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Plasma C-type natriuretic peptide forms and thyroid status in prepubertal children with acquired thyroid disease
1Center for Endocrinology, Diabetes, and Metabolism at Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA. creh@choc.org
Insights
Thyroid hormone levels impact C-type natriuretic peptide (CNP) and height velocity (HV) in children. In hyperthyroid children, CNP changes align with thyroid hormone and HV, suggesting growth plate activity influences CNP production.
Area of Science:
- Pediatric Endocrinology
- Skeletal Growth Regulation
- Thyroid Hormone Physiology
Background:
- C-type natriuretic peptide (CNP) and thyroid hormone (TH) are crucial for skeletal development.
- Plasma CNP levels correlate with growth velocity, but the link to thyroid status is unclear.
- Understanding this relationship is key for managing pediatric growth disorders.
Purpose of the Study:
- To investigate the effect of normalizing thyroid hormone levels on CNP and height velocity (HV) in children with acquired hypothyroidism and hyperthyroidism.
- To explore the correlation between thyroid status, CNP production, and skeletal growth parameters.
Main Methods:
- Prospective observational study of prepubertal children with acquired hypothyroidism (n=15) and hyperthyroidism (n=12).
- Measurement of plasma CNP, NTproCNP, BSAP, IGF-I, and TH levels before and during 6 months of standard treatment.
- Correlation analysis to determine relationships between variables.
Main Results:
- Baseline HV, CNP, NTproCNP, and BSAP were higher in hyperthyroid versus hypothyroid children.
- TH normalization correlated with CNP and NTproCNP changes in hyperthyroid, but not hypothyroid, children.
- HV positively associated with CNP peptides during hyperthyroid treatment; TH normalization did not affect BSAP or IGF-I.
Conclusions:
- Plasma CNP levels are elevated in hyperthyroid children and change with TH and HV during treatment.
- CNP production appears dependent on growth plate activity rather than a direct TH effect on gene expression.
- Findings suggest new mechanisms for skeletal response changes in pediatric thyroid disease.
Objective:
C-type natriuretic peptide (CNP) and thyroid hormone (TH) are essential for normal skeletal growth. Plasma CNP peptides correlate with growth velocity, but the relationship between thyroid status and CNP production is unknown. This study examined the impact of restoring normal TH levels on CNP and height velocity (HV) in children with acquired hypo- and hyperthyroidism.
Design:
We performed a prospective, observational study in prepubertal children with acquired hypothyroidism (n = 15) and hyperthyroidism (n = 12).
Measurements:
Blood levels of CNP, amino-terminal proCNP (NTproCNP), bone-specific alkaline phosphatase (BSAP), IGF-I and TH levels were measured before and during the first 6 months of standard treatment for hypo- and hyperthyroidism, and correlations were determined.
Results:
At baseline, HV, CNP, NTproCNP and BSAP were significantly higher in hyper- than in hypothyroid subjects. Changes in TH after treatment were closely coupled to change in CNP and NTproCNP in hyperthyroid, but not in hypothyroid, children. In addition, a positive association of HV with CNP peptides was found during treatment of hyperthyroidism. Normalizing TH did not correlate with changes in BSAP or IGF-I in either group.
Conclusions:
Plasma CNP peptides are higher in children with hyperthyroidism than in those with hypothyroidism at diagnosis and, in hyperthyroid children, change concordantly with TH and HV during treatment. Differential responses of CNP in the two groups suggest CNP production is dependent on growth plate activity and not a direct effect of TH on CNP gene expression. Our findings suggest novel mechanisms underlying changes in skeletal response during treatment in children with acquired thyroid disease.
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