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Thyroid function in children with Cushing's disease before and after transsphenoidal surgery
C A Stratakis1, G Mastorakos, M A Magiakou
1Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1928, USA.
Insights
Thyroid function in children with Cushing's disease (CD) is often mildly suppressed before and after transsphenoidal surgery (TSS). Hypothyroidism is rare and does not correlate with growth issues in these pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Endocrinology
- Neurosurgery
Background:
- Cushing's disease (CD) in children can impact growth and thyroid function.
- The effects of CD and its treatment on thyroid status in pediatric populations are not well-understood.
Purpose of the Study:
- To investigate thyroid function and its correlation with growth parameters in children and adolescents with Cushing's disease treated with transsphenoidal surgery (TSS).
Main Methods:
- Prospective follow-up of 24 children and adolescents with CD post-TSS.
- Evaluation of thyroid function tests (free thyroxine, T3, TSH) before and at 3, 6, and 12 months after surgery.
- Correlation analysis between thyroid function and body weight, BMI, and bone age.
Main Results:
- Preoperative free thyroxine was higher than at 3 months post-TSS, while T3 and TSH were lower preoperatively compared to postoperative values.
- A mild, transient suppression of thyroid function was observed in most patients in the early postoperative period.
- Hypothyroidism was an infrequent complication, affecting only a few patients, and did not correlate with growth or obesity parameters.
Conclusions:
- Mild thyroid function suppression is common in pediatric Cushing's disease patients before and shortly after transsphenoidal surgery.
- Significant hypothyroidism is a rare complication of CD and TSS in children and adolescents.
- Thyroid function normalized within 6 months post-surgery and did not influence growth delay or obesity in this cohort.
Abstract:
The degree of thyroid impairment and the effects on growth have not been investigated in children with Cushing's disease. We followed the thyroid function of 24 children and adolescents (12 males and 12 females) with CD (age, 12.9 +/- 3.2 years; mean +/- SD), who were successfully treated by transsphenoidal surgery. Patients were evaluated before, and 3, 6, and 12 months after TSS. Analysis of variance and linear correlation were performed between thyroid function tests and body weight and mass index and bone age. Preoperative free thyroxine levels (1.37 +/- 0.03 ng/dl) were significantly higher than those at 3 months (1.17 +/- 0.05 ng/dl, p < 0.05), but similar to those at 6 and 12 months postoperatively. Preoperative T3 (114.2 +/- 7.7 ng/dl) and TSH (1.36 +/- 0.2 IU/ml) were significantly lower than the postoperative values at 3 (158.9 +/- 6.8 and 2.3 +/- 0.3, respectively), 6 (159.1 +/- 10.8 and 2.5 +/- 0.3, respectively), and 12 months (136 +/- 6.5 and 2.2 +/- 0.3, respectively) (all p < 0.05). One patient had frank hypothyroidism (fT4 < 1 ng/dl) before surgery. Five additional patients had secondary hypothyroidism in the immediate postsurgical period; two of them had normal thyroid function 2 and 3 years postoperatively. One patient has remained hypothyroid for more than 5 years since surgery. No significant correlation was found between thyroid function and body weight, BMI, or BA. We conclude that hypothyroidism was an infrequent complication of CD and TSS. Mild suppression of thyroid function occurs in most children and adolescents with CD before and in the first few months after TSS, but it fully resolves after 6 months and does not correlate with the growth delay and obesity of these patients.