Thyroid dysfunction in children with Down syndrome: a literature review.
BACKGROUND
This article is an evidence-based review of thyroid disease in children with Down syndrome, including a comparison between various professional guidelines for the management of thyroid disease in children with Down syndrome. Aspects of thyroid disease which are discussed include: congenital hypothyroidism; autoimmune thyroid disease; subclinical hypothyroidism; and hyperthyroidism. The national professional guidelines of Ireland, the United Kingdom, the United States of America, Australia and Canada are reviewed and compared.


METHODS
A literature search was conducted using Medline and PubMed. Search terms included 'Down syndrome' and 'thyroid disease', 'hypothyroidism', 'hyperthyroidism', 'subclinical hypothyroidism'.


RESULTS
Eighty-nine articles were retrieved and reviewed for inclusion. The guidelines on the medical management of children with Down syndrome of five expert groups have also been retrieved and reviewed for this discussion. These various guidelines offer largely similar advice regarding frequency of thyroid function tests, with only Ireland and the UK testing less frequently than annually. Only the United Kingdom and Irish Down Syndrome Medical Interest Group guidelines suggest testing for thyroid antibodies at every thyroid screen. None of the guidelines offer suggestions on the optimal course of action to pursue after the discovery of subclinical hypothyroidism.


CONCLUSIONS
In conclusion, more evidence is required regarding the optimal course of treatment for subclinical hypothyroidism. Such evidence may be best obtained by conducting a prospective randomized control trial.
Graduate Entry Medical School, Clinical Academic Liaison Building, University of Limerick, University Hospital, Dooradoyle Campus, Limerick, Ireland, 11104228@studentmail.ul.ie.
K
K
King
C
C
O'Gorman
S
S
Gallagher
D000293:Adolescent; D000367:Age Factors; D058070:Asymptomatic Diseases; D001315:Australia; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003409:Congenital Hypothyroidism / Q000150:complications / Q000503:physiopathology; D004314:Down Syndrome / Q000150:complications*; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D013959:Thyroid Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000503:physiopathology*; D013967:Thyroiditis, Autoimmune / Q000150:complications / Q000503:physiopathology; D006113:United Kingdom; D014481:United States