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Bennett, William E. Jr*; Heuckeroth, Robert O.†
*Department of Pediatrics, Indiana University School of Medicine
†Department of Pediatrics, Washington University School of Medicine, Indianapolis, IN
To the Editor: We appreciate the comments made by Drs Tornese, Tonini, and Ventura on our article (1). We agree that a minority of patients (31.9%) seen in our clinic for slow growth during the 5-year study time period had thyroid testing ordered in our office. Because the design of our study included a thorough chart review only for the 873 patients on whom thyroid testing was ordered, we are unable to specify a precise reason for the relatively low rate of thyroid screening in that population; however, we suspect that it is a combination of factors, including prior thyroid testing ordered by the primary care physician, so not repeated by us; thyroid disease excluded by history, physical examination, or growth pattern; or slow growth present for a known chronic condition, such as inflammatory bowel disease or short bowel syndrome, and thus hypothyroidism not suspected.
We also certainly agree that children with slow growth of unknown cause with or without constipation should be screened for hypothyroidism. Our data show that 2.5 of the patients we saw for slow growth were given a diagnosis of hypothyroidism, although this is likely to be an underestimate because many may have had laboratory testing performed elsewhere before our visit. Furthermore, we agree with Tornese et al and with the most recent North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition constipation guidelines (2) that any constipated child with symptoms refractory to adequate treatment or with associated slow growth should be screened for celiac disease.
Copyright 2012 by ESPGHAN and NASPGHAN
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