Problemi speciali
Ipotiroidismo subclinico: realtà e falsi miti
Subclinical hypothyroidism: myths and reality
Francesca Burlo1, Stefania Tonetto1, Gianluca Tamaro2, Elena Faleschini2, Gianluca Tornese2
1Scuola di Specializzazione in Pediatria, Università di Trieste
2SS di Endocrinologia, Diabetologia e altre Malattie del Metabolismo, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Giugno 2023 - pagg. 369 -373 | DOI: 10.53126/MEB42369
Abstract
Subclinical hypothyroidism (SH or hyperthyrotropinemia) is a biochemical condition defined as elevated serum TSH concentrations and normal thyroxine (FT4). Generally, it is asymptomatic and is distinguished in mild (TSH between the upper limit and 9.9 μUI/ml) and severe (TSH equal to or higher than 10 μUI/ml). Replacement L-thyroxine treatment is requested for the severe form, while mild form treatment is still debated. In children, SH is usually a benign and remitting condition and progression to overt hypothyroidism is uncommon. By contrast, the risk of a deterioration of thyroid status is higher in children with SH and Hashimoto’s thyroiditis or chromosomal abnormalities, such as Turner syndrome or trisomy 21. Thyroid function is involved in many aspects of growth and development; therefore, it is important to evaluate whether untreated hyperthyrotropinemia implies long-term consequences. On the contrary, mild thyroid disfunction is improperly considered the cause of some clinical issues, such as obesity, sleep disorders and constipation. Finally, testing only TSH and FT4 in the suspicion of hypothyroidism is highly recommended.
Riassunto
L’ipotiroidismo subclinico (o ipertireotropinemia) è caratterizzato da un rialzo del TSH, con valori normali di FT4. Generalmente è una condizione asintomatica, e si distingue in lieve (TSH tra il limite superiore e 9,9 μUI/ml) e severa (TSH maggiore o uguale a 10 μUI/ml). Il trattamento sostitutivo con L-tiroxina è necessario nelle forme severe, mentre il trattamento delle forme lievi è ancora dibattuto. Nei bambini l’ipotiroidismo subclinico è una condizione generalmente benigna e risolutiva, e la progressione a ipotiroidismo franco è poco frequente. Ciononostante, il rischio di un peggioramento della funzione tiroidea è più alto nei bambini affetti da ipotiroidismo subclinico associato a tiroidite di Hashimoto o anomalie cromosomiche, come sindrome di Turner o trisomia 21. La funzionalità tiroidea è implicata in molteplici aspetti di crescita e sviluppo; pertanto, è importante valutare se la ipertireotropinemia non trattata abbia conseguenze a lungo termine. Al contrario, però, si attribuisce erroneamente la causa di alcune problematiche, quali l’obesità, la stipsi e i disturbi del sonno, a lievi alterazioni della funzionalità tiroidea. Inoltre, ricordiamo che la valutazione della funzionalità tiroidea nel sospetto di ipotiroidismo deve considerare solo TSH e FT4.
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Corrispondenza: francesca.burlo@gmail.com