In an effort to reduce health care costs, standardize clinical practices, and eliminate unnecessary testing, routine thyroid function screening among children with alopecia areata (AA) should be restricted to those with a medical history of Down syndrome, a family history of thyroid disease, a personal history of atopy, or those who have clinical findings suggestive of possible thyroid dysfunction, according to the results of a recent study published in JAMA Dermatology

The investigators conducted a single-site retrospective medical chart review in an outpatient pediatric dermatology clinic in a tertiary referral medical center. A total of 298 patients with AA who underwent thyroid function screening were included in the analysis. During the first visit, patient age ranged from 10 months to 19 years (mean, 9.57±4.34 years). Patterns of AA included patchy (68%), ophiasis (13%), totalis (9%), and universalis (10%). Severity, which was based on percentage of hair loss on the scalp, was rated as mild (30.2%), moderate (32.9%), and severe (36.9%). 

When patients’ prior medical history was reviewed, atopy (61%) was the highest concomitant disorder, followed by thyroid disease (17%), Down syndrome (6%), and other autoimmune diseases (3%). Family history was significant for thyroid disease (42.2%), autoimmune disease (24%), AA (19%), and atopy (14%).

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Overall, 20% of patients exhibited abnormalities on thyroid test results. Hypothyroidism was the most frequent finding in this group (49%), with Hashimoto thyroiditis the most common cause (41%). Hyperthyroidism secondary to Grave disease (20%) and subclinical thyroid dysfunction (12%) were among the other abnormalities reported.

Although age at AA diagnosis, disease duration, pattern of AA, and presence of autoimmune diseases were not significantly associated with abnormal thyroid findings, a medical history of Down syndrome, a personal history of atopy, and a family history of thyroid disease were all significantly linked to incidence of thyroid abnormalities (P =.004, P =.009, and P= .001, respectively).

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The investigators concluded that thyroid function screening among patients with AA should be limited to those with a medical history of Down syndrome, a personal history of atopy, a family history of thyroid disease, or clinical findings indicative of possible thyroid dysfunction.


Patel D, Li P, Bauer AJ, Castelo-Soccio L. Screening guidelines for thyroid function in children with alopecia areata [published online September 27, 2017]. JAMA Dermatol. doi: 10.1001/jamadermatol.2017.3694