Choosing Wisely:

Avoid routinely measuring thyroid function and/or insulin levels in children with obesity.

Rationale and Comments: TSH levels can be slightly elevated in obesity but this is more likely a consequence of obesity and rarely true hypothyroidism. Free T4 levels are usually normal and if so there is no proven benefit to treatment when TSH is minimally elevated. Testing thyroid function in otherwise healthy children should be considered only if stature and/or height velocity is decreased in relation to the stage of puberty. There are significant limitations in the use of insulin levels as a marker of insulin resistance; furthermore, it is not necessary to order this test to establish a weight control management plan. (This item submitted jointly with the AAP Section on Obesity)
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Endocrinology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • Endocrinologic
  • References: • Gertig, A.M., E. Niechcial, and B. Skowronska. Thyroid axis alterations in childhood obesity. Pediatr Endocrinol Diabetes Metab, 2012. 18(3): p. 116-9.
    • Grandone, A., et al., Thyroid function derangement and childhood obesity: an Italian experience. BMC Endocr Disord, 2010. 10: p. 8.
    • August, G.P., et al., Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab, 2008. 93(12): p. 4576-99.
    • Reinehr, T., et al., Definable somatic disorders in overweight children and adolescents. J Pediatr, 2007. 150(6): p. 618-22, 622 e1-5.
    • Levy-Marchal, C., et al., Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab, 2010. 95(12): p. 5189-98.

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