism (SH) in children and adolescents is a condition characterized by elevated thyroid-stimulating hormone (TSH) levels with normal serum free thyroxine (T4). The clinical significance and natural course of SH remain subjects of debate, necessitating a review of the literature to guide management decisions.

Methods: This review analyzed ten studies, encompassing both observational cohorts and reviews, to evaluate the progression, stability, and regression of SH in pediatric populations. Studies varied in methodology, including longitudinal follow-ups and comparative analyses between treated and untreated groups.

Review: The findings revealed a wide variability in outcomes, with a significant proportion of subjects experiencing normalization of thyroid function over time. Factors influencing the course of SH included initial TSH levels, presence of thyroid antibodies, and therapeutic interventions.

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Table: Summary of the studies reviewed
Study Reference	Number of Participants	Percentage Reverted to Normal	Follow-Up Duration
Aijaz et al., 2006	11	No significant neuropsychological function changes	Short term
Lazar et al., 2009	121,052 screened; subset followed	Substantial percentage normalized or remained stable	5 years
Wasniewska et al., 2009	92	41.3% normalized TSH	24 months
Monzani et al., 2012	Review of 15 articles	Low risk of evolution toward overt hypothyroidism; Majority reverted to euthyroid or remained SH	Varied
Radetti et al., 2012	382 (323 HT, 59 IH)	HT: G0 to G0 (170 stable), G1 to G0 (36 reverted); IH: 23 normalized	3 years
Aversa et al., 2015	122 (32 HT, 90 idiopathic)	HT: 21.9% normalized; Idiopathic: 41.1% normalized	2 years
Aversa et al., 2016	234	52.6% remained euthyroid, 40.6% SH normalized	5 years
Wasniewska et al., 2012	161 (69 treated, 92 untreated)	Higher normalization in treated group	24 months
Murillo-Vallés et al., 2020	65	89%	6-24 months
Szeliga et al., 2023	130	Low progression to overt hypothyroidism; Majority remained SH or normalized	Not specified

Comments: The studies underscore the importance of individualized management strategies for children with SH, highlighting the need for careful monitoring and consideration of treatment in cases with higher risks of progression to overt hypothyroidism.

Conclusion: The majority of children and adolescents with SH exhibit a benign course with a high likelihood of spontaneous normalization of thyroid function. However, long-term observational studies are essential to optimize management guidelines and identify patients who may benefit from intervention.

ESPE Abstracts

P3-248