1
|
Besci Ö, Akçura YD, Acinikli KY, Kağızmanlı GA, Demir K, Böber E, Kır M, Abacı A. Aromatase Inhibitors May Increase the Risk of Cardiometabolic Complications in Adolescent Boys. Pediatr Cardiol 2024; 45:228-239. [PMID: 37544952 DOI: 10.1007/s00246-023-03260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Aromatase inhibitors (AIs) are increasingly used in children and adolescents to augment adult height. The aim of this study was to investigate the effects AIs have on cardiac morphology, functions and their relation to several metabolic parameters in adolescent boys. METHODS Three groups matched for sex (boys, n = 67), age (median age 13.5 years), weight, height, body mass index, and puberty stages were enrolled: (i) Group 1: 23 patients using AIs (only AI (n = 6) or in combination with growth hormone (GH) (n = 17)) for at least 6 months; (ii) Group 2: 22 patients using only GH, and (iii) Group 3: 22 healthy boys. Two-dimensional, M-mode conventional Doppler and tissue Doppler examinations of the left ventricle (LV) were performed. Bioelectrical bioimpedance analyses was conducted and follicle-stimulating hormone, luteinizing hormone, total testosterone, lipid, and hemogram parameters were obtained. RESULTS Patients in Group 1 had significantly higher serum total testosterone (p < 0.001) and hemoglobin (p < 0.001) levels, fat free mass (p = 0.005), LV mass (LVM) (p = 0.002), as well as increased LV posterior wall diameter (LVPWD) (p = 0.002), interventricular septum diameter (IVSD) (p = 0.019), and myocardial systolic wave velocity (Sm) (p = 0.020) compared to the two other control groups. No significant differences were observed in terms of diastolic and systolic functions and lipid profiles (p > 0.05). There were positive correlations between total testosterone, hemoglobin levels, LVM, LVPWD and IVSD (p < 0.05). CONCLUSION Increased LVM, LVPWD, IVSD and Sm of patients receiving AI therapy in comparison to the control groups, and the significant correlations of these parameters with total testosterone and hemoglobin levels were determined as potential side effects of AIs. These findings emphasize the need of routine cardiac follow-up in patients using AIs.
Collapse
Affiliation(s)
- Özge Besci
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Yağmur Damla Akçura
- Division of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Kübra Yüksek Acinikli
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Gözde Akın Kağızmanlı
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Korcan Demir
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Ece Böber
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey
| | - Mustafa Kır
- Division of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ayhan Abacı
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Inciraltı-Balcova, İzmir, 35340, Turkey.
| |
Collapse
|
2
|
Metwalley KA, Farghaly HS. Subclinical hypothyroidism in children: updates for pediatricians. Ann Pediatr Endocrinol Metab 2021; 26:80-85. [PMID: 34218629 PMCID: PMC8255859 DOI: 10.6065/apem.2040242.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/12/2021] [Indexed: 01/02/2023] Open
Abstract
Subclinical hypothyroidism (SH) is defined as serum thyroid-stimulating hormone (TSH) above the upper limit of the reference range in the presence of normal free T4 concentrations. Depending on the degree of TSH elevation, SH could be defined as mild (TSH, 4.5-10 mIU/L) or severe (TSH>10 mIU/L). While there is a general consensus to treat children with serum TSH levels above 10 mU/L, the management of the mild form is uncertain and should be individualized. In this mini-review, we present a brief review of SH in children based on extensive literature review and long-standing clinical experience. This review provides the prevalence, causes, clinical presentation, consequences, investigation, and up-to-date therapeutic approach of SH in children. Generally, the purpose of the review is to provide pediatricians with an update of this common and continuously evolving condition.
