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Evaluation of catch-up growth in severe pediatric Hashimoto's hypothyroidism
A Vincent1, C Bouvattier1, C Teinturier1
1Department of Pediatric Endocrinology and diabetology, Bicêtre Hospital and Paris Sud University, Le Kremlin-Bicêtre, France.
Insights
Children with severe Hashimoto's hypothyroidism (HH) experience significant height loss. Thyroid hormone replacement therapy alone showed insufficient catch-up growth, suggesting growth hormone may be beneficial in severe cases.
Area of Science:
- Pediatric Endocrinology
- Growth Disorders
- Thyroidology
Background:
- Severe Hashimoto's hypothyroidism (HH) in children can cause substantial growth deficits.
- Early diagnosis and treatment are crucial for managing pediatric endocrine disorders.
Purpose of the Study:
- To evaluate catch-up growth in children with severe HH following thyroid hormone replacement therapy (HRT).
- To determine the efficacy of HRT alone versus HRT combined with growth hormone (GH) in achieving final height.
Main Methods:
- A multicenter retrospective study included 29 children diagnosed with HH between 1998 and 2017.
- Patients were analyzed based on treatment received: HRT alone or HRT plus GH.
- Height standard deviation scores (SDS) and thyroid function tests were assessed at diagnosis and during follow-up.
Main Results:
- Children presented with a median height deficit of -2.7 SDS and significant height loss.
- HRT alone led to significant height improvements up to 5 years of treatment, but not final height.
- Patients treated with GH were smaller at diagnosis but achieved similar final heights compared to those on HRT alone.
Conclusions:
- Severe HH results in significant height deficits, with catch-up growth often insufficient with HRT alone.
- Growth hormone administration may be considered in severe pediatric HH cases to potentially enhance catch-up growth.
- Further research is needed to optimize growth outcomes in children with severe HH.
Background:
We aimed to evaluate catch-up growth in children with severe Hashimoto's hypothyroidism (HH) after thyroid hormone replacement therapy (HRT).
Methods:
A multicenter retrospective study was conducted including children referred for growth slowdown that led to the diagnosis of HH between 1998 and 2017.
Results:
A total of 29 patients were included, with a median age of 9.7 years (13-172 months). Median height at diagnosis was -2.7 [-4.6; -0.1] standard deviation score (SDS), with a height loss of 2.5 [0.7; 5.4] SDS compared to height before growth deflection (p<0.0001). At diagnosis, the median TSH level was 819.5 mIU/L [100; 1844], the median FT4 level was 0 pmol/L [undetectable; 5.4], and the median anti-thyroperoxidase antibody level was 1601 UI/L [47; 25,500]. In the 20 patients treated only with HRT, there were significant differences between height at diagnosis and height at 1 year (n = 19, p<0.0001), 2 years (n = 13, p = 0.0005), 3 years (n = 9, p = 0.0039), 4 years (n = 10, p = 0.0078), and 5 years (n = 10, p = 0.0018) of treatment but not in the case of final height (n = 6, p = 0.0625). Median final height was -1.4 [-2.7; 1,5] SDS (n = 6), with a significant difference between height loss at diagnosis and total catch-up growth (p = 0.003). The other nine patients were also given growth hormone (GH). They were smaller at diagnosis (p = 0.01); however, there was no difference in final height between those two groups (p = 0.68).
Conclusion:
Severe HH can lead to a major height deficit, and catch-up growth seems to be insufficient after treatment with HRT alone. In the most severe cases, administration of GH may enhance this catch-up.
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