Should thyroid testing be part of screening for SCFE?

After finding that almost one-third of their patients with slipped capital femoral epiphysis (SCFE) had thyroid abnormalities, the authors of a retrospective study in such patients concluded that thyroid testing should be included in screening for the disorder.

Researchers conducted the review in 98 patients with 106 hips who were treated for SCFE at a single pediatric hospital during a 1.5-year period. They documented the height, weight, and body mass index (BMI) of all patients, in addition to levels of thyroid-stimulating hormone (TSH), free T4, vitamin D, creatinine, blood urea nitrogen, and hemoglobin A1c. However, it was up to the attending surgeon on call to decide whether or not to obtain labs.

The most common comorbid conditions were endocrinopathies (10%), trisomy 21(5%), and attention-deficit/hyperactivity disorder (4%). The average BMI at presentation was 27.9, with an average BMI percentile of 92%. Among the 66% of patients for whom a TSH level was obtained at initial presentation, the median TSH level was 2.99; in 32% of these patients, the level had an abnormal value. The median TSH level for patients with high TSH was 6.09, although 2 patients had a low level with values of 0.02 and 0.48. Of patients with an elevated TSH level, 3 were diagnosed with hypothyroidism and received levothyroxine.

According to the authors, although the incidence rate of thyroid abnormalities in patients tested at their institution was 32%, treatment was effected in only 24% of these patients. Further, investigators noted that even more children may have needed endocrine treatment but were missed due to the lack of screening. Finally, according to the authors, the current investigation found a much higher incidence of hypothyroid-associated SCFE than was previously demonstrated in the literature. These observations indicate that a universal screening protocol represents a “significant opportunity to improve care for this population,” the authors wrote.

THOUGHTS FROM DR FARBER

I wonder if hypothyroidism would have been suspected in the 3 patients who were treated for it if they had a good evaluation in the absence of SCFE (eg, if they had a goiter). Nevertheless, it is probably worth doing thyroid studies in these patients, remembering that an elevated TSH level by itself often warrants nothing more than repeating the study down the line to see how that level changes.

Reference:

Nielsen E, Leiby B, Blumberg TJ. A role for thyroid testing in slipped capital femoral epiphysis? 32% rate of abnormal values in tested patients. J Pediatr Orthop. 2024;44(5):303-307. doi:10.1097/BPO.0000000000002630