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Eliav T, Kuruppu D, Sanchez-Lara PA, Grand K, Schweiger B, Allen-Sharpley M. A Reversible Etiology of Progressive Motor Decline in a Previously Healthy Child. Pediatrics 2024:e2023064093. [PMID: 39091240 DOI: 10.1542/peds.2023-064093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024] Open
Abstract
We describe the clinical presentation and evaluation of a 10-year-old boy who presented to our medical center with years of progressive proximal muscle weakness, muscle atrophy, and weight loss. In addition to a myopathic phenotype, he was found to have tachycardia, tremor, and learning difficulties. Electromyography revealed chronic myopathic changes and laboratory screening was notable for undetectable thyroid stimulating hormone. Follow-up testing revealed elevated thyroid peroxidase antibodies and thyroid stimulating immunoglobulins. Ultrasound examination revealed an enlarged heterogeneous thyroid gland. Four weeks after treatment with atenolol and methimazole, his strength and cognition began to improve. This case highlights the importance of evaluating for potentially reversible toxic-metabolic etiologies in children presenting with any progressive neurologic symptoms.
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Affiliation(s)
- Tal Eliav
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Deandra Kuruppu
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Pedro A Sanchez-Lara
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Katheryn Grand
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Bahareh Schweiger
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Michelle Allen-Sharpley
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
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Lee HS, Rho JG, Kum CD, Lim JS, Hwang JS. Low Bone Mineral Density at Initial Diagnosis in Children and Adolescents with Graves' Disease. J Clin Densitom 2021; 24:275-280. [PMID: 32546346 DOI: 10.1016/j.jocd.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
Previous studies have reported reduced bone mineral density (BMD) in patients with hyperthyroidism. We assessed the association of BMD in children and adolescents with Graves' disease (GD) after correcting for potential confounders affecting BMD such as age, sex, and pubertal status. Forty-four children and adolescents with GD and 172 age- and sex-matched healthy controls were enrolled in this study. We analyzed auxological features, BMD, and levels of thyroid hormone, thyroid-stimulating hormone, and thyroid autoantibodies. We measured BMD by dual-energy X-ray absorptiometry at the time of diagnosis in all patients. The mean age of all patients with GD (9 boys and 32 girls) was 12.1 ± 2.2 years (range, 7.0-16.0). Their initial mean free T4 and thyroid-stimulating hormone levels were 3.51 ± 1.56 ng/dL and 0.04 ± 0.03 IU/L, respectively. The mean BMD Z-scores of the lumbar spine (LS), femoral neck, and total body less head of patients with GD were significantly lower than those of control subjects. Eleven patients (26.8%) had low bone density (LS BMD Z-scores < -2.0). To identify correlations of patient characteristics with BMD Z-scores at each site, alkaline phosphatase had a significant negative correlation with BMD Z-scores at LS and femoral neck, but not total body less head (r = -0.441; p = 0.004 and r = -0.351; p = 0.025, respectively). Children and adolescents with newly diagnosed GD had lower bone mass than their healthy peers. These results suggest that BMD measurement at initial evaluation may be necessary in this population.
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Affiliation(s)
- Hae Sang Lee
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Jung Gi Rho
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Chang Dae Kum
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea.
