Evaluating and managing thyroid disease in children

Primary care providers play a critical role in recognizing suspected thyroid disease in children and can work closely with pediatric endocrinologists to manage the disease once diagnosed. According to Harvey Chiu, MD, an associate professor in the Division of Pediatric Endocrinology and director, UCLA Pediatric Thyroid Program, David Geffen School of Medicine at the University of California, Los Angeles, early recognition of thyroid disease in children is critical for early correction to optimize outcomes.

“Primary care providers’ astute judgment is the key to starting the process,” he said. “Once diagnosed, pediatric endocrinologists can work closely with the primary care provider to not only normalize but to further optimize the management of thyroid hormone levels.”

In a session on Saturday, October 11, titled “Evaluation and management of the child with suspected thyroid disease: beyond the basics!” Chiu focused on a number of issues to help pediatricians hone their judgment on the diagnosis and management of thyroid disease in children. Highlighted was the need to think of congenital hypothyroidism as an emergency, to recognize the presentation of acquired hypothyroidism, to understand the preferred treatments for hyperthyroidism in children, to understand the pitfalls in thyroid function testing, and to recognize thyroid hormone resistance.

Chiu used case studies to illustrate the process of diagnosis and management based on clinical presentation. He emphasized that hypothyroidism in children manifests with growth failure and seldom with obesity, and highlighted the need to remember that screening programs for newborns commonly miss secondary hypothyroidism.

Fortunately, he noted, diagnosis is usually easy with a simple blood draw to test serum levels for thyroid stimulating hormone (TSH) and tetraiodothyronine (T4), and he recommended considering free T4 by equilibrium dialysis as the gold standard test. When the TSH is confounding, Chiu suggested considering interference by heterophile antibodies.

He also briefly discussed the role of thyroid nodules in diagnosis. “With rapid advances in technology, thyroid nodules are able to be quickly biopsied with portable ultrasound machines that are now found in many endocrinologists’ offices,” he said.

Finally, Chiu talked about the need to recognize thyroid hormone resistance and said to consider this for cases of unusual hyperthyroidism.