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Recombinant human growth hormone increases thyroid hormone-binding sites in recovering severely burned children
Cara M Connolly1, Robert E Barrow, David L Chinkes
1Department of Surgery, The University of Texas Medical Branch, Galveston, Texas 77550, USA.
Insights
Recombinant human growth hormone (rhGH) treatment in severely burned children increases thyroid hormone-binding sites (THBS), potentially by boosting albumin and prealbumin levels. This may help mitigate growth arrest associated with severe burns.
Area of Science:
- Endocrinology
- Metabolic Research
- Pediatric Burn Care
Background:
- Severely burned children exhibit reduced levels of thyroxine (T4) and tri-iodothyronine (T3).
- Thyroid hormones are transported by serum proteins via thyroid hormone-binding sites (THBS).
- Recombinant human growth hormone (rhGH) is known to increase albumin (Alb) and prealbumin (PreAlb), key binding proteins for T4 and T3.
Purpose of the Study:
- To investigate the effect of rhGH on THBS in pediatric burn patients.
- To determine if rhGH influences serum transport proteins and thyroid hormone levels in burned children.
Main Methods:
- A randomized study of 11 severely burned children (total body surface area >40%) treated with rhGH or placebo for 6 months post-discharge.
- Measurements included thyroxine uptake percentage (TU%), total T4 (TT4), albumin (Alb), and prealbumin (PreAlb).
- Data collected at discharge and 6 months later were compared between the rhGH and placebo groups.
Main Results:
- rhGH treatment significantly decreased TU% (P < 0.001) and increased TT4 (P < 0.02), Alb (P < 0.0001), and PreAlb (P < 0.006).
- The placebo group showed no significant changes in these parameters.
- No significant changes in height or weight were observed in either group.
Conclusions:
- rhGH significantly increases THBS in severely burned children, likely mediated by elevated serum Alb and PreAlb.
- The observed increase in circulating thyroxine may play a role in preventing growth arrest in these patients.
Abstract:
Thyroxine (T4), Tri-iodothyronine (T3), and total serum protein levels are reduced in severely burned children. T4 and T3 are carried on serum transport proteins via thyroid hormone-binding sites (THBS). Treatment of bums with recombinant human growth hormone (rhGH) increases albumin (Alb) and prealbumin (PreAlb), which bind nearly 30% of circulating T4 and T3. This study investigated the effect of rhGH on THBS sites in burned children. Records of 11 acutely burned children with a total body surface area burned >40% who were randomized to either a daily subcutaneous injection of rhGH at 0.05 mg/kg/day or placebo for 6 months after discharge from hospital were reviewed. Thyroxine uptake percentage (TU%), Total T4 levels (TT4), free thyroxine index, Alb and PreAlb, and height and weight measurements taken at discharge and 6 months later were compared in both groups. In the six children who received rhGH, mean TU% had decreased from 41 +/- 1 to 33 +/- 1% by 6 months postdischarge, (P < 0.001), mean TT4 increased from 5.8 +/- 0.3 to 8.1 +/- 0.8 microg/dL, (P < 0.02), mean Alb increased from 2.0 +/- (0.6) to 3.5 +/- (0.1) g/dL (P < 0.0001), and mean PreAlb increased from 8.7 +/- 0.7 to 16.5 +/- 2.1 mg/dL, (P < 0.006). There were no significant changes in the five children in the placebo (control group), and height and weight did not significantly change in either group. rhGH significantly increases THBS in severely burned children, possibly through increases in serum Alb and PreAlb. The increases in circulating thyroxine observed in this group may be involved in the attenuation of growth arrest.