ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P744 | DOI: 10.1530/endoabs.63.P744

Levothyroxine treatment of subclinical (SH) and overt (OH) hypothyroidism in children with autoimmune hashimoto thyroiditis (AHT): defining the TSH cut-off level

Sofia Leka-Emiri1, Vassilios Petrou1, Caterina Evangelopoulou1, Aspasia Fotinou2, Elpis Vlachopapdopoulou1 & Stefanos Michalacos1

1Department of Endocrinology, ‘P&A KYRIAKOU’ Children’s Hospital, Athens, Greece; 2Department of Biochemistry-Hormonology, ‘P&A KYRIAKOU’ Children’s Hospital, Athens, Greece.

Objectives: Assess the dose of levothyroxine in relation to TSH and FT4 at diagnosis of AHT in children with SH and OH.

Methods: Two hundred one children (155 girls) with AHT were devided according to TSH and FT4 levels at diagnosis of hypothyroidism [SH-FT4 >1.0 ng/dl: Group 1: TSH: 5–7.5 mU/l, Group 2: TSH: >7.5 mU/l, OH: Group 3: TSH>7.5 mU/l and FT4 ≤1.0 ng/dl]. Mean L-T4 dose was reported in μg/Kg per day at diagnosis and at 2.9 years of follow up and TSH targeted levels under treatment were 1–4 mU/l.

Results: Mean age at diagnosis was 9.6 yrs (SD, 2.6). Main characteristics are shown in table 1. At diagnosis, TSH, FT4 levels and L-T4 dose were significantly different (P<0.05) between SH (groups 1 and 2) as opposed to OH (group 3). At follow-up all patients were euthyroid and TSH and FT4 levels did not differ significantly between groups. L-T4 dose was significantly higher in OH as opposed to group 1 but not group 2. Table 1. Data are shown as means (S.D.).

Group 1 (n=70)Group2 (n=72)Group 3 (n=59)*P
Age (yrs)10.4 (2.6)8.9 (2.6)9.6 (2.4)
Height z-score0.55 (0.9)0.52 (1.0)0.43 (0.9)
BMI z-score0.87 (0.9)0.93 (0.9)0.92 (1.1)
TSH (mU/l)6.1 (0.7)10.9 (5.6)47.9 (74.2)*
FT4 (ng/dl)1.2 (0.2)1.3 (0.16)0.85 (0.1)*
L-T4 (μg/Kg/day)1.1 (0.4)1.3 (0.51)1.5 (0.6)*
AT FOLLOW UP (yrs)2.8 (1.4)3.16 (1.6)2.98 (1.6)
Age (yrs)13.2 (2.4)12.1 (2.7)12.6 (2.4)
Height z-score0.56 (1.0)0.59 (0.9)0.43 (0.8)
BMI z-score0.82 (0.8)0.76 (0.9)0.92 (0.9)
TSH (mU/l)2.2 (1.2)2.6 (1.2)2.2 (1.1)
FT4 (ng/dl)1.4 (0.2)1.4 (0.4)1.3 (0.2)
L-T4 (μg/Kg per day)1.1 (0.3)1.4 (0.4)1.6 (0.7)*
*One-Way Analysis of variance (ANOVA), P<0.05.

Conclusions: At diagnosis, L-T4 needs are significantly lower in subclinical hypothyroidism patients as opposed to overt hypothyroidism patients. At 2.9 yrs, children with overt hypothyroidism receive significantly higher LT-4 doses than those with SH and TSH < 7.5 mU/l but similar with those of SH and TSH > 7.5 mU/l.

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