TSH and free triiodothyronine concentrations are associated with weight loss in a lifestyle intervention and weight regain afterwards in obese children

Wolters, Barbara; Lass, Nina; Reinehr, Thomas

doi:10.1530/eje-12-0981

Cited by 61 publications

(74 citation statements)

References 35 publications

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“…This result may be the reason why the studied biochemical parameters remained unchanged overall (Table 4). Like several other studies (4,13,14,17,30) we did not find an association between BMI-SDS variation and TSH, even after substantial weight loss (BMI-SDS variation ≤ -0.5).…”

Section: δBmc-sdssupporting

confidence: 68%

Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study

Santos

Limbert

Marquês

et al. 2015

Journal of Pediatric Endocrinology and Metabolism

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Background: Serum thyroid stimulating hormone (TSH) levels are frequently elevated in obese children and are most likely to be associated with insulin resistance. However, clinical relevance of this association remains unclear. Objectives: To assess the prevalence of hyperthyrotropinemia; to analyze the relationship between TSH and homeostasis model assessment -insulin resistance (HOMA-IR); and to verify whether TSH levels and HOMA-IR vary with weight loss in obese children. Subjects and Methods: Retrospective longitudinal study with data from baseline and 1 year after lifestyle intervention in a pediatric obese group (344 children were recruited and 100 among them completed follow-up). For postintervention analysis, three groups were considered according to body mass index-standard deviation score (BMI-SDS) variations: ≤ -0.5 (significant weight loss); 0.5-0 (weight loss); and > 0 (weight gain). Statistical analysis was performed using SPSS 19.0

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Section: δBmc-sdssupporting

confidence: 68%

Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study

Santos

Limbert

Marquês

et al. 2015

Journal of Pediatric Endocrinology and Metabolism

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“…One of these studies that stringently corrected for age, smoking habits and menopausal status indicated that for every unit increase in log TSH, there was 2.3 kg greater weight in females and 1.1 kg in men [50]. Conversely, substantial weight loss appears to be associated with a decrease in TSH levels as shown in several studies in children and adolescents, and also in adults following bariatric procedures such as gastric banding or gastric bypass surgery [51,52,53,54]. Currently there have been no randomised trials of the impact of L -thyroxine therapy in patients with obesity-related elevation of TSH serum levels.…”

Section: Who To Treat/who To Observe: Younger Adults (<65-70 Years)mentioning

confidence: 99%

“…Currently there have been no randomised trials of the impact of L -thyroxine therapy in patients with obesity-related elevation of TSH serum levels. However, as observational studies are consistent in showing that TSH levels revert to normal upon weight reduction [51,52,53,54], a causal relation between SCH and obesity is not anticipated.…”

Section: Who To Treat/who To Observe: Younger Adults (<65-70 Years)mentioning

confidence: 99%

2013 ETA Guideline: Management of Subclinical Hypothyroidism

Pearce¹,

Brabant²,

Duntas³

et al. 2013

Eur Thyroid J

710

613

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Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroid-stimulating hormone (TSH) level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT₄ within reference range, should be investigated with a repeat measurement of both serum TSH and FT₄, along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval. Even in the absence of symptoms, replacement therapy with L-thyroxine is recommended for younger patients (<65-70 years) with serum TSH >10 mU/l. In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of L-thyroxine replacement therapy should be considered. For such patients who have been started on L-thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached. If there is no improvement in symptoms, L-thyroxine therapy should generally be stopped. Age-specific local reference ranges for serum TSH should be considered in order to establish a diagnosis of SCH in older people. The oldest old subjects (>80-85 years) with elevated serum TSH ≤10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. If the decision is to treat SCH, then oral L-thyroxine, administered daily, is the treatment of choice. The serum TSH should be re-checked 2 months after starting L-thyroxine therapy, and dosage adjustments made accordingly. The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4-2.5 mU/l). Once patients with SCH are commenced on L-thyroxine treatment, then serum TSH should be monitored at least annually thereafter.

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“…In contrast, other studies failed to confirm the association between SCH and obesity [131,144]. Furthermore, as the TSH level in obese children tends to decrease with weight loss from lifestyle changes [150,151,152] and levothyroxine treatment in children with hypothyroidism is associated with minimal change in BMI [153], it is thought that the mildly elevated TSH is the consequence of obesity rather than the cause [154]. …”

Section: Sch In Childhoodmentioning

confidence: 99%

2014 European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children

Lazarus¹,

Brown²,

Daumerie³

et al. 2014

Eur Thyroid J

604

457

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This guideline has been produced as the official statement of the European Thyroid Association guideline committee. Subclinical hypothyroidism (SCH) in pregnancy is defined as a thyroid-stimulating hormone (TSH) level above the pregnancy-related reference range with a normal serum thyroxine concentration. Isolated hypothyroxinaemia (defined as a thyroxine level below the 2.5th centile of the pregnancy-related reference range with a normal TSH level) is also recognized in pregnancy. In the majority of SCH the cause is autoimmune thyroiditis but may also be due to iodine deficiency. The cause of isolated hypothyroxinaemia is usually not apparent, but iodine deficiency may be a factor. SCH and isolated hypothyroxinaemia are both associated with adverse obstetric outcomes. Levothyroxine therapy may ameliorate some of these with SCH but not in isolated hypothyroxinaemia. SCH and isolated hypothyroxinaemia are both associated with neuro-intellectual impairment of the child, but there is no evidence that maternal levothyroxine therapy improves this outcome. Targeted antenatal screening for thyroid function will miss a substantial percentage of women with thyroid dysfunction. In children SCH (serum TSH concentration >5.5-10 mU/l) normalizes in >70% and persists in the majority of the remaining patients over the subsequent 5 years, but rarely worsens. There is a lack of studies examining the impact of SCH on the neuropsychological development of children under the age of 3 years. In older children, the evidence for an association between SCH and impaired neuropsychological development is inconsistent. Good quality studies examining the effect of treatment of SCH in children are lacking.

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TSH and free triiodothyronine concentrations are associated with weight loss in a lifestyle intervention and weight regain afterwards in obese children

Cited by 61 publications

References 35 publications

Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study

Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study

2013 ETA Guideline: Management of Subclinical Hypothyroidism

2014 European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children

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