Long-Term Effects of Growth Hormone Replacement Therapy on Thyroid Function in Adults with Growth Hormone Deficiency

Losa, Marco; Scavini, Marina; Gatti, Elisa; Rossini, Alessandro; Madaschi, Sara; Formenti, Ilaria; Caumo, Andrea; Stidley, Christine A.; Lanzi, Roberto

doi:10.1089/thy.2008.0266

Cited by 48 publications

(44 citation statements)

References 21 publications

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“…GH replacement increases conversion of T 4 to T 3 and decreases that of T 4 to reversed T 3 (9,78,79). Therefore, careful monitoring of thyroid function is mandatory during GH treatment (78), as it may indicate changes in the T 4 dose needed.…”

Section: Central Hypothyroidismmentioning

confidence: 99%

“…Therefore, careful monitoring of thyroid function is mandatory during GH treatment (78), as it may indicate changes in the T 4 dose needed. Patients with untreated GHD may have higher FT 4 levels than on GH replacement; GH therapy may, therefore, unmask undiagnosed CH (74,79,80). This effect is also seen in children with MHPD, but not in children with IGHD (81).…”

Section: Central Hypothyroidismmentioning

confidence: 99%

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GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Filipsson

Johannsson

2009

European Journal of Endocrinology

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Severe GH deficiency (GHD) in adults has been described as a clinical entity. However, some of the features associated with GHD could be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult. Moreover, oral estrogen replacement therapy decreases IGF1 levels compared with the transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral estrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH replacement may unmask both an incipient adrenal insufficiency and central hypothyroidism. Therefore, awareness and proper monitoring of these hormonal interactions are important in order to reach an optimal replacement therapy. This review will focus on the complex hormonal interactions between GH and other pituitary hormones in GHD and in GH replacement. European Journal of Endocrinology 161 S85-S95

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Section: Central Hypothyroidismmentioning

confidence: 99%

Section: Central Hypothyroidismmentioning

confidence: 99%

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Filipsson

Johannsson

2009

European Journal of Endocrinology

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“…This was first observed in children with an initial diagnosis of isolated GHD, who were subsequently reclassified as having multiple (or combined) pituitary hormone deficiency (MPHD) [11]. Later on, it was also reported in adults, especially in those with acquired GHD due to "organic" pituitary disease, i.e., trauma, tumor or after pituitary surgery [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Low FT4 Concentrations around the Start of Recombinant Human Growth Hormone Treatment: Predictor of Congenital Structural Hypothalamic-Pituitary Abnormalities?

et al. 2018

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Background: Growth hormone (GH) treatment may unmask central hypothyroidism (CeH). This was first observed in children with GH deficiency (GHD), later also in adults with GHD due to acquired “organic” pituitary disease. We hypothesized that newly diagnosed CeH in children after starting GH treatment for nonacquired, apparent isolated GHD points to congenital “organic” pituitary disease. Methods: Nationwide, retrospective cohort study including all children with nonacquired GHD between 2001 and 2011 in The Netherlands. The prevalence of CeH, hypothalamic-pituitary (HP) abnormalities, and neonatal congenital hypothyroidism screening results were evaluated. Results: Twenty-three (6.3%) of 367 children with apparent isolated GHD were prescribed LT4 for presumed CeH within 2 years after starting GH treatment. Similarly to children already diagnosed with multiple pituitary hormone deficiency, 75% of these 23 had structural HP abnormalities. In children not prescribed LT4, low pre- or post-GH treatment FT4 concentrations were also associated with structural HP abnormalities. Neonatal screening results of only 4 of the 23 children could be retrieved. Conclusion: In children with nonacquired, apparent isolated GHD, a diagnosis of CeH after, or a low FT4 concentration around the start of GH treatment, is associated with congenital structural HP abnormalities, i.e., “organic” pituitary disease. Neonatal values could not be judged reliably.

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“…Following GH administration, some studies have demonstrated different degrees of thyroid hormone level changes, such as a reduction in serum fT 4 [8,29] or an increase in fT 3 [10,11,16,30], while other studies have not confirmed these observations [18,20,21,30,31,32]. It has been suggested that the incidence of both central and peripheral hypothyroidism should be taken into account during recombinant human GH administration, as hypothyroidism may worsen the response to therapy.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Severity of Growth Hormone Deficiency and Thyroid Metabolism and Effects of Long-Term Growth Hormone Treatment on Thyroid Function in Children with Idiopathic Growth Hormone Deficiency

Ciresi

Guarnotta²,

Amato³

et al. 2014

Horm Res Paediatr

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Background/Aim: The significance of changes in thyroid function in children during growth hormone (GH) treatment remains uncertain. We aimed to evaluate the impact of GH replacement on thyroid status in children with idiopathic GH deficiency (GHD). Methods: Data of 105 GHD children (82 M, 23 F; aged 11.13 years) during a 36-month follow-up were analyzed. At diagnosis the areas under the curve of GH (AUC_GH) were calculated during a GH-releasing hormone + arginine (GHRH-Arg) and insulin tolerance test. Results: A significant ΔfT₃ (p < 0.001) was documented at 12 months, without any further change at 24 and 36 months and without fT₄ and TSH modifications. Grouping patients according to ΔfT₃ at 12 months into those with lower (n = 80, 76%) or greater values than the 75th percentile (n = 25, 24%), the latter showed lower AUC_GH and GH peak during a GHRH-Arg (p = 0.018 and 0.014, respectively) and insulin tolerance test (p = 0.023 and 0.020, respectively) at diagnosis. In addition, children with lower GH at diagnosis showed a greater ΔfT₃ at 12 months (p = 0.030). Conclusions: In GHD children, GH treatment is associated with a significant increase in fT₃ in the first 12 months, more pronounced in patients with more severe GHD, highlighting the strong correlation between severity of GHD and thyroid metabolism.

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Long-Term Effects of Growth Hormone Replacement Therapy on Thyroid Function in Adults with Growth Hormone Deficiency

Cited by 48 publications

References 21 publications

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Low FT4 Concentrations around the Start of Recombinant Human Growth Hormone Treatment: Predictor of Congenital Structural Hypothalamic-Pituitary Abnormalities?

Correlation between Severity of Growth Hormone Deficiency and Thyroid Metabolism and Effects of Long-Term Growth Hormone Treatment on Thyroid Function in Children with Idiopathic Growth Hormone Deficiency

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