Hilary Seeley

All Publications

• Severe Undiagnosed Congenital Hypothyroidism Due to Missed Newborn Screening. JCEM case reports Zhang, M., Golchin, A., Donner, J., Lee, M. Y., Seeley, H., Meister, K. D. 2025; 3 (11): luaf233

  Abstract

  We report the case of a 5-month-old female infant with undiagnosed congenital hypothyroidism (CH), presenting with failure to thrive (FTT), hypotonia, developmental delay, and severe constipation. Born full-term as an elective home birth, she had not undergone newborn screening (NBS). Evaluation revealed a markedly elevated thyroid-stimulating hormone (TSH) level and undetectable free thyroxine (T4). Treatment with levothyroxine was initiated at a conservative dosage of 37.5 mcg (7.5 mcg/kg/day) and titrated over time daily to avoid cardiac adverse effects. Nutritional support via nasogastric tube (NG) tube was also initiated due to poor oral intake. Free T4 normalized after 2 weeks, and TSH reached the normal range after 5 weeks, with the goal of maintaining T4 levels on the higher end of normal and TSH on the lower end of normal. By 4 months after the initial admittance, the patient demonstrated significant improvement in weight, progress in occupational therapy and physical therapy, and developmental milestones. This case highlights the significance of verifying NBS in infants with classic signs of CH, especially those born outside of hospital systems, and underscores the value of multidisciplinary collaboration-including social work-in optimizing patient outcome.

  View details for DOI 10.1210/jcemcr/luaf233

  View details for PubMedID 41064663

  View details for PubMedCentralID PMC12501844

• Incidence of Pediatric Graves' Disease in the United States: An Epidemiological Analysis of 2007-2022 Outpatient Insurance Claims. Thyroid : official journal of the American Thyroid Association Polkampally, S., Halagur, A. S., Green, A., Wei, E., Qian, J., Donner, J., Seeley, H., Meister, K. 2025

  Abstract

  Background: Graves' disease is the leading cause of hyperthyroidism in children and adolescents, with recent studies indicating a rising incidence. Epidemiological data on trends and determinants influencing this rise remain limited. This study aims to assess the trends in incidence of pediatric Graves' disease in the United States and stratify incidence patterns based on patient sex, age, geographic region, urban vs. rural setting, and insurance plan type. Methods: This retrospective cohort study utilized the Merative™ Marketscan® outpatient insurance claims database from 2007 to 2022. Pediatric patients diagnosed with Graves' disease were identified using International Classification of Diseases (ICD)-9 and ICD-10 codes. Annual incidence rates were analyzed over the study period to detect temporal trends. Incidence rates were further stratified by demographic variables including sex, age, geographic region, community setting (urban vs. rural), and insurance plan. Statistical methods included chi-square, ANOVA, and linear regression models to identify significant trends and differences across subgroups. Results: 3377 total new diagnoses of pediatric Graves' disease were identified during the 16-year study period. The average annual incidence rate was 3.33 per 100,000 (SD = 0.33), with an annual increase of 0.042 per 100,000 (p = 0.39). Marked differences in average annual incidence rates were observed across sex and age group; female patients exhibited greater average annual incidence rate (5.04 per 100,000) compared with male patients (1.67 per 100,000). Adolescents, patients 13-17 years of age, had the highest average annual incidence rate (5.72 per 100,000) compared with other age groups. On multivariable regression analysis, female patients had a significant increase in annual incidence by 1.69 cases per 100,000 compared with male patients [CI: 0.82-2.56]. Adolescents also saw a significant increase in adjusted annual incidence by 4.92 cases per 100,000 compared with the other age groups [CI: 3.80-6.04]. No significant change in annual incidence rate was observed across insurance plan, geographic region, or rural status. Conclusions: This study quantifies and delineates trends in pediatric Graves' disease incidence in the United States. The greatest average incidence rate was observed among female and adolescent patients. This study underscores the importance of monitoring Graves' disease trends to facilitate early disease detection and management. Further research is needed to elucidate the genetic and environmental factors underlying these epidemiological trends.

