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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma

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Volume 26, Issue 11-12


A levothyroxine dose recommendation for the treatment of children and adolescents with autoimmune thyroiditis induced hypothyroidism

Victoria Ellerbroek
  • Corresponding author
  • Department of Pediatric Endocrinology, Children’s Hospital, Technical University of Munich, Germany
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Katharina Warncke
  • Department of Pediatric Endocrinology, Children’s Hospital, Technical University of Munich, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Julia Köhle
  • Department of Pediatric Endocrinology, Children’s Hospital, Technical University of Munich, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Walter Bonfig
  • Corresponding author
  • Department of Pediatric Endocrinology, Children’s Hospital, Technical University of Munich, Germany
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2013-06-08 | DOI: https://doi.org/10.1515/jpem-2013-0038


Objective: To determine a levothyroxine (T4) dose recommendation for the treatment of autoimmune thyroiditis (AIT)-induced hypothyroidism.

Methods: T4 doses in 75 children and adolescents with newly diagnosed AIT were prospectively collected and compared to T4 doses of patients with congenital hypothyroidism (CH, n=22).

Results: Sixty-four patients with AIT and 22 patients with CH were included in the analysis. The thyroid-stimulating hormone declined significantly from 25.8±50.1 to 2.1±1.5 μIU/mL (AIT group; p<0.01) and from 338.7±380.7 to 1.9±1.6 μIU/mL (CH group; p<0.01). The required T4 dose for patients with AIT was 1.5±0.5 μg/kg per day (≥6 to <10 years: 2.0±0.4 μg T4/kg per day; ≥10 to <12 years: 1.6±0.4 μg T4/kg per day; ≥12 to <14 years: 1.5±0.6 μg T4/kg per day; ≥14 years: 1.4±0.6 μg T4/kg per day). It deviated significantly from the CH patients’ mean T4 dose of 2.8±0.7 μg T4/kg per day, p<0.01. CH patients with athyreosis required an average dose of 3.1±0.5 μg T4/kg per day; patients with ectopia, 2.6±0.7 μg T4/kg per day; and patients with dyshormonogenesis, 2.5±0.6 μg T4/kg per day.

Conclusion: Juvenile patients with AIT require significantly lower T4 doses than patients with CH.

Keywords: autoimmune thyroid disease; Hashimoto’s thyroiditis; pediatric hypothyroidism; thyroxine


  • 1.

    Zois C, Stavrou I, Kalogera C, Svarna E, Dimoliatis I, et al. High prevalence of autoimmune thyroiditis in schoolchildren after elimination of iodine deficiency in northwestern Greece. Thyroid 2003;13:485–89.PubMedCrossrefGoogle Scholar

  • 2.

    Rallison ML, Dobyns BM, Meikle AW, Bishop M, Lyon JL, et al. Natural history of thyroid abnormalities: prevalence, incidence, and regression of thyroid diseases in adolescents and young adults. Am J Med Genet 1991;91:363–70.Google Scholar

  • 3.

    Gaudino R, Garel C, Czernichow P, Léger J. Proportion of various types of thyroid disorders among newborns with congenital hypothyroidism and normally located gland: a regional cohort study. Clin Endocrinol (Oxf) 2005;62:444–8.CrossrefGoogle Scholar

  • 4.

    Skordis N, Toumba M, Savva SC, Erakleous E, Topouzi M, et al. High prevalence of congenital hypothyroidism in the Greek Cypriot population: results of the neonatal screening program 1990–2000. J Pediatr Endocrinol Metab 2005;18:463–71.Google Scholar

  • 5.

    Rivkees SA, Bode HH, Crawford JD. Long-term growth in juvenile acquired hypothyroidism: the failure to achieve normal adult stature. N Engl J Med 1988;318:599–602.Google Scholar

  • 6.

    Rovet JF. Congenital hypothyroidism: long-term outcome. Thyroid 1999;9:741–8.PubMedCrossrefGoogle Scholar

  • 7.

    Arbeitsgemeinschaft Pädiatrische Endokrinologie (APE) als Sektion der Deutschen Gesellschaft für Kinderheilkunde und Jugendmedizin (DGKJ) sowie der Deutschen Gesellschaft für Endokrinologie (DGE) Sektion Pädiatrische Endokrinologie und Diabetologie (2012). Leitlinie Autoimmunthyreoiditis. Available at: http://www.awmf.org/leitlinien/detail/ll/027-040.html.

