In pediatric practice it is important to look for hypothyroidism whenever there is some suspicion, especially in infants. As a matter of policy we look for organic causes in all infants presenting with constipation during infancy and we do thyroid profile (T3, T4, and TSH) in them. In our study population there were 11 cases of infants (up to 12 months of age) but none of them were found to have hypothyroidism [1]. Due to the newborn screening program in the West, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) practice guideline [2] has not stressed on screening for hypothyroidism among infants with constipation. However, in India, we must investigate all infants with chronic constipation for hypothyroidism as the neonatal screening program is not in practice. Regarding older children with refractory constipation, yes if a child has other features to suggest hypothyroidism then the child should be investigated for hypothyroidism. None of our cases among non-responders/difficult responders to medical therapy had hypothyroidism.

1. Khanna V, Poddar U, Yachha SK. Etiology and clinical spectrum of constipation in Indian children. Indian Pediatr. 2010;47:1025-30.