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Bone metabolism in children with congenital hypothyroidism--a longitudinal study
A Verrotti1, R Greco, E Altobelli
1Department of Pediatrics, University of Chieti, Italy.
Insights
Congenital hypothyroidism in newborns causes bone metabolism abnormalities, including altered calcium and vitamin D levels. L-thyroxine therapy rapidly normalizes these parameters, indicating transient and reversible effects.
Area of Science:
- Pediatrics
- Endocrinology
- Bone Metabolism
Background:
- Congenital hypothyroidism (CH) affects thyroid hormone production from birth.
- Thyroid hormones are crucial for normal growth and development, including bone metabolism.
- Abnormalities in calcium and vitamin D metabolism are suspected in CH.
Purpose of the Study:
- To evaluate the impact of thyroid replacement therapy on bone metabolism in infants with CH.
- To assess calcium, 1,25-dihydroxy-vitamin D, and osteocalcin levels before and after treatment.
Main Methods:
- Studied 23 infants (3-8 weeks old) with CH and 46 healthy controls.
- Measured serum calcium, 1,25-dihydroxy-vitamin D, and osteocalcin levels.
- Compared parameters before and after 3 months of L-thyroxine therapy.
Main Results:
- CH infants had higher calcium and 1,25-dihydroxy-vitamin D, and lower osteocalcin than controls.
- L-thyroxine therapy normalized all measured parameters within 3 months.
- Osteocalcin levels showed a progressive increase post-therapy.
Conclusions:
- Congenital hypothyroidism is associated with transient bone metabolism abnormalities.
- L-thyroxine replacement therapy effectively reverses these metabolic disturbances.
- Early treatment is vital for normalizing bone metabolism in CH patients.
Abstract:
In order to evaluate the effect of thyroid replacement therapy on bone metabolism in congenital hypothyroid children, we studied 23 (10 girls and 13 boys) consecutive patients. Their age ranged from 3 to 8 weeks. One of these patients had familiar dyshormonogenesis, 21 had ectopic glands and one hemiagenesis. As a control group, we studied 46 sex- and age-matched healthy newborns. Before the beginning of therapy, the hypothyroid patients showed higher values of calcium (2.78 +/- 0.04 vs 2.65 +/- 0.07 mmol/l; p < 0.05) and of 1,25-dihydroxy-vitamin D (159.7 +/- 31.6 vs 90.5 +/- 33.1 ng/l; p < 0.01), while they showed lower values of osteocalcin (1.9 +/- 0.8 vs 2.9 +/- 0.9 ng/ml; p < 0.01) than controls. After 3 months of therapy, we found a complete normalization of all these parameters and a progressive increase of osteocalcin. Our data show that in congenital hypothyroid children there are abnormalities in calcium metabolism which seem to be transient and reversible after L-thyroxine replacement therapy.