Epicardial Fat Thickness in Children with Subclinical Hypothyroidism and Its Relationship to Subclinical Atherosclerosis: A Pilot Study

Abstract

<b><i>Background/Aims:</i></b> Thyroid hormones (TSH) play a key role in the working of the cardiovascular system, with direct effects on cardiac function, vascular system, and atherosclerotic factors. Epicardial adipose tissue, the visceral fat of the heart, has emerged as a new cardiometabolic risk marker because of its close anatomical proximity to the myocardium and coronary artery. This study aimed to evaluate epicardial fat thickness (EFT) in children with subclinical hypothyroidism (SH) and its relation to early atherosclerotic changes. <b><i>Methods:</i></b> The study included 32 children with SH due to autoimmune thyroiditis and 32 healthy children matched for age and gender as control group. Patients and controls underwent anthropometric evaluation and measurement of fasting lipids, glucose, insulin, homeostasis model assessment for insulin resistance and high-sensitivity C-reactive protein (hs-CRP). TSH, free thyroxine (FT4 and FT3) and antithyroid autoantibodies (antithyroid peroxidase and thyroglobulin antibodies) were also measured. Conventional echo­cardiography was used to assess EFT. Noninvasive ultrasound was used to measure carotid intima-media thickness and brachial artery flow-mediated dilation (FMD) responses. <b><i>Results:</i></b> Compared to controls, patients had higher atherogenic index (AI) and hs-CRP (<i>p</i> = 0.001 for each). Conventional echocardiography revealed that patients with SH had higher EFT (<i>p</i> = 01) and significantly lower FMD response compared with the control (<i>p</i> = 0.001). In multivariate analysis, EFT values were significantly correlated with TSH (OR 1.2; 95% CI 1.04–1.34; <i>p</i> = 0.01), hs-CRP (OR 1.1; 95% CI 1.09–1.14; <i>p</i> = 0.001, AI (OR 1.6; 95% CI 1.17–2.03; <i>p</i> = 0.001), and FMD response (OR 2.4; 95% CI 1.14–2.53; <i>p</i> = 0.01). <b><i>Conclusions:</i></b> Our study demonstrated that EFT is higher in children with SH compared with controls and associated with FMD responses. Measurement of EFT by echocardiography in children with SH may help to identify those at high risk of developing subclinical atherosclerosis.

Subclinical hypothyroidism in children: updates for pediatricians

“…Among children with untreated SH, mild abnormalities in lipid profile have been reported in the form of slight decreases in high-density lipoprotein-cholesterol (HDL-C) and mild increases in triglyceride/HDL-C ratio. 48) In addition, a higher www.e-apem.org atherogenic index has been reported by Farghaly et al 47) in children with mild SH caused by HT.…”

“…45) Moreover, epicardial fat thickness (EFT) is a sensitive and reliable marker of cardiovascular risk and has become an emerging target for medical interventions. 46) Only one study that we are aware of, conducted by Farghaly et al, 47) has evaluated FMD and EFT. Their evaluation included 32 children with mild SH caused by HT.…”

Cardiovascular Risk Factors in Children and Adolescents with Subclinical Hypothyroidism: A Meta-analysis and Systematic Review

“…A total of 3995 participants were included, of whom 817 children and adolescents had SCH, and 3,178 were euthyroid. 9 studies [23][24][25][26][27][28][29][30][31] compared TC levels in 753 SCH patients and 3097 controls. 8 studies [23][24][25][26][27][28][29]32 (540 cases and 1923 controls) evaluated TG, 6 studies [23][24][25][26][27]29 reported LDL (453 cases and 1832 controls), 8 [23][24][25][26][27]29,31,32 reported HDL (715 cases and 3107 controls), 5 [24][25][26][27]29 reported insulin resistance (312 cases and 1160 controls), and 3 studies 24,28,29 (112cases and 83 controls) assessed CIMT, isovolumic relaxation time (IVRT) was evaluated in 3 studies 29,32,33 (91 cases and 110 controls).…”

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

“…Likewise, the EAT of SH cases were found to be significantly higher than the control group [28]. Farghaly et al Studied a total of 64 children (32 SH and 32 without thyroid dysfunction), of which all of the SH group consisted of cases due to autoimmune thyroiditis, they found that the EAT of SH cases were found to be significantly higher than the control group [29]. In our study, we observed that mean EAT0 of not treated SH cases was 4,31±1,09 mm and the mean EAT0 thickness of treated SHs (SH1) was determined as 4,08±1,41 mm.…”