Collapse
Affiliation(s)
- Kotb Abbass Metwalley
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt,Address for correspondence: Kotb Abbass Metwalley Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, 71111 Assiut, Egypt
| | - Hekma Saad Farghaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| |
Collapse
|
3
|
Akın A, Unal E, Yildirim R, Ture M, Balik H, Haspolat YK. Left and right ventricular functions may be impaired in children diagnosed with subclinical hypothyroidism. Sci Rep 2020; 10:19711. [PMID: 33184320 PMCID: PMC7661521 DOI: 10.1038/s41598-020-76327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
Subclinical hypothyroidism (SH) may influence both ventricular functions. The aim of this study was to evaluation the findings of Tissue Doppler Imaging (TDI) and other echocardiography modalities in children with SH. We compared left ventricular mass index (LVMI) and TDI parameters of patients with SH and children with euthyroidism. Subclinical hypothyroidism was diagnosed when thyroid stimulating hormone level was higher than the reference value of the laboratory (> 4.2 mIU/L) and free thyroxine level was in normal range. The study included a group of 35 patients with SH and a control group of 38 children with euthyroidism (mean age was 7.6 ± 3.5 years and 9.0 ± 2.4 years, respectively). LVMI was significantly higher in the patient group (p = 0.005). TDI parameters including mitral septal ejection time was lower (p = 0.003) and mitral septal myocardial performance index was higher (p = 0.009) in the patient group. Right ventricular TDI revealed that tricuspid lateral E/Ea and tricuspid septal E/Ea were higher (p = 0.015 and p = 0.024, respectively) and tricuspid septal Ea/Aa and ejection time were lower (p = 0.018 and p = 0.017, respectively) in the patient group. SH may lead to increase LVMI. Left ventricular systolic and diastolic TDI parameters (lower mitral septal ejection time, higher mitral septal myocardial performance index) as well as right ventricular systolic (lower tricuspid septal ejection time) and diastolic (higher tricuspid septal and lateral E/Ea, lower tricuspid septal Ea/Ea) functions may be also impaired in children with subclinical hypothyroidism. TDI is a useful method used for the assessment of the effect of SH on cardiac functions.
Collapse
Affiliation(s)
- Alper Akın
- Department of Pediatric Cardiology, Dicle University Faculty of Medicine, Sur, Diyarbakır, Turkey.
| | - Edip Unal
- Department of Pediatric Endocrinology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Ruken Yildirim
- Department of Pediatric Endocrinology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mehmet Ture
- Department of Pediatric Cardiology, Dicle University Faculty of Medicine, Sur, Diyarbakır, Turkey
| | - Hasan Balik
- Department of Pediatric Cardiology, Dicle University Faculty of Medicine, Sur, Diyarbakır, Turkey
| | - Yusuf Kenan Haspolat
- Department of Pediatric Endocrinology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| |
Collapse
|
4
|
Kocaaslan Atli S, Olgaç Dündar N, Bayazit O, Evirgen Esin N, Erdoğan U, Çatli G, Kahya MC, Dündar BN. Auditory event-related potentials demonstrate early cognitive impairment in children with subclinical hypothyroidism. J Pediatr Endocrinol Metab 2019; 32:689-697. [PMID: 31194683 DOI: 10.1515/jpem-2018-0463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/15/2019] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to examine the cognitive functions of children with subclinical hypothyroidism (SH) and healthy children with the use of auditory event-related potentials (AERPs) and neuropsychological tests. Methods Twenty children aged between 8 and 17 years, diagnosed with SH, and 20 age-matched healthy controls were included in this study. A classical auditory oddball paradigm was applied during the electroencephalography (EEG) recordings, and event-related potentials (ERPs) were evaluated between the 0.5- and 20-Hz frequency intervals. P1, N1, P2, N2 and P3 amplitudes and latencies were measured in Fz, FCz, Cz, CPz, Pz and Oz electrodes. Additionally, a number of neuropsychological tests evaluating the reaction time and various cognitive functions were carried out. Results In children with SH, P3 amplitudes in FCz, Cz and CPz electrodes were significantly lower than those in controls (p < 0.05). In addition to this, the P1N1 and N1P2 peak-to-peak amplitude values were also found to be smaller for children with SH than controls (p < 0.05). With regard to the neuropsychological tests, no significant difference was observed between the SH and control groups on any of the cognitive test parameters, reaction time or correct response rates. Conclusions In the present study, while children with SH did not differ from controls with respect to their cognitive functions evaluated via neuropsychological tests, cognitive differences were detected via electrophysiological investigations. This result implies that implicit changes in cognition which are not yet overtly reflected on neuropsychological tests may be detected at an early stage in children with SH.
