title: Subclinical hypothyroidism in children.
abstract: OBJECTIVE
  Subclinical hypothyroidism is a biochemical diagnosis characterized by raised thyroid stimulating hormone and normal free T4, without clinical features of hypothyroidism. This review analyzes the current evidence to arrive at a consensus and algorithm to manage this condition.
  
  
  METHODS
  We searched Pubmed, Cochrane and Embase for articles published between 1990 to 2014, and identified 13 relevant articles dealing with pediatric subclinical hypothyroidism which were suitable to include in our review.
  
  
  CONCLUSIONS
  Subclinical hypothyroidism is often a benign problem which requires expectant management with periodic monitoring of thyroid function tests and natural progression to overt hypothyroidism occur lot less frequently than expected. There is a paucity of robust randomized intervention studies, especially studies focusing on clinical outcomes. Thyroid replacement therapy is not justified in children with subclinical hypothyroidism when Thyroid stimulating hormone is <10 mIU/L. The main risk factors for progression to overt hypothyroidism are female sex, goiter, family history of thyroid disorder, strongly positive thyroid peroxidase antibodies and symptoms suggesting hypothyroidism. An algorithm for managing this condition is suggested.
authors.affiliation: Department of Pediatrics, Apollo Childrens Hospital, Chennai. Correspondence to: Dr M Sridhar, Consultant Pediatrician, Apollo childrens Hospital, No. 15, Shafee Mohammed Road, Thousand Lights, Chennai 600 006, India. hemasridha@yahoo.co.uk.
authors.forename: M
authors.initials: M
authors.lastname: Shriraam
authors.forename: M
authors.initials: M
authors.lastname: Sridhar
mesh_terms: D005260:Female; D006042:Goiter / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000627:therapeutic use
chemical_list: D013972:Thyrotropin; D013974:Thyroxine