Can Epicardial Adipose Tissue be Defined as an Early Marker of Treatment Decisions of Subclinical Hypothyroidism in Childhood?

Abstract

Introduction and Aim: Childhood overt hypothyroidism is a chronic disease that affect many system adversely and requires treatment. However, Subclinical Hypothyroidism (SH) ,defined obvious cases, impacts on other systems are unknown and there is no common approach to be treated. Moreover, SH may continue for many years, before they become overt hypothyroidism. Cardiovascular System (CVS) is one of the host system, which hypothyroidism adversely affects. Epicardial Adipose Tissue thickness (EAT) is known to be an important marker in terms of the cardiovascular risks. We aimed to determine the effects on CVS in children with SH. Material and Methods: The study included were 100 cases, which are 1-18 years had categorized in two groups; control group (50 children), who had no signs of thyroidal dysfunction and case group (50 children) who had diagnosed with SH, are recruited in the study. SH was diagnosed according to the slightly higher TSH than the upper limit (4.2M/L), normal free T4 and T3 levels. Medical Treatment (LT4) was decided according to the levels of TSH, sT3, sT4 and clinical status. EAT was determined by transthoracic echocardiographic measurements in millimeters. The SH cases were classified into two groups in terms of medical treatment. EAT thickness was measured in patients with treated group (SH1) and non-treated group (SH2) at admission (EAT0) and at 6. months (EAT 6). Results: Epicardial adipose tissue thickness was significantly higher in SH children, than the children without thyroid dysfunction. The mean value of the EAT in control group was 2,11 ± 0,52mm. Mean of EAT0 was 4,08 ± 1,41 in group SH1, mean of EAT0 was 4,31 ± 1,09mm in group SH2. In addition, mean of EAT6 was 3.65 ± 1,27mm in group SH1 and mean of EAT6 was 4,16 ± 1,10 in group SH2. Although there were a decrease in both group SH1 and SH2, at EAT6 compared to the EAT0, and this decrease was more significant in group SH1. Discussion: This study suggests that subclinical hypothyroidism effects adversly the cardiovascular system in children before hypothyroidism become overt. In future this data may be marker at the begining of LT4 treatment in children with SH.