  • 8.

    Brown RS. The thyroid. In: Brook C, Clayton P, Brown RS, editors. Brook’s clinical pediatric endocrinology, 6th ed. New York: Wiley-Blackwell, 2009:250–81.Google Scholar

  • 9.

    Latrofa F, Pinchera A. Autoimmune hypothyroidism. In: Weetman AP, editor. Autoimmune diseases in endocrinology, 12th ed. New Jersey: Humana Press, 2008:137–76.Google Scholar

  • 10.

    Deutsche Gesellschaft für Endokrinologie, Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V., Arbeitsgemeinschaft Pädiatrische Endokrinologie. Diagnostik, Therapie und Verlaufskontrolle der Primären angeborenen Hypothyreose. Available at:http://www.awmf.org/leitlinien/detail/ll/027-017.html.

  • 11.

    Rose SR, Brown RS, Foley T, Kaplowitz PB, Kaye CI, et al. Update of newborn screening and therapy for congenital hypothyroidism. American Academy of Pediatrics and American Thyroid Association. Pediatrics 2006;117:2290–303.PubMedGoogle Scholar

  • 12.

    Taketomo CK, Hodding JH, Kraus DM, editors. Lexi-Comp’s pediatric dosage handbook with international trade names index: including neonatal dosing, drug administration, and extemporaneous preparations. American Pharmacist Association (APhA). Hudson, Ohio: Lexi-Comp, 2011.Google Scholar

  • 13.

    Fisher DA, Grueters A. Thyroid disorders in childhood and adolescence. In: Sperling M, editor. Pediatric endocrinology, 3rd ed. Philadelphia: Saunders/Elsevier, 2008:227–53.Google Scholar

  • 14.

    Van Vliet G. Hypothyroidism in infants, children and adolescents: Acquired hypothyroidism. In: Braverman LE, Utiger RD, editors. The thyroid: A fundamental and clinical text, 9th ed. Philadelphia: Lippincott Williams and Wilkins, 2005:1041–47.Google Scholar

  • 15.

    Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3–126.Google Scholar

  • 16.

    Roche Diagnostics GmbH. Reference intervals for children and adults: Elecsys thyroid tests. Mannheim, Germany, 2009.Google Scholar

  • 17.

    Mosteller RD. Simplified calculation of body surface area. N Engl J Med 1987;317:1098.Google Scholar

  • 18.

    De Fries L, Bulvik S, Phillip M. Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up. Am J Dis Child 2008;94:33–7.Web of ScienceGoogle Scholar

  • 19.

    Abbassi V, Aldige C. Evaluation of sodium l-thyroxine (T4) requirement in replacement therapy of hypothyroidism. J Pediatr 1977;90:298.PubMedCrossrefGoogle Scholar

  • 20.

    Rezvani IR, DiGeorge AM. Reassessment of the daily dose of oral thyroxine for replacement therapy in hypothyroid children. J Pediatr 1977;90:291.PubMedCrossrefGoogle Scholar

  • 21.

    Gordon MB, Gordon MS. Variations in adequate levothyroxine replacement therapy in patients with different causes of hypothyroidism. Endocr Pract 1999;5:233–8.CrossrefPubMedGoogle Scholar

  • 22.

    Radetti G, Gottardi E, Bona G, Corrias A, Salardi S, et al. The natural history of euthyroid Hashimoto’s thyroiditis in children. J Pediatr 2006;149:827–32.Google Scholar

  • 23.

    Fava A, Oliverio R, Giuliano S, Parlato G, Michniewicz A, et al. Clinical evolution of autoimmune thyroiditis in children and adolescents. Thyroid 2009;19:361–7.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 24.

    Özen S, Berk Ö, Simsek DG, Darcan S. Clinical course of Hashimoto’s thyroiditis and effects of levothyroxine therapy on the clinical course of the disease in children and adolescents. J Clin Res Pediatr Endocrinol 2011;3:192–7.Google Scholar

About the article

Corresponding authors: Victoria Ellerbroek and Walter Bonfig, Department of Pediatrics, Children’s Hospital, Technical University of Munich, Parzivalstr. 16, 80804 München, Germany, Phone: +49 89 3068 2589, Fax: +49 89 3068 3849, E-mail: ;

Received: 2013-01-26

Accepted: 2013-05-14

Published Online: 2013-06-08

Published in Print: 2013-11-01

Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 26, Issue 11-12, Pages 1023–1028, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2013-0038.

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