IGF1 and hypothyroidism: Areas where further research is needed include the etiology and management of hyperphagia, risks and management of high IGF-1 levels associated with relatively low hGH doses, optimal surveillance of sleep disordered breathing, further elucidation of the effect of hGH on cognition, the impact of hGH therapy in adulthood, frequency and management of adrenal insufficiency, and the frequency and natural history of hypothyroidism.