The effect of L-thyroxine treatment on left ventricular functions in children with subclinical hypothyroidism

Çatlı, Gönül; Kır, Mustafa; Anık, Ahmet; Yılmaz, Nuh; Böber, Ece; Abacı, Ayhan

doi:10.1136/archdischild-2014-306381

Cited by 16 publications

(21 citation statements)

References 39 publications

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“…Moreover, recent longitudinal case-control studies demonstrated that untreated mild SH in children can be associated with early CV risk factors such as mild dyslipidemia, increased visceral adiposity, increased levels of homocysteine, early markers of endothelial dysfunction, and preclinical alteration in left ventricular function [94, 96, 101]. L-T4 treatment was associated with beneficial effects on most biochemical markers of CV risk and cardiac and endothelial function [96, 101]. …”

Section: Management Of Mild Sh In Childhoodmentioning

confidence: 99%

Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?

Vigone

Capalbo

Weber

et al. 2018

Journal of the Endocrine Society

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Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.

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Section: Management Of Mild Sh In Childhoodmentioning

confidence: 99%

Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?

Vigone

Capalbo

Weber

et al. 2018

Journal of the Endocrine Society

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“…Only few studies have evaluated the effect of shortterm trials with L-T4 in heterogeneous populations of children with mild to severe SH (5,20,23), and none of them have focused on the relationship between SH and metabolic aspects.…”

Section: Introductionmentioning

confidence: 99%

Effects of L-thyroxine treatment on early markers of atherosclerotic disease in children with subclinical hypothyroidism

Cerbone¹,

Capalbo²,

Waśniewska

et al. 2016

European Journal of Endocrinology

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Objective: To investigate the effect of levothyroxine (L-T4) treatment on early markers of atherosclerotic disease in children with mild idiopathic subclinical hypothyroidism (SH). Design: Two-year, open, case-control prospective study. Methods: A total of 39 children, aged 9.18 ± 3.56 years, with SH and 39 healthy controls were enrolled in the study. Waist-to-height ratio (WHtR), blood pressure, triglycerides, total cholesterol (total-C), HDL-C, LDL-C, non-HDL-C, triglycerides/HDL-C, atherogenic index (AI), homocysteine (Hcy), asymmetric dimethylarginine (ADMA), flow-mediated dilation (FMD) and intima-media thickness (IMT) were evaluated at baseline and after 2 years of L-T4 treatment in SH children and after 2 years of follow-up in controls. Results: At study entry WHtR was higher in SH subjects compared with controls (0.56 ± 0.08 vs 0.49 ± 0.07, P = 0.04) and significantly decreased after 2 years of treatment (0.50 ± 0.06, P < 0.0001). Mean HDL-C levels (50.47 ± 11.43 vs 61.06 ± 13.83 mg/dL, P = 0.002) were lower, while triglycerides/HDL-C (1.63 ± 1.07 vs 1.19 ± 0.69, P = 0.05), AI (3.32 ± 0.90 vs 2.78 ± 0.68, P = 0.005), and Hcy (9.35 ± 2.61 vs 7.71 ± 1.94 μmol/L, P = 0.01) were higher in SH subjects compared with controls and improved after 2 years of treatment (HDL-C 56.26 ± 13.76 mg/dL, P < 0.0001; triglycerides/HDL-C 1.23 ± 0.78, P = 0.006; AI 2.82 ± 0.68, P < 0.0001; and Hcy 8.25 ± 2.09 μmol/L, P = 0.06). ADMA concentrations at baseline were higher in SH subjects compared with controls (0.77 ± 0.21 vs 0.60 ± 0.16 μmol/L, P = 0.001) and decreased after therapy (0.58 ± 0.13 μmol/L, P < 0.0001). FMD, IMT and other metabolic parameters were not different among SH subjects and controls at baseline and after 2 years. Conclusions: Children with SH may have subtle pro-atherogenic abnormalities. Although L-T4 treatment exerts some beneficial effects, the long-term impact of therapy on metabolic outcomes in SH children still remains unclear.

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“…The effects of subclinical hypothyroidism on cardiac functions and Tissue Doppler Imaging parameters have www.nature.com/scientificreports/ mostly been reported in adult studies 10,11,15,16,18,[22][23][24] . Although the number of studies reporting on the cardiac effects of subclinical hypothyroidism have been growing recently, particularly in children, there is still scarcity in the number of studies conducted in children 9,25 . Left ventricle mass has been shown to increase in adults with subclinical hypothyroidism 11,18 .…”

Section: Discussionmentioning

confidence: 99%

“…Rodonti et al 12 reported that left ventricular mass might increase in patients with thyroid stimulating hormone > 10 mU/l during long-term follow-up although no increase might be seen at baseline measurements. A review of the Englishlanguage literature showed that there have been only two studies reporting on increased left ventricular mass in children with subclinical hypothyroidism 9,26 . Of these, the study by Catli et al 9 evaluated 31 children with subclinical hypothyroidism and found a significant increase in left ventricular mass index and interventricular septal thickness.…”

Section: Discussionmentioning

confidence: 99%

Left and right ventricular functions may be impaired in children diagnosed with subclinical hypothyroidism

Akın

Ünal

Yıldırım

et al. 2020

Sci Rep

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Subclinical hypothyroidism (SH) may influence both ventricular functions. The aim of this study was to evaluation the findings of Tissue Doppler Imaging (TDI) and other echocardiography modalities in children with SH. We compared left ventricular mass index (LVMI) and TDI parameters of patients with SH and children with euthyroidism. Subclinical hypothyroidism was diagnosed when thyroid stimulating hormone level was higher than the reference value of the laboratory (> 4.2 mIU/L) and free thyroxine level was in normal range. The study included a group of 35 patients with SH and a control group of 38 children with euthyroidism (mean age was 7.6 ± 3.5 years and 9.0 ± 2.4 years, respectively). LVMI was significantly higher in the patient group (p = 0.005). TDI parameters including mitral septal ejection time was lower (p = 0.003) and mitral septal myocardial performance index was higher (p = 0.009) in the patient group. Right ventricular TDI revealed that tricuspid lateral E/Ea and tricuspid septal E/Ea were higher (p = 0.015 and p = 0.024, respectively) and tricuspid septal Ea/Aa and ejection time were lower (p = 0.018 and p = 0.017, respectively) in the patient group. SH may lead to increase LVMI. Left ventricular systolic and diastolic TDI parameters (lower mitral septal ejection time, higher mitral septal myocardial performance index) as well as right ventricular systolic (lower tricuspid septal ejection time) and diastolic (higher tricuspid septal and lateral E/Ea, lower tricuspid septal Ea/Ea) functions may be also impaired in children with subclinical hypothyroidism. TDI is a useful method used for the assessment of the effect of SH on cardiac functions.

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The effect of L-thyroxine treatment on left ventricular functions in children with subclinical hypothyroidism

Cited by 16 publications

References 39 publications

Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?

Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?

Effects of L-thyroxine treatment on early markers of atherosclerotic disease in children with subclinical hypothyroidism

Left and right ventricular functions may be impaired in children diagnosed with subclinical hypothyroidism

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