Pediatrie thyroid disease usually presents to the primary care physician by contact from newbom screening programs or from referral from parents or school personnel. Recognition of the problem and initial investigation to establish a diagnosis by the primary care physician is essential for optimal patient management. Furthermore, many pediatrie thyroid diseases are appropriately managed by the pediatrician either alone or in consultation with a pediatrie endocrinologist. The laboratory procedures for complete evaluation are generally available at university-affiliated health-care centers and regional hospital facilities - often by courier service to reputable commercial laboratories.
This issue of Pediatrie Annals presents a review of pediatrie thyroid disease from birth through adolescence. Newborn screening for congenital hypothyroidism has evolved for the past two decades to become an essential part of health-care delivery in preventative medicine. The earliest screening program in Europe was developed at the Kinderspital Zurich by Professor Ruth UUg and Dr Toni Torresani. Dr Torresani has continued as a leader in this field and has introduced new methods for hypothyroid screening since originally developing the filter paper TSH procedure in Zürich.
Dr Annette Grüters from the Kinderklinik at the Free University of Berlin has remained at the forefront of the clinical approach to infants with congenital hypothyroidism ever since her presentation as a medical student at the International Symposium on Newborn Screening in Heidelberg in 1979. At that meeting, Dr Grüters reported that iodide overload on the neonatal thyroid caused transient hypothyroidism. Subsequently, she has developed one of the first newborn screening programs in Germany, identified antibody-dependent cell-mediated cytotoxicity (ADCC) as a cause of sporadic congenital hypothyroidism, and now is applying the tools of molecular biology to the study of congenital goiter without iodine deficiency. Both Drs Torresani and Grüters are members of the Congenital Hypothyroidism Working Group for the European Society for Pediatrie Endocrinology.
Since his fellowship training nearly two decades ago, Dr Stephen LaFranchi has contributed to our understanding and management of congenital and acquired pediatrie thyroid diseases. He was a collaborator in the Northwest Regional Newborn Screening Program, one of the earliest in North America and the first to combine T4 and TSH filter paper screening on large newborn populations. His experience, expertise, and interest in acquired pediatrie thyroid disease is evident from his contributions to the literature on these subjects; his frequent presentations at regional, national, and international meetings; and his scholarly discussion of thyroiditis that he has written for this issue.
Dr Wellington Hung has contributed his vast expertise in the assessment of children with thyroid nodules and the management of thyroid carcinoma. He acquired considerable clinical experience at the National Children's Hospital in Washington, DC, while a member of the Department of Child Health and Development at the George Washington University, and more recently at Georgetown University Children's Medical Center and the National Institutes of Health. He is the author of many review articles and chapters in textbooks on these subjects.
I hope that these clinical review articles, including my contribution on neonatal and acquired thyrotoxicosis in children, will be useful in the clinical recognition and management of children with these disorders. The articles also may stimulate some ideas for basic and clinical investigation in pediatrie thyroidology.