Mild Hypothyroidism in Childhood

Who, When, and How Should Be Treated?

Maria Cristina Vigone; Donatella Capalbo; Giovanna Weber; Mariacarolina Salerno


J Endo Soc. 2018;2(9):1024-1039. 

In This Article


The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. In the neonatal period, the decision to start treatment with L-T4 depends on multiple factors, such as the age of the patient, the duration of the thyroid dysfunction, the trend of TSH values, the etiology, the presence of syndromes and/or other pathologies, and the parents' choice and reliability. In case of a persistent mild increase in TSH levels and in special risk categories (preterm, LBW, twins, infants from mothers affected by autoimmune thyroiditis, twins), it might be prudent to start treatment and to reevaluate the thyroid axis at a later stage.

The optimum management of children with SH depends on the etiology and degree of TSH elevation and should be individually tailored. Although mild untreated SH seems not to be associated with alterations in growth or neurocognitive development, subtle proatherogenic abnormalities have been detected, which are reversed with treatment with L-T4.

Current recommendations support L-T4 therapy for children with severe SH, goiter, or symptoms suggestive of hypothyroidism, whereas there is not enough evidence to recommend treatment of all children with mild asymptomatic forms of SH.

In the absence of therapeutic intervention, clinical examination and thyroid function tests should be regularly performed to ensure early identification of children who might benefit from treatment.

Further data are necessary prior to fully implement recommendation in the management of children with mild SH.