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Subclinical Hypothyroidism as the Most Common Thyroid Dysfunction Status in Children With Down's Syndrome
Kamila Szeliga1,2, Aleksandra Antosz1,2, Karolina Skrzynska1,2
1Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Science, Medical University of Silesia, Katowice, Poland.
Insights
Subclinical hypothyroidism (SH) is common in children with Down syndrome (DS). Levothyroxine therapy did not significantly improve growth or BMI in these children, though a small percentage developed overt hypothyroidism.
Area of Science:
- Pediatric Endocrinology
- Genetics
- Thyroidology
Background:
- Thyroid dysfunction is a frequent comorbidity in children with Down syndrome (DS), affecting up to 54% of cases.
- Subclinical hypothyroidism (SH) is the most common form of thyroid dysfunction observed in this population.
Purpose of the Study:
- To investigate the progression of subclinical hypothyroidism (SH) in children with Down syndrome (DS).
- To assess thyroid function in relation to overt thyroid disease and autoimmunity risk.
- To identify clinical and biochemical characteristics of patients with DS and SH receiving levothyroxine (L-T4) therapy.
Main Methods:
- Retrospective analysis of DS patients' records from an Endocrinology Outpatient Clinic (2010-2019).
- Exclusion of patients with congenital hypothyroidism, leukemia, seizures, or interfering medications.
- Evaluation of 73 DS patients, with 63 diagnosed with SH, comparing outcomes with and without L-T4 treatment.
Main Results:
- 87% of the 73 DS patients studied were diagnosed with SH.
- Levothyroxine (L-T4) therapy in 74.6% of SH patients did not significantly improve growth (ΔhSDS) or BMI Z-score compared to untreated patients.
- Antithyroid antibodies (anti-TPO, anti-TG) were found in 11.1% of SH patients.
Conclusions:
- Subclinical hypothyroidism (SH) is the predominant thyroid abnormality in children with Down syndrome (DS).
- Overt hypothyroidism develops in a minority of patients, particularly females, often associated with positive antithyroid autoantibodies.
Introduction:
Thyroid dysfunctions are one of the most common abnormalities coexisting in children with Down's syndrome (DS) and have been reported in up to 54% of cases.
Aim Of The Study:
The purposes of this retrospective study were to investigate the course of subclinical hypothyroidism in children with DS, to evaluate the thyroid function of these subjects in relation to the risk of developing overt thyroid disease and autoimmunity, and to identify clinical and biochemical characteristics of patients prescribed L-T4 therapy in children and adolescents with DS and SH.
Material And Methods:
The records of DS patients referred to the Endocrinology Outpatient Clinic between 2010 and 2015 for screening of thyroid function were observed till the end of 2019 June and analyzed retrospectively. The children diagnosed with congenital hypothyroidism, acute lymphoblastic leukemia, and seizures and treated with drugs that may have interfered with thyroid function like lithium, antiepileptic, or iodinated drugs and glucocorticoids were excluded from the study.
Results:
The data of 77 DS patients were collected, evaluated, and analyzed. The study group consisted of 73 patients (32 girls and 41 boys with the mean age at baseline of 3.0 ± 4.5 years). A total of 63/73 (87%) children were diagnosed with SH. The 16/63 (25.4%) patients were followed-up without the treatment (group SH-T0), and therapy with levothyroxine (L-T4) was introduced in 47/63 (74.6%) SH children with a mean dosage of 1.8 ± 1.0 μg/kg/day (group SH-T1). Thyroxine supplementation did not improve growth expressed as ΔhSDS (0.1 ± 1.3, ranged -2.1 to 3.8 in SH-T0 vs. 0.0 ± 0.7, ranged -1.7 to 1.4 in SH-T1, p = 0.96) and ΔBMI Z-score (0.3 ± 0.9, ranged -0.9 to 2.6 in SH-T0 vs. 0.3 ± 1.1, ranged -2.1 to 2.9 in SH-T1, p = 0.65). Positive anti-TPO and anti-TG antibodies were detected in 7/63 (11.1%) DS cases.
Conclusions:
SH is the most frequent presentation of thyroid gland dysfunction in DS children. A small percentage of patients develop an overt hypothyroidism, particularly in females with mostly positive titer of antithyroid autoantibodies.
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