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Brief Report
December 2017

Screening Guidelines for Thyroid Function in Children With Alopecia Areata

Author Affiliations
  • 1Section of Pediatric Dermatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2The University of Louisville School of Medicine, Louisville, Kentucky
  • 3Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
  • 4Division of Endocrinology and Diabetes, The Thyroid Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 5The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
JAMA Dermatol. 2017;153(12):1307-1310. doi:10.1001/jamadermatol.2017.3694
Key Points

Question  Do children with alopecia areata (AA) require thyroid function screening tests?

Findings  In this retrospective review of 298 children with AA, we found a history of Down syndrome, atopy, and family history of thyroid disease had significant association with incidence of thyroid abnormalities. Age at diagnosis, duration of disease, and pattern of AA had no significant association.

Meaning  Thyroid function screening should be restricted to AA patients with a medical history of Down syndrome, personal history of atopy, a family history of thyroid disease, or clinical findings suggestive of potential thyroid dysfunction in the individual patient.

Abstract

Importance  The incidence of thyroid disease in children with alopecia areata (AA) has been widely studied with no consensus on whether a true association with AA exists. In addition, screening practices for thyroid dysfunction in children with AA vary widely among clinicians.

Objective  To reduce health care costs, eliminate unnecessary testing, and standardize clinical practices, we sought to characterize thyroid function in children with AA to establish guidelines for screening.

Design, Setting, and Participants  A single-site retrospective medical chart review was carried out in an outpatient pediatric dermatology clinic in a tertiary referral medical center between January 1, 2008 and January 1, 2016. The study included 298 patients (ages 0-21 years) who received a clinical diagnosis of AA and underwent thyroid function tests.

Main Outcomes and Measures  Age at diagnosis of AA, duration of disease, severity, location, and type were documented. Past medical history and family medical history of patients were also recorded. Results of laboratory tests including thyrotropin (formerly thyroid-stimulating hormone [TSH]), free T4 (FT4), triiodothyronine (T3), thyroid peroxidase antibodies (TPO-Abs), and thyroglobulin antibodies (Tg-Abs).

Results  During the 8-year period, 298 patients with AA had thyroid function screening. Of those with thyroid screening, patterns of AA included patchy (68%), ophiasis (13%), totalis (9%), and universalis (10%). Severity was determined by percentage of hair loss on the scalp and were divided into mild (30.2%), moderate (32.9%), and severe (36.9%). A total of 59 (20%) patients had abnormalities on thyroid testing results. In this group of patients, hypothyroidism was the most frequent finding 29 (49%), with Hashimoto thyroiditis being the most common cause(24 [41%]). Other abnormalities included hyperthyroidism secondary to Grave disease (12 [20%]) and subclinical thyroid dysfunction (7 [12%]). Whereas age, duration of disease, pattern of alopecia, and diagnosis of autoimmune diseases had no significant association with abnormal thyroid findings, a personal history of Down syndrome (P = .004), atopy (P = .009), and family history of thyroid disease (P = .001) did.

Conclusions and Relevance  We recommend that routine thyroid function screening should be restricted to AA patients with a medical history of Down syndrome, personal history of atopy, a family history of thyroid disease, or clinical findings (goiter) suggestive of potential thyroid dysfunction in the individual patient.

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