The Influence of Thyroid Hormone on Growth Hormone Secretion and Action

Leung, Angela M.; Brent, Gregory A.

doi:10.1007/978-3-319-28038-7_4

Cited by 8 publications

(5 citation statements)

References 90 publications

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“…Regardless of the cause of thyroid function alterations during rhGH therapy, most authors agree that there is a need for the regular monitoring of thyroid hormone levels in all GH-deficient children after the initiation of rhGH therapy in order to early identify and correct the possible thyroid function abnormalities that could occur during therapy [ 5 , 13 , 14 , 15 , 23 , 29 ]. Thyroid hormones directly stimulate the transcription of GH, IGF-1 and insulin-like growth factor binding protein-2 (IGFBP-2) and insulin-like growth factor binding protein-4 (IGFBP-4) genes, as well as increasing the mRNA of GH and growth hormone-releasing hormone (GHRH) receptors [ 45 , 46 ]. Moreover, Ocaranza et al [ 47 ] reported evidence of direct stimulation of the GH receptor (GHR) by thyroxine in a skin fibroblast culture, in which the simultaneous addition of GH and thyroxine increased signal transduction in the GHR/Janus kinase 2/signal transducer and the activator of the transcription 5 (GHR/JAK2/STAT5) pathway.…”

Section: Discussionmentioning

confidence: 99%

Decreased Thyroxine Levels during rhGH Therapy in Children with Growth Hormone Deficiency

Witkowska–Sędek

Kucharská

Rumińska

et al. 2021

JCM

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Background: Hypothyroidism in children leads to growth retardation. However, there is some evidence that recombinant human growth hormone (rhGH) therapy could suppress thyroid function. The most common observation in rhGH-treated patients is a decrease in thyroxine levels, which is reported as transient, but the studies in the field are inconsistent. We aimed to evaluate thyroid function in initially euthyroid children with idiopathic isolated GH deficiency during long-term rhGH therapy and to determine who is at a higher risk of thyroid function alterations during the therapy. Methods: The study group consisted of 101 children treated with rhGH for at least three years. Serum TSH and fT4 levels were determined at baseline, after the first six months and after each full year of therapy. The associations between changes in thyroid hormone levels during rhGH therapy and GH deficit, insulin-like growth factor-1 levels and growth response were investigated. Results: A significant decrease in fT4 levels (p = 0.01) was found as early as after the first six months of rhGH therapy. This effect persisted in the subsequent years of treatment without any significant changes in TSH values and tended to be rhGH dose related. Children with a greater fT4 decrease after the initiation of rhGH therapy were older, had higher bone age and responded to that therapy worse than children with lower fT4 changes. Conclusions: Our study revealed a long-term decrease in fT4 levels during rhGH therapy in initially euthyroid GHD children. The decrease in fT4 levels was associated with a lower growth response to rhGH therapy.

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Section: Discussionmentioning

confidence: 99%

Decreased Thyroxine Levels during rhGH Therapy in Children with Growth Hormone Deficiency

Witkowska–Sędek

Kucharská

Rumińska

et al. 2021

JCM

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“…Almost one-third of children with idiopathic steroid resistant NS have overt or subclinical hypothyroidism [ 16 ]. Early diagnosis and treatment of thyroid hormone deficiency in children is critical for preserving normal linear growth and bone development [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nephrotic children may also rarely develop thyroid hormone dysfunction due to urinary excretion of thyroid-binding globulin, transthyretin, and thyroid hormones [ 2 ]. Thyroid hormones are essential for normal growth [ 3 ], however, thyroid function tests are not generally performed in children with NS. Child’s growth may be impaired in NS even with normal kidney function as long steroid treatment can affect growth is.…”

Section: Introductionmentioning

confidence: 99%

Overt Hypothyroidism and Severe Growth Retardation in a Preschool Girl with Poorly Controlled Nephrotic Syndrome: Case Report and Literature Review

Mikulevič,

Tumelienė,

Kemežys

et al. 2023

AML

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Background. Nephrotic children may develop thyroid hormone dysfunction due to urinary excretion of thyroid hormones. In contrast to the subclinical hypothyroidism that affects around 30% of children with nephrotic syndrome (NS), the patient in this case had overt hypothyroidism and severe growth retardation.Clinical case. A 5 years and 8 months old girl with steroid-dependent NS was referred from another center due to persistent edema and decreased diuresis, being treated with mycophenolate mofetil (MMF) 250 mg once a day and L-thyroxine 50 mcg daily since 4 months of NS onset because of hypothyroidism. Her albumin was 12.64 g/l, cholesterol 25.64 mmol/l and proteinuria 5 g/l. Severe growth retardation was observed: patient’s height was 93.5 cm (–13 cm <3 percentile), weighted 17.2 kg (15–25 percentile). Her disease vintage was over 3 years. Girl’s growth velocity has slowed down from 3.5 months. The patient received a high cumulative dose of prednisolone (approx. 7800 mg in 1 year and 8 months). Thyroid-stimulating hormone was higher (18.04 mU/L) with reduced FT4 11.43 pmol/l and IGF-1 < 15 µg/L. Kidney biopsy revealed minimal change disease, and genetic testing was negative. Intensive NS treatment with methylprednisolone pulse therapy, enlarged doses of MMF and albumin infusion were started and L-thyroxine dose was increased to 75 mcg. TPOAb was in normal range (12.65 IU/ml). After 3 weeks she was discharged with no edema and after stopping methylprednisolone treatment thyroid function normalized and L-thyroxin was discontinued. Two weeks later standard growth hormone stimulation test with clonidine showed partially insufficient growth hormone secretion. During NS remission with normalization of thyroid function (TSH 6.680 mU/l, FT4 13.85 pmol/l) and normalization of IGF-1 level (132 mcg/l) partial catch-up growth was observed (height velocity increased from 3.5 cm/year to 7.3 cm/year, based on 4-month calculation period).Conclusions. Clinicians should be aware of a risk of developing hypothyroidism and consider thyroid function testing during the treatment of children with NS, as well as actively treat hypothyroidism and evaluate growth.

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“…They have a particularly strong effect on the central nervous system and the basal metabolic rate, by regulating carbohydrate metabolism. Moreover, thyroid hormones have a great impact on a person's mood and behavior, which is why thyroid gland disorders manifest in such a distinguishing manner [9,10].…”

Section: Introductionmentioning

confidence: 99%