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Natural History of Thyroid-Stimulating Hormone in Children

Initially abnormal TSH levels tended to normalize within 5 years.

Few population-based data on thyroid function tests in children are available. Investigators in Israel determined the natural history of thyroid-stimulating hormone (TSH) using data from a health insurance administrative database. Of 1 million enrolled children (age range, 6 months to 16 years), 121,000 (12%) with no history of thyroid disease underwent TSH testing in 2002. The reason for testing was not specified in most cases.

On initial testing, TSH levels were normal (0.35–5.50 mIU/L) in 96.5% of children, mildly elevated (>5.50–10 mIU/L) in 2.9%, highly elevated (>10 mIU/L) in 0.4%, and low (<0.35 mIU/L) in 0.2%. After initial testing, treatment was started for overt thyroid dysfunction in 1% of children; data for these children were excluded from further analysis. About half the remaining children had second TSH tests during the next 5 years. Among those with low initial TSH levels, 79% had normal levels on the second test. Among those with mildly elevated and highly elevated initial TSH levels, 74% and 40%, respectively, had normal levels on the second test. Female sex and TSH level >10.0 mIU/L were significantly associated with persistently elevated TSH levels in multivariate analysis.

Comment: Apparently, routine TSH testing was common in this population of Israeli children. The findings suggest that about 1% of tests are likely to lead to a diagnosis of overt thyroid dysfunction and that most TSH abnormalities will normalize with time.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine June 3, 2009

Citation(s):

Lazar L et al. Natural history of thyroid function tests over 5 years in a large pediatric cohort. J Clin Endocrinol Metab 2009 May; 94:1678.

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• TSH in children
  François Isabelle, Saint-Hubert, Quebec, 5 Jun 2009 12:29 PM EST
  Circadian TSH level fluctuates more in children. We don't hear much about a longer period fluctuation, seasonal or hormonal in... [more]