Low free thyroxine and normal thyroid-stimulating hormone in infants and children: possible causes and diagnostic work-up.
Central hypothyroidism
Children
FT4
TSH
Journal
European journal of pediatrics
ISSN: 1432-1076
Titre abrégé: Eur J Pediatr
Pays: Germany
ID NLM: 7603873
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
20
11
2020
accepted:
02
02
2021
revised:
09
01
2021
pubmed:
16
2
2021
medline:
24
6
2021
entrez:
15
2
2021
Statut:
ppublish
Résumé
Screening for hypo- or hyperthyroidism in adults is generally done by measuring the serum thyrotropin (thyroid-stimulating hormone, TSH) concentration. This is an efficient approach in case of suspected acquired thyroid disease. However, in infants and children, congenital hypothalamus-pituitary-thyroid (HPT) axis disorders also need to be considered, including primary and central congenital hypothyroidism, and even rarer thyroid hormone receptor and transporter defects. In primary congenital hypothyroidism, TSH will be elevated, but in the other congenital HPT axis disorders, TSH is usually within the normal range. Free thyroxine (FT4) assessment is essential for the diagnosis in these conditions.Conclusion: Here we discuss a number of rare congenital HPT axis disorders in which TSH is normal, but FT4 is low, and provide a clinical algorithm to distinguish between these disorders. What is Known: • A single thyroid-stimulating hormone (TSH) measurement is an appropriate screening method for primary hypothyroidism. • For central hypothyroidism and rare thyroid hormone receptor and transporter defects a free thyroxine (FT4) measurement is essential for the diagnosis because TSH is usually normal. What is New: • Here we present a new problem-oriented clinical algorithm including a diagnostic flow-chart for low FT4 and normal TSH in infants and children.
Identifiants
pubmed: 33585976
doi: 10.1007/s00431-021-03976-6
pii: 10.1007/s00431-021-03976-6
pmc: PMC8195777
doi:
Substances chimiques
Thyrotropin
9002-71-5
Thyroxine
Q51BO43MG4
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2333-2338Références
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