  View details for DOI 10.1177/10507256251382559

  View details for PubMedID 40982291

• Composition and Priorities of Multidisciplinary Pediatric Thyroid Programs: A Consensus Statement. Thyroid : official journal of the American Thyroid Association Kothari, R., Donner, J. R., Balakrishnan, K., Hartman, G., Alazraki, A., Antal, Z., Bauer, A., Chelius, D., Cherella, C., Dahl, J. P., Dimachkieh, A., Fox, L. A., Helmig, S., Jiang, W., Kazahaya, K., Laetsch, T. W., Lodish, M., Mahajan, P., Parsons, L., Prickett, K., Quintanilla-Dieck, L., Rastatter, J., Rothstein, D. H., Simons, J., Sheyn, A., Wagner, A., Waguespack, S. G., Wasserman, J. D., Wassner, A. J., Seeley, H., Meister, K. D. 2025

  Abstract

  Background: The incidence of pediatric thyroid cancer has been increasing, and care varies due to socioeconomic disparities or differing practice patterns. Clinical guidelines call for care in multidisciplinary teams to minimize variance and provide protocols. Based on expert opinion, we hope to describe the form and function of such multidisciplinary teams for pediatric thyroid programs. Methods: A modified Delphi method to reach consensus statements over two rounds. Twenty-one experts with varying backgrounds responded to each statement on a 9-point Likert scale. Upon completion of the survey, the panel reviewed and shared the results and comments from participants and modified the statements accordingly. This process was repeated such that statements reached consensus, were deemed no consensus, or had no change in the mean. Results: There was an 88% and 83% completion rate for Rounds 1 and 2, respectively. A consensus was observed that there is a distinct definable model of care for pediatric thyroid patients. No consensus was reached for the age range of patients, but programs should care for children with medullary thyroid cancer, differentiated thyroid cancer, and patients with genetic predisposition syndromes. A comprehensive team includes, but is not limited to, a thyroid surgeon, a pediatric endocrinologist, a high-volume fine-needle aspiration (FNA) proceduralist, an oncologist, a nuclear medicine physician, a pediatric pathologist, a pediatric radiologist, and a nurse coordinator. Necessary support services involve care coordination, access to a multidisciplinary tumor board, ability to perform ultrasound-guided FNA, and access to molecular testing. The panel emphasized cross-institutional collaborative research prioritizing guidelines development, disease-specific outcomes, treatment toxicity, and the molecular landscape of thyroid cancer. Conclusions: These consensus statements can be beneficial in improving multidisciplinary care, by describing which elements of pediatric thyroid programs should be consistent across institutions. Overall, the panel agreed that pediatric thyroid centers should provide integrated care with defined team members, services, resources, and research priorities. This model has the potential to standardize various aspects of clinical care and enhance our ability to study patient outcomes, improve health care delivery, and increase scholarly collaboration.

  View details for DOI 10.1089/thy.2024.0496

  View details for PubMedID 39950999

• Recurrent Small Variants in NESP55/NESPAS Associated with Broad GNAS Methylation Defects and Pseudohypoparathyroidism Type 1b. JCI insight Li, D., Jan de Beur, S., Hou, C., Ruzhnikov, M. R., Seeley, H., Cutting, G. R., Sheridan, M. B., Levine, M. A. 2024

  Abstract

  Pseudohypoparathyroidism type 1B (PHP1B) is associated with epigenetic changes on the maternal allele of the imprinted GNAS gene that inhibit expression of the alpha subunit of Gs (Gsalpha), thereby leading to parathyroid hormone resistance in renal proximal tubule cells where expression of Gs from the paternal GNAS allele is normally silent. Although all patients with PHP1B show loss of methylation for the exon A/B differentially methylated region (DMR), some patients with autosomal dominant PHP1B (AD-PHP1B) and most patients with sporadic PHP1B have additional methylation defects that affect the DMRs corresponding to exons XL, AS1, and NESP. Because the genetic defect is unknown in most of these patients, we sought to identify the underlying genetic basis for AD-PHP1B in two multigenerational families with broad GNAS methylation defects and negative clinical exomes. Genome sequencing identified small GNAS variants in each family that were also present in unrelated PHP1B subjects in a replication cohort. Maternal transmission of one GNAS microdeletion showed reduced penetrance in some unaffected patients. Expression of AS transcripts was increased, and NESP was decreased, in cells from affected patients. These results suggest that the small deletion activate AS transcription leading to methylation of the NESP DMR with consequent inhibition of NESP transcription, and thereby provide a potential mechanism for PHP1B.

