Evaluation of Subclinical Hypothyroidism in Children and Adolescents: A Single-Center Study

Such, Kamila; Gawlik, Aneta; Dejner, Aleksandra; Waśniewska, Małgorzata; Zachurzok, Agnieszka; Antosz, Aleksandra; Gawlik, Tomasz; Małecka-Tendera, Ewa

doi:10.1155/2016/1671820

Cited by 10 publications

(10 citation statements)

References 32 publications

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“…A BMI Z-score over +2.0 SD was classified as obesity, between +2.0 and +1.0 SD as overweight, between -1.0 and -2.0 as underweight and under -2.0 SD as significant weight deficiency (26). The boys’ sexual maturity stages were assessed using the Tanner scale (27).…”

Section: Methodsmentioning

confidence: 99%

Clinical and Biochemical Phenotype of Adolescent Males with Gynecomastia

Lorek

Tobolska-Lorek

Kalina-Faska

et al. 2019

Jcrpe

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Objective:Gynecomastia is defined as a benign proliferation of male breast glandular tissue. Its prevalence during puberty varies between 50-60% and is also common in neonatal and elderly males. It develops mainly due to the disequilibrium between estrogen and androgen activity in breast tissue, where estradiol (E2) binds to estrogen receptors and stimulates ductal and glandular cells. The aim of this work was to investigate the relationship between sex hormone alterations and the natural history of gynecomastia.Methods:Participants in this study were young males referred to an outpatient clinic, between January 2011 and February 2016, with breast enlargement. Thyroid function, liver function, hormone concentrations and tumor markers were measured and anthropometric assessment was conducted.Results:Subjects comprised 93 males, aged 9 to 18 (mean±standard deviation age 13.8±2.6) years. In 63 of 93 (67.7%) the gynecomastia was confirmed and 28 were followed-up for a median period of three months. None of the boys showed any reduction in breast size during follow-up. There was no correlation between body mass index Z-score and breast size. Breast enlargement progressed in nine boys (32.1%). A positive correlation between estrogen to testosterone (E2/TTE) ratio and Tanner B stage (r=0.47; p=0.034) was observed.Conclusion:The E2/TTE ratio may be a helpful tool in diagnosing gynecomastia. Altered E2/TTE ratio might be responsible for a proportion of cases described previously as idiopathic. Additionally, weight loss does not imply reduction of breast size in boys. Nonetheless it should be the first step in the management of prolonged gynecomastia.

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Section: Methodsmentioning

confidence: 99%

Clinical and Biochemical Phenotype of Adolescent Males with Gynecomastia

Lorek

Tobolska-Lorek

Kalina-Faska

et al. 2019

Jcrpe

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“…Group 1 (G1): TSH ≤5μUI/mL (n: 44); Group 2 (G2): TSH 5-10μUI/mL, normal fT4 and negative TPOAb/TgAb (n: 14); Group 3 (G3): suitable for thyroxin therapy due to TSH ≥10μUI/mL or TSH 5-10μUI/mL and positive TPOAb/TgAb (n: 7) variable time in most cases (68-88%) and only a few cases progress to overt hypothyroidism or autoimmune thyroiditis. There are few studies to date that evaluate SH and its evolution in childhood [5,10,13,14]. In our study, most of the patients either normalized their TSH levels or maintained their TSH levels under subclinical range values (89%).…”

Section: Discussionmentioning

confidence: 66%

Subclinical hypothyroidism in childhood, treatment or only follow-up?

et al. 2020

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Background: Subclinical hypothyroidism (SH) is defined as serum levels of thyroid-stimulating hormone (TSH) above the upper limit with normal concentrations of free T4 (fT4). Its management remains challenging. The aim of the study was to evaluate clinical and laboratory findings as well as the clinical course of children with SH followed in a third level hospital. Sixty-five patients aged between 2 and 18 years old were retrospectively studied. Methods: The patients were followed for a median period of 9 months (range 6 months to 24 months). Those who normalized TSH levels were discharged (Group 1). If TSH persisted mildly elevated (5-10μUI/mL) with normal fT4 and negative TPOAb/TgAb, they were classified as Group 2 and followed semi-annually without treatment. Those patients whose TSH raised ≥10μUI/mL or who maintained TSH 5-10μUI/mL and positive TPOAb/TgAb were considered suitable for thyroxin therapy (Group 3, G3). Results: In 89% of our patients, TSH concentrations spontaneously reverted to normality or remained stable without treatment (Groups 1 and 2), whereas less than 11% progressed to clinical hypothyroidism (Group 3). Baseline TSH was significantly lower in group 1 than in group 3. In group 3 the prevalence of female sex (71%) was higher and TPO antibodies were present in 85% of patients. The risk of developing overt hypothyroidism in patients with positive anti-thyroid antibodies respect to those who normalized TSH was 45 (95%CI 6.5-312.5). Conclusion: Baseline TSH, female sex and the presence of thyroid autoimmunity were the best predictors of the evolution to SH over time.

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“…In general terms, SH seems to affect less than 3% of the child population and usually displays a natural course towards the maintenance or spontaneous resolution in variable time in most cases (68-88%) and only a few cases progress to overt hypothyroidism or autoimmune thyroiditis. There are few studies to date that evaluate SH and its evolution in childhood (5,10,13,14). In our study, most of the patients either normalized their TSH levels or maintained their TSH levels under subclinical range values (89%).…”

Section: Discussionmentioning

confidence: 66%

Subclinical Hypothyroidism In Childhood, Treatment Or Only Follow-Up?

Murillo-Valles

Martínez

Aguilar-Riera

et al. 2020

Preprint

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Background: Subclinical hypothyroidism is defined as serum levels of thyroid-stimulating hormone (TSH) above the upper limit with normal concentrations of free T4 (fT4). Its management remains challenging. The aim of the study was to evaluate clinical and laboratory findings as well as clinical course of children with SH followed in a third level hospital. 65 patients aged between 2 and 18 years were retrospectively studied. Methods: The patients were followed for a median period of 9 months (range 6 months to 24 months). Those who normalized TSH levels were discharged (Group 1). If TSH persisted mild elevated (5-10µUI/mL) with normal fT4 and negative TPOAb/TgAb were classified as Group 2 and followed semiannually without treatment. In those patients who’s TSH raised ≥10µUI/mL or maintained TSH 5-10µUI/mL and positive TPOAb/TgAb were considered suitable for thyroxin therapy (Group 3, G3). Results: By ROC curves analysis we tested which initial TSH concentration best discriminated between patients who reverted to normality (Group 1) from those who finally required treatment (Group 3), the best cut-off being a TSH concentration >8.1µUI/mL (93.18% E, 57.14% S, AUC 0.765±0.107, p= 0.01). In 89% of our patients, TSH concentrations spontaneously reverted to normality or remained stable without treatment, whereas less than 11% progressed to clinical hypothyroidism. Conclusion: patients with initial TSH concentrations above 8.1µUI/mL have an increased risk of progression to hypothyroidism.

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Evaluation of Subclinical Hypothyroidism in Children and Adolescents: A Single-Center Study

Cited by 10 publications

References 32 publications

Clinical and Biochemical Phenotype of Adolescent Males with Gynecomastia

Clinical and Biochemical Phenotype of Adolescent Males with Gynecomastia

Subclinical hypothyroidism in childhood, treatment or only follow-up?

Subclinical Hypothyroidism In Childhood, Treatment Or Only Follow-Up?

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