Hipotireoidismo subclínico em pediatria: o que o clínico precisa saber?
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Introdução: O hipotireoidismo subclínico em crianças caracteriza-se por elevação do hormônio estimulante de tireoide com tiroxina livre normal. Apesar de muitas vezes transitório, pode evoluir para hipotireoidismo manifesto e trazer repercussões no crescimento, metabolismo e risco cardiovascular. Objetivo: Revisar aspectos clínicos e terapêuticos do hipotireoidismo subclínico pediátrico, com foco na indicação de levotiroxina. Método: Revisões, metanálises, diretrizes e estudos originais das bases PubMed, Scielo e Embase dos últimos 20 anos, voltados para pediatria. Resultados: O nível basal de hormônio estimulante de tireoide é o principal preditor de evolução. Casos leves e idiopáticos tendem à remissão espontânea, sem impacto relevante em crescimento ou cognição. O hipotireoidismo subclínico associado à tireoidite de Hashimoto tem maior risco de progressão. Achados cardiovasculares e ósseos ainda são incertos. O uso de levotiroxina é indicado quando hormônio estimulante de tireoide maior que 10 mUI/L. Nos casos leves (4,5-10 mUI/L), recomenda-se apenas seguimento clínico-laboratorial. Conclusões: Na maioria dos casos, o hipotireoidismo subclínico pediátrico tem curso benigno. O tratamento deve ser individualizado, reservado a situações de risco, privilegiando vigilância nos quadros leves.
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