Collapse
Affiliation(s)
- Sibel Kocaaslan Atli
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Biophysics, İzmir, Turkey
| | - Nihal Olgaç Dündar
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Pediatric Neurology, Izmir, Turkey
| | - Onur Bayazit
- Aydın University, Faculty of Medicine, Biophysics Department, Istanbul, Turkey
| | | | - Uğraş Erdoğan
- Izmir Institute of Technology, Faculty of Engineering, Department of Electrical - Electronics, Izmir, Turkey
| | - Gönül Çatli
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Endocrinology, Izmir, Turkey
| | - Mehmet Cemal Kahya
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Biophysics, İzmir, Turkey
| | - Bumin Nuri Dündar
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Endocrinology, Izmir, Turkey
| |
Collapse
|
5
|
Kuwata S, Takanashi M, Hashimoto M, Iwamoto Y, Ishido H, Masutani S, Saiki H, Sugamoto K, Senzaki H. Thyroid Function in Patients With a Fontan Circulation. Am J Cardiol 2019; 123:979-983. [PMID: 30617007 DOI: 10.1016/j.amjcard.2018.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
In this study, we tested our hypothesis that thyroid function is impaired and contributes to perturbed hemodynamics in patients after Fontan operation. Cardiac catheterization and blood tests for thyroid function were performed in 37 patients who underwent a Fontan operation. Among them, 12 patients (33%) had subclinical thyroid dysfunction with an elevated thyroid-stimulating hormone level despite normal thyroxine levels. Thyroid-stimulating hormone levels were significantly correlated with central venous pressure (p <0.01, R2 = 0.3), and patients with subclinical hypothyroidism showed significantly elevated γ-glutamyltransferase level, an indicator of liver congestion, compared with the other patients (125.6 ± 12.2 vs 67.6 ± 4.6 IU/L, p <0.01). In addition, the levels of free triiodothyronine, an effective thyroid hormone, were significantly lower in patients with subclinical hypothyroidism than in those with normal thyroid function (3.1 ± 0.1 vs 3.5 ± 0.1 pg/dl, p <0.01). The free triiodothyronine level was significantly and negatively correlated with the relaxation time constant (p = 0.03) and brain natriuretic hormone (p <0.01) level and positively correlated with the cardiac index (p = 0.04). In conclusion, venous congestion in Fontan patients may cause thyroid dysfunction, which can be responsible for decreased ventricular function and cardiac output in Fontan patients. Thus, thyroid function should be routinely monitored after Fontan surgery.
Collapse
|
6
|
Vukovic R, Zeljkovic A, Bufan B, Spasojevic-Kalimanovska V, Milenkovic T, Vekic J. Hashimoto Thyroiditis and Dyslipidemia in Childhood: A Review. Front Endocrinol (Lausanne) 2019; 10:868. [PMID: 31920978 PMCID: PMC6914680 DOI: 10.3389/fendo.2019.00868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022] Open
Abstract
Hashimoto autoimmune thyroiditis (AIT) is the most common cause of acquired hypothyroidism in the pediatric population. Development of AIT is mediated mainly by cellular immune response directed toward thyroid autoantigens, leading to inflammation and impaired function of thyroid gland. Both thyroid dysfunction and inflammation affect the metabolism of plasma lipoproteins. The alterations in lipid profile worsen with the advancement of hypothyroidism, ranging from discrete changes in euthyroid AIT patients, to atherogenic dyslipidemia in the overt hypothyroidism. In this review, characteristics of dyslipidemia in pediatric AIT patients, and the consequences in respect to the risk for cardiovascular disease (CVD) development are discussed. Additionally, benefit of L-thyroxine treatment on serum lipid profile in pediatric AIT patients is addressed. Finally, potential usefulness of novel lipid biomarkers, such as proprotein convertase subtilisin/kexin type 9 (PCSK9), non-cholesterol sterols, low-density lipoprotein particle size and number, and high-density lipoprotein structure and functionality in AIT patients is also covered. Further longitudinal studies are needed in order to elucidate the long-term cardiovascular outcomes of dyslipidemia in pediatric patients with Hashimoto AIT.
