In 2014, treatment guidelines from the American Thyroid Association reflected the
general consensus that levothyroxine (LT4), adjusted to maintain a normal thyrotropin
(TSH) level, is the preferred method for treatment of hypothyroidism. Although this
is generally applicable to children, there are subsets of children for whom the diagnosis
and treatment of hypothyroidism are problematic. These include children with congenital
hypothyroidism (CH), low birth weight (LBW) and very low birth weight (VLBW), Down
syndrome (DS), subclinical hypothyroidism, and obesity. In this Review, we focus on
the progress and remaining pitfalls in diagnosis and treatment of hypothyroidism in
these and other groups.
