[Etiological assessment of hyperthyrotropinemia in children with Down's syndrome].

OBJECTIVE To study the prevalence of increased TSH level and its probable cause in children with Down's syndrome treated at Policlínica Antônio Cândido. METHODS The data were collected using medical records of 169 patients. Of these, 46 patients, whose TSH increased at some time during their follow-up, were re-evaluated. In these patients, TSH, free T4, total T4 and thyroid peroxidase autoantibody (anti-TPO) levels were measured. Thyroid ultrasound, iodine-131 scintigraphy, and a perchlorate discharge test were performed. RESULTS In 169 children, 86 (50.8%) of whom were male, aged between 1-16 years (median 4 years), 67 (39.6%) presented increased TSH levels. Out of these 67 patients, 46 were prospectively studied. In 31 (67.4%) of them serum TSH returned to normal levels; in 11, TSH remained between 5 and 10 microU/ml, three (6.5%) had a TSH level over 10 microU/ml and one (2.2%) had hyperthyroidism. The diagnoses in 34 patients who were fully studied were: goiter in five (14.7%); Hashimoto's thyroiditis in four (5.9%); hypoplasia in three (8.8%) and iodide organification defect in one (2.9%). The increased TSH levels had a statistically positive relationship with anti-TPO (p = 0.02), but not with gender, abnormal ultrasound or scintigraphy findings. TSH levels did not have any relationship with persistent hyperthyrotropinemia. CONCLUSIONS In patients with Down's syndrome, slightly elevated and transient TSH levels are frequently detected. Positive anti-TPO antibody test is a key factor in the follow-up of these patients because of its potential risk of progression to manifest thyroid disease.