In Reply We appreciate the interest of Drs Rustagi and Weiss in our proposed screening guidelines for thyroid function in children with alopecia.1 We have noted that many blood tests are performed in children with alopecia areata who have no symptoms outside of their hair loss, and so the goal of our article was to suggest a reduction in the number of patients who are being screened for thyroid disease when they present with alopecia areata. We stand by our conclusions that the specific subpopulation of patients who have both alopecia areata and trisomy 21 should undergo thyroid screening at the occurrence of new-onset alopecia areata if they have not had recent screening. The association between Down syndrome and thyroid disorders is well recognized, and patients with Down syndrome have an increased prevalence of both congenital hypothyroidism and acquired thyroid dysfunction, with hypothyroidism being most common.2 The American Academy of Pediatrics recommends screening at age 6 months, age 12 months, and annually thereafter or at the development of new symptoms.3 We found a statistically significant association between Down syndrome in patients with alopecia areata who also had thyroid abnormalities.
Castelo-Soccio LA, Patel D, Bauer A. Thyroid Function Screening in Children With Alopecia Areata—Reply. JAMA Dermatol. 2018;154(5):629. doi:10.1001/jamadermatol.2018.0213
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