Session: SAT 622-631-Pediatric Endocrinology: Thyroid
Poster Board SAT-624
Methods: Charts were reviewed for all children (0-18) with Down syndrome seen at Children’s Hospital Colorado primary care clinics in a 5 year period. Data on laboratory values, symptoms, and management were collected. Subclinical hyperthyrotropinemia was defined as mildly elevated TSH (5-15) with normal or high T4, no symptoms attributable to hypothyroidism and without evidence of autoimmunity.
Results: 446 subjects met inclusion criteria. 169 (38%) had abnormal TSH on record: 6 (3%) had low TSH and were diagnosed with autoimmune hyperthyroidism, 20 (12%) were congenital hypothyroidism, and 143 (85%) was acquired elevation of TSH. Of those with acquired TSH elevation, 94 (66%) met the definition for hyperthyrotropinemia (TSH mean 9.9, range 4.95-14.9). Average age of abnormal TSH was 2.7 years, 50% male. Among subjects with hyperthyrotropinemia, 29% were never treated with thyroid replacement hormone, 17% were initially treated but later taken off the medication, 37% remained on the same dose, and 17% had a dose increase.
Discussion: In this retrospecitive chart review, more than 20% of children with DS had a presentation consistent with hyperthyrotropinemia. There was not a female predominance which suggests this is not simply a "pre-Hashimoto's" state. Previous studies suggest hyperthyrotropinemia may be due to inadequate dopaminergic regulation of pituitary TSH secretion unique to DS and may not require treatment, however our study suggests the management of this clinical scenario varies greatly. Future research should focus on neurodevelopmental outcomes among children with DS and hyperthyrotropinemia to allow for development of management guidelines in this population given the high prevalence and frequent screening recommendations in DS.
Nothing to Disclose: SMD, JMB, ERE
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