Effect of thyroxine on initial catch-up growth in children with hypothyroidism

Authors

  • Ami H. Patel Department of Pediatrics, GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India
  • Pinakin P. Trivedi Department of Pediatrics, GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20195746

Keywords:

Catch-up growth, Height standard deviation scores, Height velocity, Primary hypothyroidism, Thyroxine

Abstract

Background: Hypothyroidism is a common endocrinal cause of growth retardation in children. Following adequate treatment with thyroxine, growth resumes at an accelerated rate which is known as catch-up growth. There are few observational studies from India on the growth parameters following treatment with thyroxine in children with hypothyroidism.

Methods: A retrospective study was done in children aged 2-10 years who were newly diagnosed cases of primary hypothyroidism [Total serum Thyroxine (T4) levels <5 µg/dl and serum Thyroid Stimulating Hormone (TSH) levels ˃15 µU/ml] and treated with oral thyroxine to attain euthyroid state. Height measured before starting treatment and at the time of follow up visits was noted, the Height Standard Deviation Scores (HSDS) were calculated. The effect of thyroxine on linear growth was studied.

Results: There were 23 children who were diagnosed as having primary hypothyroidism of whom 16(69.6%) were females and 7(30.4%) were males. The mean age of the children studied was 7.3±2.3 years. The mean dose of thyroxine required to maintain euthyroid status was 4.6±2.2 µg/kg/day. Mean duration of follow up was 13.7±2.4 months. The initial HSDS was - 2.31±0.9 which improved to a final value of - 1.7±0.76 (ΔHSDS0.61, p value <0.0001). Mean height velocity was 8.1 cms/year.

Conclusions: Following adequate thyroxine replacement therapy catch-up growth occurs and increased growth velocity leads to partial regain of height deficit in the first couple of years of treatment.

References

Desai MP. Disorders of the thyroid gland. In: Desai MP, Menon PSN, Bhatia V, eds. Pediatric Endocrine Disorders, 3rd Ed. Hyderabad: Universities Press (India) Private limited; 2014:47-52,61,189-210,464.

Saranac L, Stamenkovic H, Stankovic T, Zivanovic S, Djuric Z. Growth in children with thyroid dysfunction. In: Potlukova E, eds. Current topics in hypothyroidism with focus on development. In Tech publishers; 2013:119-134.

Soliman AT, Azzam S, ElAwwa A, Saleem W, Sabt A. Linear growth and neurodevelopmental outcome of children with congenital hypothyroidism detected by neonatal screening: A controlled study. Ind J Endocrinol Metab. 2012 Jul;16(4):565.

Lotfi MH, Pordanjani SR, Akhondi-Meybodi M, Rabei A, Ordooei M, Pourmohammadi B. Five-year follow up of physical growth and thyroid hormone levels in infants with congenital hypothyroidism. Iranian J Pediatr. 2017;27(1).

Salerno M, Micillo M, Di Maio S, Capalbo D, Ferri P, Lettiero T, et al. Longitudinal growth, sexual maturation and final height in patients with congenital hypothyroidism detected by neonatal screening. Eur J Endocrinol. 2001 Oct 1;145(4):377-83.

WHO child growth standards. Height for age. Department of Nutrition for Health and Development. Geneva: World Health Organization. 2006. Available at: https://www.int/childgrowth/standards/height_for_age/en/ Accessed 10 May 2017.

Khadilkar V, Yadav S, Agrawal KK, Tamboli S, Banerjee M, Cherian A, et al. Revised IAP growth charts for height, weight and body mass index for 5-to 18-year-old Indian children. Ind Pediatr. 2015 Jan 1;52(1):47-55.

Soliman AT, De Sanctis V, Bedair ES. Congenital Hypothyroidism: Effects on Linear Growth, Catch-Up Growth, GH-IGF-I Axis and Bones. In: Potlukova E, eds. Current topics in hypothyroidism with focus on development. In Tech publishers; 2013:91-118.

deWit CC, Sas TC, Wit JM, Cutfield WS. Patterns of Catch-up growth. J Pediatr. 2013;162 (2):415-20.

Boersma B, Wit JM. Catch-up growth. Endoc Rev. 1997;18(5):646-61.

Marino R, Hegde A, Barnes KM, Schrier L, Emons JA, Nilsson O, et al. Catch-up growth after hypothyroidism is caused by delayed growth plate senescence. Endocrinol. 2008 Jan 3;149(4):1820-8.

Lui JC, Nilsson O, Baron J. Growth plate senescence and catch-up growth. Cartilage Bone Develop Dis. 2011;21:23-29.

Khadilkar V, Khadilkar A, Arya A, Ekbote V, Kajale N, Parthasarathy L, et al. Height Velocity Percentiles in Indian Children Aged 5-17 Years. Ind Pediatr. 2019 Jan 1;56(1):23-8.

Rajitha D, Suresh V, Sunil E, Arun M, Srinivasarao C, Rajagopal G, et al. Initial catch-up growth in children with hypothyroidism on thyroxine replacement therapy. J Clin Sci Res. 2015 Jul 1;4(3):199.

Gutch M, Kumar S, Razi SM, Gupta A, Kumar S, Gupta KK, et al. Prevalence of short stature in juvenile hypothyroidism and the impact of treatment on various skeletal manifestation and growth velocity in a teritary care center. Chrismed J Health Res. 2015 Jul 1;2(3):251.

Ranke MB, Schwarze CP, Mohnike K, Von Mühlendahl KE, Keller E, Willgerodt H, et al. Catch-up growth after childhood-onset substitution in primary hypothyroidism: is it a guide towards optimal growth hormone treatment in idiopathic growth hormone deficiency?. Hormone Res Paediatr. 1998;50(5):264-70.

Soliman AT, Omar M, Awwa AE, Rizk MM, El Alaily RK, Bedair EM. Linear growth, growth-hormone secretion and IGF-I generation in children with neglected hypothyroidism before and after thyroxine replacement. J Trop Pediatr. 2008 May 1;54(5):347-9.

Pantsiouou S, Stanhope R, Uruena M, Preece MA, Grant DB. Growth prognosis and growth after menarche in primary hypothyroidism. Archiv Dis Childhood. 1991 Jul 1;66(7):838-40.

Rivkees SA, Bode HH, Crawford JD. Long-term growth in juvenile acquired hypothyroidism. New Eng J Med. 1988 Mar 10;318(10):599-602.

Boersma B, Otten BJ, Stoelinga GB, Wit JM. Catch-up growth after prolonged hypothyroidism. Eur J Pediatr. 1996 May 1;155(5):362-7.

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Published

2019-12-24

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Original Research Articles