  View details for DOI 10.1172/jci.insight.185874

  View details for PubMedID 39541438

• Easier for the next 'Gen': Early success of one dose rTSH injection prior to I-131 radioligand therapy in children and teens Seekins, J., Seeley, H., Meister, K., Nadel, H. SOC NUCLEAR MEDICINE INC. 2024

  View details for Web of Science ID 001289165602126

• The safety and efficacy of radiofrequency ablation in benign pediatric thyroid disease in the US: An initial case series. Laryngoscope investigative otolaryngology Kim, G. S., Seeley, H., Noel, J., Ahmad, I., Meister, K. 2024; 9 (1): e1198

  Abstract

  To evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules or functional lingual thyroid gland in a pediatric population.Four pediatric patients (four female; mean age 13.50 ± 4.04, range 8-17 years) with either benign thyroid nodules or mildly obstructive lingual thyroid glands were treated with RFA from 2020 to 2021 were evaluated. The inclusion criteria for RFA therapy were (i) age < 18 years; (ii) benign cytopathological results on ultrasound guided fine needle aspiration; (iii) pressure or pain symptoms caused by the thyroid nodules; (iv) dysphagia or obstruction caused by the lingual thyroid tissue; (v) follow up for >6 months with otolaryngology or endocrinology.Two patients had benign non-functioning thyroid nodules and two had mildly obstructive functioning lingual thyroid glands. Mean follow up was 10.75 ± 4.79 months. Each patient underwent one RFA session with no complications. For the patients with thyroid nodules, there was >74% reduction in nodule size at last follow up with improvement in neck swelling and pain. For the patients with lingual thyroid glands, both did not have any other functional thyroid gland identified. Both had visible decrease in size of the gland as visualized transorally with improvement in dysphagia and obstructive symptoms when lying flat.RFA is a safe and effective option for managing benign thyroid nodules and lingual thyroid glands in a pediatric patient population.4.

  View details for DOI 10.1002/lio2.1198

  View details for PubMedID 38362180

  View details for PubMedCentralID PMC10866600

• Use of Neoadjuvant Vandetanib in Aggressive Pediatric Medullary Thyroid Carcinoma. JCO precision oncology Kothari, R., Kreimer, S., Nadel, H., Seeley, H., Hartman, G., Meister, K. D. 2024; 8: e2300257

  Abstract

  Novel use of vandetanib in a child with aggressive MTC with prolonged response to treatment.

  View details for DOI 10.1200/PO.23.00257

  View details for PubMedID 38207224

• Parathyroid Autofluorescence in Pediatric Thyroid Surgery: Experience With False Positive and False Negative Results. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Su-Velez, B. M., Hartman, G. E., Seeley, H., Orloff, L. A., Noel, J. E., Meister, K. D. 2023

  Abstract

  Devices for near-infrared light stimulation of autofluorescence (NIRAF) allow for intraoperative identification of parathyroid glands with high sensitivity in adults. However, their performance in the pediatric population is unknown. In this case series with chart review at a tertiary academic children's hospital, we investigated pediatric patients undergoing thyroid surgery and concurrent use of a probe-based NIRAF device. Thirteen patients (ages 6-18 years) underwent thyroid and/or neck dissection procedures, and 2 patients had revision procedures for a total of 15 cases with the NIRAF device. Eight cases had NIRAF values that matched surgeon opinion of parathyroid tissue or histology when available. Six cases had false positive NIRAF readings (40.0%) and 1 case had false negative readings (6.7%). Compared with surgeon opinion or histology, the NIRAF device confirmed 26 of 34 parathyroid gland candidates (76.5%). These devices need further investigation in pediatric patients, whose tissues may have different autofluorescence characteristics.

