Abstract
Background:
Subclinical hypothyroidism (SH), defined as mild thyroid-stimulating hormone (TSH) elevation with normal free thyroxine (FT4) levels and no symptoms, is common during the first few years of life in Down syndrome (DS) and can be self-limiting. Our objective was to confirm that SH is usually a transitory disorder and to identify the factors associated with spontaneous remission.
Methods:
We reviewed clinical histories of patients from the Catalan Down Syndrome Foundation (CDSF) with DS and SH diagnosed before 5 y of age. SH was defined as TSH 5.5–25 µU/ml (6 mo–4 y) or 4.13–25 µU/ml (4–7 y), with FT4 0.89–1.87 ng/dl (6 mo–4 y) or 0.96–1.86 ng/dl (4–7 y).
Results:
Fifty-three patients with SH were identified, with an average age of 2.4 ± 1.1 y, median (range) TSH at diagnosis 7.1 (4.2–23.9 µU/ml), and median (range) FT4 1.1 (0.9–1.7 ng/dl). SH resolved spontaneously in 39 cases (73.6%), with TSH at the most recent visit (mean age 6.7 ± 1.4 y) 3.9 (1.8–12.7 µU/ml). The rate of remission was significantly higher in patients without goiter (94.9 vs. 28.6%) and in those who were negative for antithyroid antibodies (89.7 vs. 42.9%).
Conclusion:
SH in infants and preschool children with DS is usually a transitory disorder, with remission in >70% of cases. The absence of goiter and thyroid autoantibodies was associated with a greater rate of spontaneous remission in our study.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Gruñeiro de Papendieck L, Chiesa A, Bastida MG, Alonso G, Finkielstain G, Heinrich JJ . Thyroid dysfunction and high thyroid stimulating hormone levels in children with Down’s syndrome. J Pediatr Endocrinol Metab 2002;15:1543–8.
Pueschel SM, Jackson IM, Giesswein P, Dean MK, Pezzullo JC . Thyroid function in Down syndrome. Res Dev Disabil 1991;12:287–96.
Goday-Arno A, Cerda-Esteva M, Flores-Le-Roux JA, Chillaron-Jordan JJ, Corretger JM, Cano-Pérez JF . Hyperthyroidism in a population with Down syndrome. Clin Endocrinol (Oxf) 2009;71:110–4.
Prasher V . Prevalence of thyroid dysfunction and autoimmunity in adults with Down syndrome. Downs Syndr Res Pract 1994;2:67–70.
Kinnell HG, Gibbs N, Teale JD, Smith J . Thyroid dysfunction in institutionalised Down’s syndrome adults. Psychol Med 1987;17:387–92.
Rubello D, Pozzan GB, Casara D, et al. Natural course of subclinical hypothyroidism in Down’s syndrome: prospective study results and therapeutic considerations. J Endocrinol Invest 1995;18:35–40.
Cutler AT, Benezra-Obeiter R, Brink SJ . Thyroid function in young children with Down syndrome. Am J Dis Child 1986;140:479–83.
Sharav T, Collins RM Jr, Baab PJ . Growth studies in infants and children with Down’s syndrome and elevated levels of thyrotropin. Am J Dis Child 1988;142:1302–6.
Gibson PA, Newton RW, Selby K, Price DA, Leyland K, Addison GM . Longitudinal study of thyroid function in Down’s syndrome in the first two decades. Arch Dis Child 2005;90:574–8.
Selikowitz M . A five-year longitudinal study of thyroid function in children with Down syndrome. Dev Med Child Neurol 1993;35:396–401.
van Trotsenburg AS, Vulsma T, van Rozenburg-Marres SL, et al. The effect of thyroxine treatment started in the neonatal period on development and growth of two-year-old Down syndrome children: a randomized clinical trial. J Clin Endocrinol Metab 2005;90:3304–11.
van Trotsenburg AS, Kempers MJ, Endert E, Tijssen JG, de Vijlder JJ, Vulsma T . Trisomy 21 causes persistent congenital hypothyroidism presumably of thyroidal origin. Thyroid 2006;16:671–80.
van Trotsenburg AS, Vulsma T, van Santen HM, Cheung W, de Vijlder JJ . Lower neonatal screening thyroxine concentrations in down syndrome newborns. J Clin Endocrinol Metab 2003;88:1512–5.
Karlsson B, Gustafsson J, Hedov G, Ivarsson SA, Annerén G . Thyroid dysfunction in Down’s syndrome: relation to age and thyroid autoimmunity. Arch Dis Child 1998;79:242–5.
Zori RT, Schatz DA, Ostrer H, Williams CA, Spillar R, Riley WJ . Relationship of autoimmunity to thyroid dysfunction in children and adults with Down syndrome. Am J Med Genet Suppl 1990;7:238–41.
Popova G, Paterson WF, Brown A, Donaldson MD . Hashimoto’s thyroiditis in Down’s syndrome: clinical presentation and evolution. Horm Res 2008;70:278–84.
Jiménez-López V, Arias A, Arata-Bellabarba G, Vivas E, Delgado MC, Paoli M . Concentration of thyrotropic hormone and free thyroxin in children with Down’s syndrome. Invest Clin 2001;42:123–30.
Tüysüz B, Beker DB . Thyroid dysfunction in children with Down’s syndrome. Acta Paediatr 2001;90:1389–93.
Vila L, Castell C, Wengrowicz S, de Lara N, Casamitjana R . [Urinary iodide assessment of the adult population in Catalonia]. Med Clin (Barc) 2006;127:730–3.
Billewicz WZ, Chapman RS, Crooks J, et al. Statistical methods applied to the diagnosis of hypothyroidism. Q J Med 1969;38:255–66.
Noble SE, Leyland K, Findlay CA, et al. School based screening for hypothyroidism in Down’s syndrome by dried blood spot TSH measurement. Arch Dis Child 2000;82:27–31.
Dinani S, Carpenter S . Down’s syndrome and thyroid disorder. J Ment Defic Res 1990;34 (Pt 2):187–93.
McGowan S, Jones J, Brown A, et al. Capillary TSH screening programme for Down’s syndrome in Scotland, 1997–2009. Arch Dis Child 2011;96:1113–7.
Pastor X, Quintó L, Corretger JM, Gassió R, Hernández M, Serés A . [Updated growth charts of Spanish children with Down syndrome]. Revista médica internacional sobre el síndrome de Down 2004;8:34–46.
Acknowledgements
We thank Reyes Alcoverro, secretary of the Medical Center of CDSF, for the facilities for the collection of clinical data for our study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Claret, C., Goday, A., Benaiges, D. et al. Subclinical hypothyroidism in the first years of life in patients with Down syndrome. Pediatr Res 73, 674–678 (2013). https://doi.org/10.1038/pr.2013.26
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/pr.2013.26
This article is cited by
-
Epidemiological and clinical aspects of autoimmune thyroid diseases in children with Down’s syndrome
Italian Journal of Pediatrics (2018)
-
Thyroid Stimulating Hormone Level at Diagnosis as a Predictor of Persistent Subclinical Hypothyroidism in Children with Down Syndrome
Indian Pediatrics (2018)
-
Analysis of the factors affecting the evolution over time of subclinical hypothyroidism in children
Italian Journal of Pediatrics (2017)
-
Subclinical hypothyroidism in childhood — current knowledge and open issues
Nature Reviews Endocrinology (2016)
-
Heterogeneous phenotype in children affected by non-autoimmune hypothyroidism: an update
Journal of Endocrinological Investigation (2015)