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Liu C, Zhang Y, Fu T, Liu Y, Wei S, Yang Y, Zhao D, Zhao W, Song M, Tang X, Wu H. Effects of electromagnetic fields on bone loss in hyperthyroidism rat model. Bioelectromagnetics 2016; 38:137-150. [PMID: 27973686 DOI: 10.1002/bem.22022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/22/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Chaoxu Liu
- Department of Orthopaedics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Yingchi Zhang
- Department of Orthopaedics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Tao Fu
- Department of Orthopaedics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Yang Liu
- Department of Orthopaedics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Sheng Wei
- Department of Orthopaedics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Yong Yang
- Department of Orthopaedics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Dongming Zhao
- Department of Orthopaedics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | | | - Mingyu Song
- Department of Gynaecology and Obstetrics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Xiangyu Tang
- Department of Radiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Hua Wu
- Department of Orthopaedics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Pimentel J, Chambers M, Shahid M, Chawla R, Kapadia C. Comorbidities of Thyroid Disease in Children. Adv Pediatr 2016; 63:211-26. [PMID: 27426902 DOI: 10.1016/j.yapd.2016.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Janiel Pimentel
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa Chambers
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Madhia Shahid
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Reeti Chawla
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Chirag Kapadia
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
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Mendonça Monteiro de Barros G, Madeira M, Vieira Neto L, de Paula Paranhos Neto F, Carvalho Mendonça LM, Corrêa Barbosa Lima I, Corbo R, Fleiuss Farias ML. Bone mineral density and bone microarchitecture after long-term suppressive levothyroxine treatment of differentiated thyroid carcinoma in young adult patients. J Bone Miner Metab 2016; 34:417-21. [PMID: 26056020 DOI: 10.1007/s00774-015-0680-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
Bone mineral density (BMD) seems not to be decreased in young patients given long-term suppressive doses of levothyroxine (LT4), but information regarding the bone microstructure in these patients is lacking. The aim of this study was to determine whether supraphysiologic doses of LT4, initiated during childhood or adolescence for treatment of differentiated thyroid carcinoma (DTC), have any detrimental effects on bone microarchitecture as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT). Seventeen patients (27.3 ± 7.1 years old) with DTC with subclinical hyperthyroidism since adolescence and 34 healthy volunteers matched for age, sex, and body mass index were studied by dual-energy X-ray absorptiometry (DXA) to determine the areal BMD at the lumbar spine, hip, and proximal third of the radius. Volumetric BMD and structural parameters of the trabecular and cortical bone were assessed by HR-pQCT of the distal radius and distal tibia. DTC patients were given suppressive doses of LT4 starting at a mean age of 12.6 years, and the mean duration of treatment was 14.2 years. In DTC patients, clinical parameters did not correlate with DXA or HR-pQCT parameters. No differences were found between the patients and controls with respect to BMD and Z scores at any site evaluated by DXA, and no differences were found in the bone microstructure parameters evaluated by HR-pQCT. This cross-sectional study suggests that long-standing suppressive therapy with LT4 during the attainment of peak bone mass may have no significant adverse effects on bone density or microarchitecture.
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Affiliation(s)
| | - Miguel Madeira
- Division of Endocrinology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Leonardo Vieira Neto
- Division of Endocrinology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco de Paula Paranhos Neto
- Division of Endocrinology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura Maria Carvalho Mendonça
- Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Inayá Corrêa Barbosa Lima
- Laboratory of Nuclear Instrumentation-COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rossana Corbo
- Division of Endocrinology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | - Maria Lucia Fleiuss Farias