  View details for DOI 10.1002/ohn.272

  View details for PubMedID 36939554

• Parathyroid Autofluorescence in Pediatric Thyroid Surgery: Experience With False Positive and False Negative Results OTOLARYNGOLOGY-HEAD AND NECK SURGERY Su-Velez, B. M., Hartman, G. E., Seeley, H., Orloff, L. A., Noel, J. E., Meister, K. D. 2023

  View details for DOI 10.1002/ohn.272

  View details for Web of Science ID 000921354900001

• Sociodemographic Disparities in the Diagnostic Management of Pediatric Thyroid Nodules. JAMA otolaryngology-- head & neck surgery Moon, P. K., Qian, Z. J., Noel, J. E., Orloff, L. A., Seeley, H., Hartman, G. E., Josephs, S., Meister, K. D. 2022

  Abstract

  Importance: Thyroid cancer is the most common pediatric endocrine malignant neoplasm. Disparities in the workup of thyroid nodules may be significantly associated with thyroid cancer outcomes.Objective: To determine the association of sociodemographic factors with the odds of receiving a biopsy, timeliness of the procedure, and risk of nodule malignancy.Design, Setting, and Participants: This was a retrospective cross-sectional study using insurance claims data from the Optum Clinformatics Data Mart database. The study cohort comprised pediatric patients diagnosed with single thyroid nodules between 2003 and 2020. Data analysis was performed from January 1, 2003, to June 30, 2020.Main Outcomes and Measures: Multivariable logistic regression models were used to identify demographic variables associated with biopsy and nodule malignant neoplasm. A multivariable linear regression model was used to assess the time between thyroid nodule diagnosis and biopsy.Results: Of 11 643 children (median [IQR] age at diagnosis or procedure, 15 [12-17] years; 8549 [73.2%] were female and 3126 [26.8%] were male) diagnosed with single thyroid nodules, 2117 (18.2%) received a biopsy. Among the patients who received a biopsy, 304 (14.4%) were found to have a malignant nodule. Greater parental education was associated with a shorter diagnosis-to-biopsy interval (mean difference, -7.24 days; 95% CI, -13.75 to -0.73). Older age at nodule diagnosis (odds ratio [OR], 1.11; 95% CI, 1.09-1.13) and female gender (OR, 1.25; 95% CI, 1.11-1.40) were associated with increased odds of receiving a biopsy, while Black/African American (OR, 0.80; 95% CI, 0.65-0.99) and Hispanic (OR, 0.84; 95% CI, 0.72-0.99) patients had lower odds of receiving a biopsy compared with White patients. Finally, female gender (OR, 1.08; 95% CI, 0.80-1.47) was not associated with lower odds of nodule malignant neoplasm.Conclusions and Relevance: Findings of this cross-sectional study highlight disparities in the diagnostic management of pediatric thyroid nodules. These results call for future work to ensure equitable access to thyroid care for all children.

  View details for DOI 10.1001/jamaoto.2022.3167

  View details for PubMedID 36227590

• Type 1 Diabetes is Associated with Bone and Muscle Deficiencies in Children and Adolescents Long, J., Seeley, H., Whalen, J., Strickland, A., Kent, K., Aye, T., Bachrach, L., Leonard, M. WILEY. 2020: 76

  View details for Web of Science ID 000593119300207

• Type 1 Diabetes Mellitus and the Presence of Other Autoimmune Disease JOURNAL OF PEDIATRICS Seeley, H. H., Maahs, D. M. 2020; 223: 19-+

  View details for Web of Science ID 000551283500006

• LEG LEAN MASS IS CORRELATED WITH BONE MINERAL DENSITY IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES Seeley, H., Long, J., Bachrach, L., Wilson, D. M., Leonard, M. KARGER. 2017: 418

  View details for Web of Science ID 000412595404225