vrijdag 15 februari 2013

Subklinische hypothyreoïdie bij jongeren en kinderen

Studies regarding the natural history of SH and its consequences in childhood are lacking and very few studies have examined the effects of levothyroxine (l-T4) replacement therapy in young people with SH. The aim of this review is to summarize what is known about the natural course of SH in children and adolescents and the potential effects of a replacement therapy.

Natural history of subclinical hypothyroidism in children and adolescents and potential effects of replacement therapy: a review
A Monzani, F Prodam, A Rapa, S Moia, V Agarla, S Bellone and G Bona

Objective

Subclinical hypothyroidism (SH) is quite common in children and adolescents. The natural history of this condition and the potential effects of replacement therapy need to be known to properly manage SH. The aim of this review is to analyze:
  1. the spontaneous evolution of SH, in terms of the rate of reversion to euthyroidism, the persistence of SH, or the progression to over hypothyroidism; and
  2. the effects of replacement therapy, with respect to auxological data, thyroid volume, and neuropsychological functions.

Methods

We systematically searched PubMed, Cochrane, and EMBASE (1990–2012) and identified 39 potentially relevant articles of which only 15 articles were suitable to be included.

Results and conclusions

SH in children is a remitting process with a low risk of evolution toward overt hypothyroidism. Most of the subjects reverted to euthyroidism or remained SH, with a rate of evolution toward overt hypothyroidism ranging between 0 and 28.8%, being 50% in only one study (nine articles). The initial presence of goiter and elevated thyroglobulin antibodies, the presence of celiac disease, and a progressive increase in thyroperoxidase antibodies and TSH value predict a progression toward overt hypothyroidism. Replacement therapy is not justified in children with SH but with TSH 5–10 mIU/l, no goiter, and negative antithyroid antibodies. An increased growth velocity was observed in children treated with levothyroxine (l-T4; two articles). l-T4 reduced thyroid volume in 25–100% of children with SH and autoimmune thyroiditis (two studies). No effects on neuropsychological functions (one study) and posttreatment evolution of SH (one study) were reported.



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