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Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence

Department of Pediatrics, University of Messina, 98124 Messina, Italy¹ Department of Pediatrics, University ‘Federico II’, Naples, Italy² Department of Pediatrics, Univestity of Bologna, Bologna, Italy³ Department of Pediatrics, University of Turin, Turin, Italy

(Correspondence should be addressed to F De Luca; Email: wasniewska{at}yahoo.it)

Objective: To prospectively evaluate the course of subclinical hypothyroidism (SH) in children and adolescents with no underlying diseases and no risk factors, which might interfere with the progression of SH.

Design: Clinical status, thyroid function, and autoimmunity were prospectively evaluated at entry and after 6, 12, and 24 months in 92 young patients (mean age 8.1±3.0 years) with idiopathic SH.

Results: During the study, mean TSH levels showed a trend toward a progressive decrease while FT₄ levels remained unchanged. Overall, 38 patients normalized their TSH (group A): 16 patients between 6 and 12 months, and 22 patients between 12 and 24 months. Among the remaining 54 patients, the majority maintained TSH within the baseline values (group B), whereas 11 exhibited a further increase in TSH above 10 mU/l (group C). Baseline TSH and FT₄ levels were similar in the patients who normalized TSH, compared with those with persistent hyperthyrotropinemia. Even in the patients of group C, both TSH and FT₄ at entry were not different with respect to those of groups A and B. No patients showed any symptoms of hypothyroidism during follow-up and no changes in both height and body mass index were observed throughout the observation period.

Conclusions: (a) The natural course of TSH values in a pediatric population with idiopathic SH is characterized by a progressive decrease over time; (b) the majority of patients (88%) normalized or maintained unchanged their TSH; and (c) TSH changes were not associated with either FT₄ values or clinical status or auxological parameters.