Collapse
Affiliation(s)
- Rade Vukovic
- Department of Pediatric Endocrinology, Mother and Child Healthcare Institute of Serbia “Dr Vukan Cupic”, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
- *Correspondence: Rade Vukovic
| | - Aleksandra Zeljkovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Biljana Bufan
- Department of Microbiology and Immunology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | - Tatjana Milenkovic
- Department of Pediatric Endocrinology, Mother and Child Healthcare Institute of Serbia “Dr Vukan Cupic”, Belgrade, Serbia
| | - Jelena Vekic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
7
|
Ergin Z, Savaş-Erdeve Ş, Kurnaz E, Çetinkaya S, Aycan Z. Follow-up in children with non-obese and non-autoimmune subclinical hypothyroidism. J Pediatr Endocrinol Metab 2018; 31:1133-1138. [PMID: 30252648 DOI: 10.1515/jpem-2018-0095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/13/2018] [Indexed: 11/15/2022]
Abstract
Background The aim of our study was to evaluate clinical, laboratory and imaging findings and to have an idea about the clinical course of subclinical hypothyroidism in children. Methods Our study included 25 patients who were diagnosed with non-autoimmune subclinical hypothyroidism without goitre, between the ages of 3 and 18 and with body mass index (BMI) below the 85th percentile. Results The mean thyroid-stimulating hormone (TSH) level was 6.92±0.92 μIU/mL at diagnosis, 4.77±1.57 μIU/mL in the third month and 4.51±1.79 μIU/mL in the first year of follow-up. About 73.7% of subclinical hypothyroidism was recovered. There was no statistically significant difference between heart rate, diastolic blood pressure, lipid profile, fasting blood glucose (FBG), fasting insulin level, homeostatic model assessment of insulin resistance (HOMA-IR), hemoglobin, white blood cell, platelet, C-reactive protein (CRP) levels and thyroid volume at diagnosis and in the first year of follow-up. In the first year of follow-up, systolic blood pressure and high-sensitivity CRP value were significantly higher than at diagnosis. However, it was observed that these values were similar in the present group with subclinical hypothyroidism. Conclusions We concluded that there was no progression to overt hypothyroidism during 1-year follow-up and that subclinical hypothyroidism had no effect on height standard deviation score (SDS), BMI SDS, blood pressure, glucose and lipid metabolism during follow-up without treatment.
Collapse
Affiliation(s)
- Zeynep Ergin
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatrics, Ankara, Turkey
| | - Şenay Savaş-Erdeve
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Erdal Kurnaz
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Semra Çetinkaya
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Zehra Aycan
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
| |
Collapse
|
8
|
Vigone MC, Capalbo D, Weber G, Salerno M. Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated? J Endocr Soc 2018; 2:1024-1039. [PMID: 30187015 PMCID: PMC6117400 DOI: 10.1210/js.2017-00471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/20/2018] [Indexed: 12/12/2022] Open
Abstract
Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.
Collapse
Affiliation(s)
| | - Donatella Capalbo
- Department of Pediatrics, University Hospital Federico II, Naples, Italy
| | - Giovanna Weber
- Department of Pediatrics, Vita-Salute San Raffaele University, Milano, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences-Pediatric Section, University of Naples Federico II, Naples, Italy
| |
Collapse
|
9
|
Salerno M, Capalbo D, Cerbone M, De Luca F. Subclinical hypothyroidism in childhood - current knowledge and open issues. Nat Rev Endocrinol 2016; 12:734-746. [PMID: 27364598 DOI: 10.1038/nrendo.2016.100] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Subclinical hypothyroidism is defined as serum levels of TSH above the upper limit of the reference range, in the presence of normal concentrations of total T4 or free T4. This biochemical profile might be an indication of mild hypothyroidism, with a potential increased risk of metabolic abnormalities and cardiovascular disease recorded among adults. Whether subclinical hypothyroidism results in adverse health outcomes among children is a matter of debate and so management of this condition remains challenging. Mild forms of untreated subclinical hypothyroidism do not seem to be associated with impairments in growth, bone health or neurocognitive outcome. However, ongoing scientific investigations have highlighted the presence of subtle proatherogenic abnormalities among children with modest elevations in their TSH levels. Although current findings are insufficient to recommend levothyroxine treatment for all children with mild asymptomatic forms of subclinical hypothyroidism, they highlight the potential need for assessment of cardiovascular risk among children with this condition. Increased understanding of the early metabolic risk factors associated with subclinical hypothyroidism in childhood will help to improve the management of affected individuals.
