Hypothyroidism associated with short bowel syndrome in children: a report of six cases

Passos, Ananda Castro Vieira; Barros, Fábio de; Damiani, Durval; Semer, Beatriz; Cespedes, W. C. J.; Sannicola, Bruna; Tannuri, Ana Cristina Aoun; Tannuri, Uenis

doi:10.20945/2359-3997000000093

Cited by 8 publications

(11 citation statements)

References 30 publications

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“…During the past 3 decades, NTIS has been reported in a large proportion of hospitalized patients, with the prevalence varying by patient populations 4,13 . However, few studies have demonstrated an association between NTIS and SBS, particularly in adults 18,24,25 . Previously, Passos et al 18 reported 6 of 25 pediatric patients suffering from hypothyroidism during intestinal rehabilitation, among which 2 patients were diagnosed with NTIS and 4 with iodine deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…4,13 However, few studies have demonstrated an association between NTIS and SBS, particularly in adults. 18,24,25 Previously, Passos et al 18 reported 6 of 25 pediatric patients suffering from hypothyroidism during intestinal rehabilitation, among which 2 patients were diagnosed with NTIS and 4 with iodine deficiency. In the present study, we found that NTIS occurred frequently, with a prevalence of 52.5% in adults, which was much higher than the rate previously reported in pediatric patients (8%).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Passos et al 18 reported 6 cases of hypothyroidism in children with SBS during the period of intestinal rehabilitation, in which 2 patients had the disease caused by NTIS and 4 by iodine deficiency. However, no studies have systematically analyzed TH disturbances in adult patients with SBS.…”

Section: Introductionmentioning

confidence: 99%

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Nonthyroidal Illness Syndrome in Patients With Short‐Bowel Syndrome

Wan

Yang

Gao

et al. 2020

J Parenter Enteral Nutr

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Background Nonthyroidal illness syndrome (NTIS) is prevalent in critical illness and is associated with poor outcomes. However, only few studies have focused on the relationship between NTIS and short‐bowel syndrome (SBS). The aim of this study was to investigate the prevalence, etiology, and prognosis of NTIS and its correlation with clinical variables in adult patients with SBS. Methods Sixty‐one eligible adults diagnosed with SBS, from December 2016 to December 2018, were retrospectively identified from a prospectively maintained database. Demographic and clinical characteristics (including thyroid hormones and nutrition variables) were evaluated for each participant. Results The prevalence of NTIS in adults with SBS was 52.5%. Patients with NTIS tended to have a longer duration of hospital stay and poor survival, but the results were not significant. A decreased, standard thyroid‐stimulating hormone index and sum activity of deiodinases and an increased secretory capacity by the thyroid were observed in the NTIS group. Receiver operating characteristic curve analysis showed that insulin‐like growth factor‐1 (IGF‐1) had better performance for distinguishing NTIS from patients with euthyroidism, with an area under the curve of 0.862 (cutoff, 101.0; sensitivity, 0.813; and specificity, 0.800). Conclusions NTIS is a common complication in adult patients with SBS. Patients with NTIS tend to have a worse nutrition status and poor prognosis. A potential pituitary thyrotroph dysfunction and hypodeiodination condition may play a role in the pathophysiology of NTIS in SBS. Furthermore, IGF‐1 is a meaningful predictor for distinguishing NTIS from euthyroid.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Nonthyroidal Illness Syndrome in Patients With Short‐Bowel Syndrome

Wan

Yang

Gao

et al. 2020

J Parenter Enteral Nutr

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“…Several other factors can produce a hypothyroid-like state in children, including consumptive hypothyroidism due to infantile hepatic hemangioma [38], older antiepileptic drugs [39], chronic liver disease [40], or gastrointestinal disorders [41]. Other autoimmune diseases, such as type 1 diabetes or celiac disease tend to cluster with hypothyroidism in children [42][43][44].…”

Section: Other Causes Of Hypothyroidism In Childrenmentioning

confidence: 99%

Levothyroxine in Children

Brenta

2021

70 Years of Levothyroxine

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Thyroid hormones are essential for the development of the central nervous system early in life. Congenital hypothyroidism once caused the devastating cognitive and physical deficits of cretinism, but this condition is now detected routinely at birth using population-wide neonatal screening in most countries. Early and continuous treatment of these children with levothyroxine (LT4), according to age-specific reference ranges, ensures near-normal neuropsychological development, with preserved IQ, although the possibility of subtle residual effects on some indices of neuropsychological functioning remain an active area of research. Children who develop overt hypothyroidism also require treatment with LT4. Most children diagnosed with subclinical hypothyroidism are unlikely to require intervention with LT4, as this condition reverses spontaneously over time. These children should be monitored for possible deterioration of thyroid function in future, especially where thyroid autoimmunity is present.

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“…Recent studies show that doses of 1 to 3 mcg/kg/day iodine included in typical TPN formulations is not sufficient for adequate iodine status [ 13 , 24 ]. Hypothyroidism as a result of iodine deficiency in a TPN-dependent preterm infants with short bowel syndrome has been well described [ 25 , 26 ]. Currently, the neonatal parenteral multi–trace mineral product manufactured in the United States do not contain iodine and no IV single nutrient iodine product is available.…”

Section: Introductionmentioning

confidence: 99%

Risk of Iodine Deficiency in Extremely Low Gestational Age Newborns on Parenteral Nutrition

et al. 2020

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Iodine is an essential component of thyroid hormones, which play a critical role in neurodevelopment. The iodine status of pregnant women and their newborns is not checked routinely. Extremely Low Gestational Age Newborns do not receive Iodine supplementation while on parenteral nutrition (PN). We measured urine iodine levels and thyroid function tests in 50 mother–infant dyads at birth, at 1 week, 1, 2, 3 months and near discharge. We correlated maternal and neonatal urine iodine levels with thyroid functions and measured iodine levels in milk and PN. In our study, 64% of mothers were iodine deficient at the time of delivery, their free T4 levels were 0.48 (0.41–0.54) ng/dL with normal thyroid-stimulating hormone (TSH). Iodine levels were thirty-fold higher in extremely low gestational age newborns (ELGAN) exposed to iodine comparing to full terms (p < 0.001), but this effect lasted <1 week. At 1 month of age, ELGAN on PN developed iodine deficiency (p = 0.017) and had high thyroglobulin levels of 187 (156–271) ng/mL. Iodine levels improved with enteral feeds by 2 months of age (p = 0.01). Iodine deficiency is prevalent among pregnant women and ELGAN; in particular, those on PN are at risk of hypothyroidism. Iodine supplementation during pregnancy and postnatally should be considered to avoid iodine deficiency.

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Hypothyroidism associated with short bowel syndrome in children: a report of six cases

Cited by 8 publications

References 30 publications

Nonthyroidal Illness Syndrome in Patients With Short‐Bowel Syndrome

Nonthyroidal Illness Syndrome in Patients With Short‐Bowel Syndrome

Levothyroxine in Children

Risk of Iodine Deficiency in Extremely Low Gestational Age Newborns on Parenteral Nutrition

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