Should we treat subclinical hypothyroidism in obese children?

Niranjan, Usha; Wright, Neil

doi:10.1136/bmj.i941

Cited by 20 publications

(14 citation statements)

References 6 publications

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“…Studies in recent years have proven a high prevalence of thyroid dysfunction among obese patients, especially among those with extreme obesity, which suggests appropriate monitoring of thyroid function may be recommended among obese patients (Fontenelle et al, 2016 ; Niranjan and Wright, 2016 ). Some studies also suggested that obese patients with hypothyroidism had much poorer outcomes than those without thyroid dysfunction (Brienza et al, 2013 ; Wang et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults

Wang

Song

et al. 2018

Front. Physiol.

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There is an intensive link between obesity and thyroid dysfunction, but this relationship in Asians is still unclear. This study was conducted to define the impact of obesity on risk of hypothyroidism and thyroid autoimmunity among Chinese adults. A population-based, cross-sectional study was carried out, which enrolled a total of 2,808 Chinese adults. To assess the associations of obesity with hypothyroidism and thyroid autoimmunity, odds ratio (ORs) with 95% confidence intervals (95%CIs) were calculated through logistic regression model, and the correlations of body mass index (BMI) with TPOAb and TGAb were also analyzed. Obese females had higher risk of hypothyroidism (22.7 vs. 15.0%; OR = 1.66, 95%CI 1.10–2.53; P = 0.02) and higher risk of subclinical hypothyroidism (22.1 vs. 13.4%; OR = 1.83, 95%CI 1.20–2.80; P = 0.005) than non-obese females. Multivariate logistic regression analysis found significant associations of obesity with hypothyroidism (Adjusted OR = 1.54, 95%CI 1.00–2.38; P = 0.05) and subclinical hypothyroidism (Adjusted OR = 1.69, 95%CI 1.09–2.63; P = 0.02) in females after adjustment for confounding factors. No association between obesity and hypothyroidism was observed in male participants. Spearman's correlation analysis suggested BMI was significantly and positively correlated with TPOAb (Spearman's r = 0.062, P = 0.022) in men but not in women. Linear regression analysis suggested an obviously positive correlation of BMI with TPOAb in men (β = 0.018, P = 0.015) and an obviously negative correlation of BMI with TGAb in women (β = −0.025, P = 0.012), respectively. The study suggests sex differences in the associations of obesity with hypothyroidism and thyroid autoimmunity among Chinese adults. Further studies are needed to better understand the exact mechanism of sex difference in the obesity-thyroid relationship.

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Section: Discussionmentioning

confidence: 99%

Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults

Wang

Song

et al. 2018

Front. Physiol.

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“…Similar studies from elsewhere have documented that fasting and postprandial samples do not yield different results provided they are taken in the morning. (11) There is no similar literature available in children for thyroid function test to be done only in fasting state. Subclinical hypothyroidism was not a significant problem in this study.…”

Section: Discussionmentioning

confidence: 99%

Does Fasting and Postprandial Blood Sampling for Thyroid Evaluation Make a Difference in Children?

Varadarajan¹,

Kaliyan²,

Sankaran³

et al. 2017

jemds

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BACKGROUND Thyroid function tests are one of the commonly undertaken investigations in any paediatric outpatient department. Based on the existing literature, there are no standard guidelines in respect of the sampling procedure to be followed in infants and children. Every paediatrician is aware of the logistic problems in taking a fasting sample in infants and younger children unlike adults. In this context, it was planned to undertake a pilot study to identify if the timing of sampling, fasting or postprandial status, makes any difference with respect to the thyroid function tests in children MATERIALS AND METHODS This was a descriptive study undertaken at the paediatric unit of Chengalpattu Medical College to evaluate if there is any difference between fasting and postprandial blood levels of Thyroid stimulating hormone and free T4 in children. The study was approved by the institutional ethical committee and informed written consent and assent obtained prior to study. Fifty one children between 1 and 12 years of age were recruited based on their willingness, from the endocrine clinic and the paediatric outpatient clinic. Fasting and postprandial blood samples were collected by venepuncture at 8 a.m. and 10.15 a.m. respectively. Blood samples were analysed using electrochemiluminescence method. Data analysis was done using Epi info software. RESULTS 51 children underwent fasting and postprandial sampling for thyroid evaluation. The results did not reveal any statistically significant difference between the fasting and postprandial samples for both TSH and Free T4. The same was true for both hypothyroid and euthyroid children. Subclinical hypothyroidism was encountered in one child in the fasting sample. CONCLUSION This pilot study revealed that postprandial TSH and Free T4 can be used as reliable test for thyroid evaluation as is a fasting sample in children.

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“…A slightly increased TSH (<10 mIU/L) in the presence of normal FT4 is a common finding in obesity, and on its own is not enough to diagnose a condition of primary hypothyroidism. The Whickham survey estimated that annual progression of subclinical hypothyroidism to overt hypothyroidism occurs in 2-5% (63) and the rate may be lower in obesity (64). Very few clinical trials have studied the potential benefits and the safety of l-thyroxine treatment in the obese population.…”

Section: Reasoningmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Pasquali

Casanueva

Haluzı́k

et al. 2020

European Journal of Endocrinology

130

156

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Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed – which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.

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Should we treat subclinical hypothyroidism in obese children?

Cited by 20 publications

References 6 publications

Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults

Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults

Does Fasting and Postprandial Blood Sampling for Thyroid Evaluation Make a Difference in Children?

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

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