Severe Acquired Primary Hypothyroidism in Children and its Influence on Growth: A Retrospective Analysis of 43 Cases.
2021
Introduction Severe acquired hypothyroidism in childhood is a rare
condition, mostly caused by autoimmune thyroiditis. Scarce and inconsistent data
based on small patient numbers exist concerning its impact on growth in
height. Methods Patient files at a single centre university hospital over 8 years
were retrospectively reviewed. We identified 43 patients (mean age 10.6 years,
3.3–15.25, 59% prepubertal, 88% females) in a cohort of
children older than 3 years with an initial TSH>30 mIU/l and
reduced T4 or fT4; congenital and drug-induced hypothyroidism were excluded. Results All patients had signs of autoimmune thyroiditis (93%
positive autoantibodies, 95% typical ultrasonography, 63%
goiter). Median TSH was 100 mIU/l [0.3–4 mIU/l]), median
fT4 3.55 pg/ml [8–19 pg/ml], median T4
2.85 µg/dl
[5.3–11 µg/dl]. Presenting symptoms included
goiter (26%), tiredness (23%), weight gain (19%), and
growth retardation (19%). The diagnosis was made incidentally in
26% patients. In 75% growth was retarded (median height standard
deviation score (SDS)-0.55), in 17% height SDS was<-2 at
diagnosis. Midparental height SDS at diagnosis correlated significantly with T4
and fT4 (r=0.77, p=0.0012 and r=0.53, p=0.021
respectively). Catch-up growth under T4 substitution was significantly greater
in prepubertal than in pubertal children (p 0.049). Conclusion This so far largest pediatric cohort with severe acquired
hypothyroidism confirms a serious impact on growth which, however in most cases,
showed a certain catch-up growth after adequate L-thyroxine therapy. The
pubertal state seems to be important for catch-up growth. A significant number
of patients were not diagnosed clinically, although affected by severe
hypothyroidism.
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