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Evaluation of thyroid function in children with undiagnosed short stature in north India
A Virmani1, P S Menon, M G Karmarkar
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Insights
Thyroid dysfunction is a common cause of short stature in children. Routine thyroid function tests are recommended for diagnosing short stature in pediatric patients.
Area of Science:
- Pediatrics
- Endocrinology
- Medical Diagnostics
Background:
- Short stature is a common pediatric concern requiring etiological investigation.
- Hypothyroidism is a potential underlying cause of growth impairment in children.
- Comprehensive evaluation is necessary to differentiate various causes of short stature.
Purpose of the Study:
- To investigate the etiology of short stature in children, with a specific focus on hypothyroidism.
- To assess the prevalence of thyroid dysfunction in children presenting with short stature.
- To evaluate the impact of thyroid hormone replacement on growth velocity.
Main Methods:
- Clinical assessment and anthropometry were performed in 55 children with short stature.
- Thyroid function tests, including thyroxine (T4) and thyroid stimulating hormone (TSH) levels, were measured.
- Radioactive iodine uptake, thyroid scans, perchlorate discharge tests, and growth hormone estimations were conducted.
Main Results:
- Abnormal thyroid function was detected in 45.45% of the children studied.
- Primary hypothyroidism was diagnosed in 20% of cases with low/normal iodine uptake and 25.45% with high uptake and elevated TSH.
- Growth hormone reserve was reduced in three children with primary hypothyroidism, and all showed improved growth velocity with thyroxine treatment.
Conclusions:
- Thyroid dysfunction is a significant contributor to short stature in the pediatric population.
- Routine thyroid function testing is crucial for the early diagnosis and management of short stature in children.
- Prompt treatment of hypothyroidism can lead to significant improvements in growth velocity.
Abstract:
Fifty-five children with short stature were investigated for the aetiology of short stature with special reference to hypothyroidism. Clinical and laboratory parameters including anthropometry were determined to exclude any chronic systemic disorders. Thyroid function tests such as thyroxine (T4) and thyroid stimulating hormone (TSH) estimation by radioimmunoassay, radioactive iodine uptake and thyroid scan, using 131I and perchlorate discharge test, were performed. In addition, growth hormone was estimated under basal conditions and after insulin-induced hypoglycaemia. Thirty-five were boys and 20 were girls. The age at presentation in the boys was 3-12 years whereas in the girls it was 8-13 years. Forty-three of the 55 children had delayed bone age. Abnormal thyroid function was present in 25 children (45.45%). Of these, 11 (20%) had primary hypothyroidism with low or normal uptake, whereas 14 (25.45%) had glands with high uptake of 131I and elevated TSH. Three children with primary hypothyroidism had reduced growth hormone reserve. On follow-up with thyroxine, there was an increase in growth velocity in all. This study indicates that thyroid function tests should be performed routinely in children with undiagnosed short stature.