Paeds Cases · endocrinology-diabetes-and-growth
Acquired hypothyroidism and Hashimoto thyroiditis — OSCE
OSCE counselling and management station for a newly diagnosed adolescent with Hashimoto thyroiditis.
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MRCPCH ClinicalRACP DCE
Prompt
You have 8 minutes with a 13-year-old girl and her parent, seen in clinic after investigations confirmed Hashimoto thyroiditis (TSH 24 mU/L, free T4 low, anti-TPO strongly positive). She has been tired, gaining weight and falling behind at school. Explain the diagnosis, the treatment and the plan, and agree a way forward.
Station brief (candidate)
- Explain Hashimoto thyroiditis in plain language: an autoimmune process in which the body's immune cells have gradually reduced the thyroid's output of hormone, which is why energy, weight, concentration and growth have changed. [1][4]
- Reassure that this is common, not caused by anything the family did, fully treatable, and that symptoms and school performance will recover with treatment. [3]
- Explain the treatment — a small daily tablet of levothyroxine, taken on an empty stomach before breakfast, and why timing and separation from iron, calcium, soy and antacids matter. [2][6]
- Outline the monitoring plan: blood test at six weeks to check the dose is right, then every four to six months, aiming to feel well with a normal thyroid level. [2]
- Address the young person directly: adherence, anchoring the tablet to a daily habit, and (age-appropriately) future pregnancy planning. [2]
- Mention screening for related conditions and the excellent long-term outlook. [3]
References6ShowHide
- [1]Bhattacharyya SS Acquired Hypothyroidism in Children. Indian Journal of Pediatrics, 2023.PMID 37256446
- [2]Rodriguez L, et al. Treatment of hypothyroidism in infants, children and adolescents. Trends in Endocrinology and Metabolism, 2022.PMID 35537910
- [3]Hanley P, Lord K, Bauer AJ Thyroid Disorders in Children and Adolescents: A Review. JAMA Pediatrics, 2016.PMID 27571216
- [4]Diaz A, Lipman Diaz E Hypothyroidism. Pediatrics in Review, 2014.PMID 25086165
- [5]Salerno M, et al. Management of endocrine disease: Subclinical hypothyroidism in children. European Journal of Endocrinology, 2020.PMID 32580145
- [6]Jonklaas J, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid, 2014.PMID 25266247