Collapse
Affiliation(s)
- Mariacarolina Salerno
- Department of Translational Medical Sciences - Pediatric Section, University of Naples Federico II, Naples, 80131, Italy
| | - Donatella Capalbo
- Department of Pediatrics, University Hospital Federico II, Naples, 80131, Italy
| | - Manuela Cerbone
- Department of Translational Medical Sciences - Pediatric Section, University of Naples Federico II, Naples, 80131, Italy
| | - Filippo De Luca
- Department of Pediatric, Gynecology, Microbiological and Biochemical Sciences, University of Messina, Messina, 98125, Italy
| |
Collapse
|
10
|
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.
| |
Collapse
|
11
|
Cerbone M, Capalbo D, Wasniewska M, Alfano S, Mattace Raso G, Oliviero U, Cittadini A, De Luca F, Salerno M. Effects of L-thyroxine treatment on early markers of atherosclerotic disease in children with subclinical hypothyroidism. Eur J Endocrinol 2016; 175:11-9. [PMID: 27068687 DOI: 10.1530/eje-15-0833] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 04/04/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the effect of levothyroxine (L-T4) treatment on early markers of atherosclerotic disease in children with mild idiopathic subclinical hypothyroidism (SH). DESIGN Two-year, open, case-control prospective study. METHODS A total of 39 children, aged 9.18±3.56 years, with SH and 39 healthy controls were enrolled in the study. Waist-to-height ratio (WHtR), blood pressure, triglycerides, total cholesterol (total-C), HDL-C, LDL-C, non-HDL-C, triglycerides/HDL-C, atherogenic index (AI), homocysteine (Hcy), asymmetric dimethylarginine (ADMA), flow-mediated dilation (FMD) and intima-media thickness (IMT) were evaluated at baseline and after 2 years of L-T4 treatment in SH children and after 2 years of follow-up in controls. RESULTS At study entry WHtR was higher in SH subjects compared with controls (0.56±0.08 vs 0.49±0.07, P=0.04) and significantly decreased after 2 years of treatment (0.50±0.06, P<0.0001). Mean HDL-C levels (50.47±11.43 vs 61.06±13.83mg/dL, P=0.002) were lower, while triglycerides/HDL-C (1.63±1.07 vs 1.19±0.69, P=0.05), AI (3.32±0.90 vs 2.78±0.68, P=0.005), and Hcy (9.35±2.61 vs 7.71±1.94μmol/L, P=0.01) were higher in SH subjects compared with controls and improved after 2 years of treatment (HDL-C 56.26±13.76mg/dL, P<0.0001; triglycerides/HDL-C 1.23±0.78, P=0.006; AI 2.82±0.68, P<0.0001; and Hcy 8.25±2.09μmol/L, P=0.06). ADMA concentrations at baseline were higher in SH subjects compared with controls (0.77±0.21 vs 0.60±0.16μmol/L, P=0.001) and decreased after therapy (0.58±0.13μmol/L, P<0.0001). FMD, IMT and other metabolic parameters were not different among SH subjects and controls at baseline and after 2 years. CONCLUSIONS Children with SH may have subtle pro-atherogenic abnormalities. Although L-T4 treatment exerts some beneficial effects, the long-term impact of therapy on metabolic outcomes in SH children still remains unclear.
Collapse
Affiliation(s)
- Manuela Cerbone
- Pediatric Endocrinology UnitDepartment of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
| | - Donatella Capalbo
- Pediatric Endocrinology UnitDepartment of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
| | - Malgorzata Wasniewska
- Department of Pediatric, Gynecological, Microbiological and Biomedical SciencesUniversity of Messina, Messina, Italy
| | - Sara Alfano
- Pediatric Endocrinology UnitDepartment of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
| | | | - Ugo Oliviero
- Internal Medicine SectionDepartment of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
| | - Antonio Cittadini
- Internal Medicine SectionDepartment of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
| | - Filippo De Luca
- Department of Pediatric, Gynecological, Microbiological and Biomedical SciencesUniversity of Messina, Messina, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology UnitDepartment of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
| |
Collapse
|