- Division of Endocrinology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Melis D, Rossi A, Pivonello R, Del Puente A, Pivonello C, Cangemi G, Negri M, Colao A, Andria G, Parenti G. Reduced bone mineral density in glycogen storage disease type III: evidence for a possible connection between metabolic imbalance and bone homeostasis. Bone 2016; 86:79-85. [PMID: 26924264 DOI: 10.1016/j.bone.2016.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/19/2016] [Accepted: 02/22/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Glycogen storage disease type III (GSDIII) is an inborn error of carbohydrate metabolism caused by deficient activity of glycogen debranching enzyme (GDE). It is characterized by liver, cardiac muscle and skeletal muscle involvement. The presence of systemic complications such as growth retardation, ovarian polycystosis, diabetes mellitus and osteopenia/osteoporosis has been reported. The pathogenesis of osteopenia/osteoporosis is still unclear. OBJECTIVES The aim of the current study was to evaluate the bone mineral density (BMD) in GSDIII patients and the role of metabolic and endocrine factors and physical activity on bone status. METHODS Nine GSDIII patients were enrolled (age 2-20years) and compared to eighteen age and sex matched controls. BMD was evaluated by Dual-emission-X-ray absorptiometry (DXA) and Quantitative ultrasound (QUS). Clinical and biochemical parameters of endocrine system function and bone metabolism were analyzed. Serum levels of the metabolic control markers were evaluated. Physical activity was evaluated by administering the International Physical Activity Questionnaire (IPAQ). RESULTS GSDIII patients showed reduced BMD detected at both DXA and QUS, decreased serum levels of IGF-1, free IGF-1, insulin, calcitonin, osteocalcin (OC) and increased serum levels of C-terminal cross-linking telopeptide of type I collagen (CTX). IGF-1 serum levels inversely correlated with AST and ALT serum levels. DXA Z-score inversely correlated with cholesterol and triglycerides serum levels and directly correlated with IGF-1/IGFBP3 molar ratio. No difference in physical activity was observed between GSDIII patients and controls. DISCUSSION Our data confirm the presence of reduced BMD in GSDIII. On the basis of the results, we hypothesized that metabolic imbalance could be the key factor leading to osteopenia, acting through different mechanisms: chronic hyperlipidemia, reduced IGF-1, Insulin and OC serum levels. Thus, the mechanism of osteopenia/osteoporosis in GSDIII is probably multifactorial and we speculate on the factors involved in its pathogenesis.
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Affiliation(s)
- Daniela Melis
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy.
| | - Alessandro Rossi
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy.
| | - Rosario Pivonello
- Department of Medicine and Surgery, Section of Endocrinology, Federico II University, Naples, Italy.
| | - Antonio Del Puente
- Department of Medicine and Surgery, Section of Rheumatology, Federico II University, Naples, Italy.
| | - Claudia Pivonello
- Department of Medicine and Surgery, Section of Endocrinology, Federico II University, Naples, Italy.
| | - Giuliana Cangemi
- Clinical Pathology Laboratory, Istituto Giannina Gaslini, Genoa, Italy.
| | - Mariarosaria Negri
- Department of Medicine and Surgery, Section of Endocrinology, Federico II University, Naples, Italy.
| | - Annamaria Colao
- Department of Medicine and Surgery, Section of Endocrinology, Federico II University, Naples, Italy.
| | - Generoso Andria
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy.
| | - Giancarlo Parenti
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy.
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Redistribution of body composition in patients with Graves' disease after iodine-131 treatment. Eur J Clin Nutr 2014; 69:856-61. [PMID: 25351654 DOI: 10.1038/ejcn.2014.232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 09/06/2014] [Accepted: 09/11/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective of this study was to investigate body composition redistribution at 3 months after radioactive iodine therapy (RAI). METHODS Eighty patients with Graves' disease (GD) for RAI and 18 volunteers were recruited. All patients underwent thyroid status test and dual-energy x-ray absorptiometry at baseline and 3 months after RAI. According to the second thyroid status test, patients were divided into the following groups: A, with aggravated hyperthyroidism; B-1, with improved hyperthyroidism; B-2, with euthyroidism; and B-3, with hypothyroidism. RESULTS Total lean mass (LM) but fat mass (FM) and bone mineral content (BMC) of whole GD patients after RAI recovered to be not different with controls. Compared with baseline, in group A, FM in the left leg increased, and LM in left arm, right arm, trunk and total LM decreased (P<0.05). In B-2, FM in the head increased, and LM in the head, right arm, trunk and total LM increased (P<0.05). In B-3, FM in the right leg and total body fat percentage decreased, but FM in the head, android-to-gynoid fat ratio and body mass index increased (P<0.05); LM of all sites, weight and total mass increased (P<0.05); BMC in lumbar spine and left leg, and total BMC decreased (P<0.05). Body composition of unmentioned sites was retained after RAI in each group (P>0.05). CONCLUSIONS Replenishment of LM gets priority rather than FM and BMC during the first 3 months after RAI, and the increase in LM starts from the upper body; head is the regional site in which FM recovery occurs first.
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