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Some children with alopecia should undergo thyroid screening
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Researchers recommended that children with a medical history of Down syndrome and a personal history of atopy are among a limited group of patients with alopecia areata who should undergo thyroid screening.
The researchers noted that there is wide variety in screening practices for thyroid dysfunction in children with alopecia areata, possibly because there is no consensus regarding whether an association between these two conditions exists. The researchers evaluated 298 patients (aged, 0-21 years) with alopecia areata who underwent thyroid function screening at a single outpatient pediatric dermatology clinic in a tertiary referral medical center between Jan. 1, 2008, and Jan. 1, 2016.
The aim of the study was to reduce costs, eliminate unnecessary testing and attempt to standardize screening practices, according to the researchers.
A number of factors underwent assessment, including age at alopecia areata diagnosis, duration and severity of disease, location, and disease type. Clinicians gathered information on patient and family medical history, along with laboratory data for thyrotropin (formerly thyroid-stimulating hormone), free T4, triiodothyronine, thyroid peroxidase antibodies and thyroglobulin antibodies, according to study background.
Sixty-eight percent of children who underwent thyroid screening had patchy patterns of alopecia areata, while 13% had ophiasis, 9% had totalis and 10% had universalis.
Nearly one-third of the cohort (30.2%) had mild disease, while 32.9% had moderate disease and 36.9% had severe disease, with severity determined by percentage of hair loss on the scalp.
Thyroid abnormalities occurred in 20% of the cohort. In this group of 59 patients, 49% had hypothyroidism, with Hashimoto thyroiditis causing 41% of those cases.
Hyperthyroidism secondary to Grave disease was observed in 20% of patients, while 12% had subclinical thyroid dysfunction.
Abnormal thyroid findings carried significant associations with Down syndrome (P = .004), atopy (P = .009) and family history of thyroid disease (P = .001). However, no such associations were reported for age, duration of disease, pattern of alopecia, and diagnosis of autoimmune diseases.
“We recommend that routine thyroid function screening should be restricted to [alopecia areata] patients with a medical history of Down syndrome, personal history of atopy, a family history of thyroid disease, or clinical findings (goiter) suggestive of potential thyroid dysfunction in the individual patient,” the researchers concluded. – by Rob Volansky
Disclosures: The authors report no relevant financial disclosures.
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