American Academy of Pediatrics – Section on Endocrinology

View all recommendations from this society

October 2, 2017

Avoid routinely measuring thyroid function and/or insulin levels in children with obesity.

TSH levels can be slightly elevated in obesity but this is more likely a consequence of obesity and rarely true hypothyroidism [1, 2]. Free T4 levels are usually normal and if so there is no proven benefit to treatment when TSH is minimally elevated. Testing thyroid function in otherwise healthy children should be considered only if stature and/or height velocity is decreased in relation to the stage of puberty [3, 4].

There are significant limitations in the use of insulin levels as a marker of insulin resistance; furthermore, it is not necessary to order this test to establish a weight control management plan [3, 5]. (This item submitted jointly with the AAP Section on Obesity)

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics’ Section on Endocrinology (SOEn) consists of pediatric endocrinologists, pediatricians, and allied health care professionals who are actively involved in some aspect of the study of endocrinological disease in infants, children and adolescents. SOEn strives to inform pediatricians, parents, communities and policy makers on endocrinological disease in children. Thus, the Executive Committee of SOEn was queried to develop a list of on diagnostic and management decisions that have resulted in patient harm either from a misdiagnosis or inappropriate therapy. The list was shared with membership of the Section on Endocrinology for feedback and then finalized by the SOEn Executive Committee. These five clinical issues are the result. Consensus on the items was received from 20 AAP expert groups. The list was critically reviewed and approved by the AAP Executive Committee.

AAP’s disclosure and conflict of interest policy can be found at


Gertig, A.M., E. Niechcial, and B. Skowronska. Thyroid axis alterations in childhood obesity. Pediatr Endocrinol Diabetes Metab, 2012. 18(3): p. 116-9.

Grandone, A., et al., Thyroid function derangement and childhood obesity: an Italian experience. BMC Endocr Disord, 2010. 10: p. 8.

August, G.P., et al., Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab, 2008. 93(12): p. 4576-99.

Reinehr, T., et al., Definable somatic disorders in overweight children and adolescents. J Pediatr, 2007. 150(6): p. 618-22, 622 e1-5.

Levy-Marchal, C., et al., Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab, 2010. 95(12): p. 5189-98.