Introduction

This guideline relates to hypothyroidism in paediatric patients.

• Mild elevation in thyroid stimulating hormone (TSH <10U/l), is commonly seen and in many cases will often improve without treatment

• Children with mildly elevated TSH should have anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin antibodies checked

• Those with positive anti-thyroid antibodies and normal or mildly elevated TSH do not require referral, but should be monitored with surveillance thyroid function tests in 3 months

When to refer

• If TSH >20U/l and/or fT4 below the normal lab reference range;
• TSH between 10 and 20U/l (even if fT4 normal) on two occasions

Note: Children with possible central/pituitary cause for hypothyroidism may not be able to raise their TSH level and so an isolated low fT4 with ‘normal’ TSH in children with a relevant history (e.g. structural brain abnormality / lesion) is sufficient cause for concern.

Referral criteria/required information

• Clinical history/reason for testing
• Copies of reports of abnormal thyroid function tests and autoantibody testing as above
• Current height and weight (including date of assessment)
• Relevant family/personal history of thyroid disease or other autoimmunity

How to refer

RCH Specialist Clinics Referral.pdf

Please complete the above and submit via:

• Fax (03) 9345 5034 or
• Email screferrals@rch.org.au

Urgent referral or clinical query call ED admitting officer, endocrinology fellow or endocrinologist on-call (03) 9345 5522

Suggested pre-referral work-up/management 

• TSH and T4 (and previous thyroid function tests if available)
• Anti-thyroid peroxidase and anti-thyroglobulin antibodies (if done)
• Please note: routine ultrasound of children with hypothyroidism is not required

Acknowledgements

The development of this guideline was coordinated by the Department of Endocrinology. Guideline reviewed in July 2025.