Nat. Rev. Endocrinol. doi: /nrendo

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Nat. Rev. Endocrinol. doi:10.1038/nrendo.2016.100 Figure 2 Proposed management of children with subclinical hypothyroidism Figure 2 | Proposed management of children with subclinical hypothyroidism. The initial step in the management of a child with a mild increase in TSH concentration should be confirmation of hyperthyrotropinaemia by re-evaluation of TSH levels 4–12 weeks after the first test. If an elevated TSH concentration persists, the diagnostic process should first include careful assessment of the child's history and a clinical evaluation focused on the detection of signs and symptoms suggestive of thyroid dysfunction. Thereafter, evaluation of anti-thyroid antibodies and thyroid ultrasonography will enable differentiation between autoimmune and nonautoimmune forms of subclinical hypothyroidism (SH). The subsequent management and follow-up will depend both on the aetiology and the degree of TSH elevation. The final decision on treatment should be based on the assessment of clinical symptoms or signs of mild thyroid impairment and on the risk of progression to overt hypothyroidism. FT4, free T4. Salerno, M. et al. (2016) Subclinical hypothyroidism in childhood — current knowledge and open issues Nat. Rev. Endocrinol. doi:10.1038/nrendo.2016.100