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Many children undergo unnecessary screening for thyroid disorders
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Pediatric Academic Societies’ Annual Meeting 2011
Nonspecific symptoms such as weight gain, fatigue and failure to thrive often prompt primary care providers to screen for thyroid disorders in children. However, researchers for a new study found that referrals to the pediatric endocrine clinic may not be warranted because most children with abnormal thyroid function tests did not have thyroid pathology identified.
“Enhanced educational efforts aimed at PCPs are needed in order to decrease rates of unnecessary subspecialty referrals for abnormal [thyroid function tests] in children,” Andrea K. Goldyn, MD, and colleagues wrote in a study that was presented at the Pediatric Academic Societies’ Annual Meeting 2011.
Goldyn and colleagues at Riley Hospital for Children at Indiana University Health in Indianapolis conducted a retrospective chart review of children with abnormal thyroid function tests who were referred to the pediatric endocrine clinic between July 2005 and June 2010. They collected data on age, sex, race, BMI, thyroid function test results, thyroid antibodies, family histories and final diagnoses. Their study included 560 children; the mean age was 10.1 years; 62% were girls; and 83% were white.
According to the results, 68% of the children with abnormal thyroid function tests displayed no evidence of thyroid pathology documented by normal repeat thyroid function studies. Reasons for initial thyroid screening included weight gain or obesity (29%), fatigue (16.7%) and failure to thrive (7.6%).
The researchers also examined the 32% of children whose abnormal thyroid function tests identified a thyroid condition upon referral to the pediatric endocrine clinic. The most common reasons for referral for all patients were elevated thyroid-stimulating hormone levels (55.5%), suppressed TSH (11%) and low free thyroxine (10.7%). Hashimoto's thyroiditis was the most common condition and was reported in 20% of patients; however, 47.3% with Hashimoto's thyroiditis were euthyroid. Primary hypothyroidism was found in 8.6% of patients and Graves' disease in 1.8%. Data also indicated that patients referred for elevated TSH levels had a higher initial mean value compared with those without thyroid conditions (8.9 mIU/L vs. 6.09 mIU/L; P<.01).
“The majority of patients referred to the pediatric endocrine clinic for abnormal [thyroid function tests] did not have thyroid pathology identified,” Goldyn and colleagues concluded. "Screening for thyroid disease because of obesity, fatigue, or FTT is unlikely to uncover the etiology of a patient's symptoms."
For more information:
- Goldyn AK. Poster 1401.7. Poster session: Endocrinology & diabetes. Presented at: Pediatric Academic Societies 2011; April 30-May 3, 2011; Denver.
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