Growth in thyrotoxicosis.

Abstract

SUMMARY To study the effect of thyrotoxicosis on growth, 46 children and adolescents presenting with thyrotoxicosis have been reviewed and followed up for several years, in most cases until adult height was achieved. At presentation the children were underweight for height but were above expected heights even if already well advanced in puberty. Despite bone ages often being very advanced at diagnosis, the condition had no adverse effect on ultimate stature, which was commonly greater than that expected on the basis of parental height. Weight was rapidly regained on treatment, but nevertheless the younger subjects continued to be underweight despite adequate prolonged control of thyrotoxicosis.For many years it has been well recognised that thyroid hormones have a great influence on growth and bone maturation. Most of the evidence about this has been accrued, however, from observations on hypothyroidism.' Overtreatment with thyroid hormones in hypothyroidism results in an excessive acceleration of bone maturation, and thyrotoxicosis in infants has been reported to cause premature closure of skull sutures.2 3 There are, however, few reports of the effect of hyperthyroidism on final height.f6 The reason for this lack of information is that thyrotoxicosis is a rare condition in childhood and most cases develop shortly before or during puberty, when the normal acceleration of growth will be superimposed on any effects of the disease and will make interpretation difficult. A recent monograph on hyperthyroidism gives no special consideration to the condition in childhood or adolescence.7

Growth in childhood thyrotoxicosis

“…Childhood thyrotoxicosis has been documented to be more common in our locality and the current study included a large group of patients such that detailed analyses of their growth were possible. Studies have showed that children with thyrotoxicosis were tall for age at presentation and their bone ages tended to be advanced [2,8]. Buckler et al reported that a group of 40 girls with thyrotoxicosis at presentation had a mean height SDS of +0.75 [2].…”

“…Accelerated bone maturation and growth velocity in children with thyrotoxicosis have also been reported [8]. There are, however, only a few reports of the eect of thyrotoxicosis on ®nal height [1,2,9]. Only one report attempted to compare the ®nal heights of aected children with their target heights [2].…”

“…There are, however, only a few reports of the eect of thyrotoxicosis on ®nal height [1,2,9]. Only one report attempted to compare the ®nal heights of aected children with their target heights [2]. All these reports are limited by their small number of subjects because childhood thyrotoxicosis is relatively rare precluding de®nite conclusions of the eect of childhood thyrotoxicosis on ®nal height.…”

Endocrine Regulation of the Growth Plate

“…Hypothyroidism slows longitudinal bone growth and endochondral ossification, while hyperthyroidism accelerates both processes [39, 40]. In hypothyroid animals, there is a decrease in the heights of the proliferative and hypertrophic zones, and a decrease in chondrocyte proliferation, chondrocyte hypertrophy, and vascular/bone cell invasion [41].…”

Autonomous Adenomas Caused by Somatic Mutations of the Thyroid-Stimulating Hormone Receptor in Children

“…2). Such linear growth acceleration is not as pronounced in older children with hyperthyroidism due to either Graves' disease [28,29] or to an autonomous adenoma (our patient 2). A distinctive feature of autonomous adenomas is the absence of ophthalmopathy and the absence of antibodies to the TSHR, which are the hallmark of Graves' disease.…”