TSH Testing in Children with Speech Delay

Rationale for TSH Testing

Subclinical hypothyroidism is associated with poor cognitive development in children, which can manifest as speech and language delays, according to the American College of Physicians, as reported in the Annals of Internal Medicine 1, 2
Thyroid function studies, including thyroxine and thyroid-stimulating hormone, are reasonable to perform as part of the general laboratory evaluation for children with developmental issues, as recommended by the American Academy of Pediatrics 3

When evaluating children with low tone or neuromuscular weakness, thyroid testing should be considered, as recommended by the American Academy of Pediatrics 3
In children with speech and language difficulties, particularly expressive speech delay, and in those with Down syndrome, evaluating for symptoms of hypothyroidism is crucial, as reported in the Annals of Internal Medicine 1, 2

TSH and free T4 should be included in the initial laboratory workup, as recommended by the American Academy of Pediatrics 3
TSH values above 6.5 mU/L are considered elevated, according to the American College of Physicians, as reported in the Annals of Internal Medicine 1, 2
Interpretation of results may be complicated by underlying illness or other factors, as noted in the Annals of Internal Medicine 2

Consider referral to early intervention services while diagnostic evaluations are ongoing, as recommended by the American Academy of Pediatrics 3