ABSTRACT
BACKGROUND: We aimed to evaluate catch-up growth in children with severe Hashimoto's hypothyroidism (HH) after thyroid hormone replacement therapy (HRT). METHODS: A multicenter retrospective study was conducted including children referred for growth slowdown that led to the diagnosis of HH between 1998 and 2017. RESULTS: A total of 29 patients were included, with a median age of 9.7 years (13-172 months). Median height at diagnosis was -2.7 [-4.6; -0.1] standard deviation score (SDS), with a height loss of 2.5 [0.7; 5.4] SDS compared to height before growth deflection (p<0.0001). At diagnosis, the median TSH level was 819.5 mIU/L [100; 1844], the median FT4 level was 0 pmol/L [undetectable; 5.4], and the median anti-thyroperoxidase antibody level was 1601 UI/L [47; 25,500]. In the 20 patients treated only with HRT, there were significant differences between height at diagnosis and height at 1 year (n = 19, p<0.0001), 2 years (n = 13, p = 0.0005), 3 years (n = 9, p = 0.0039), 4 years (n = 10, p = 0.0078), and 5 years (n = 10, p = 0.0018) of treatment but not in the case of final height (n = 6, p = 0.0625). Median final height was -1.4 [-2.7; 1,5] SDS (n = 6), with a significant difference between height loss at diagnosis and total catch-up growth (p = 0.003). The other nine patients were also given growth hormone (GH). They were smaller at diagnosis (p = 0.01); however, there was no difference in final height between those two groups (p = 0.68). CONCLUSION: Severe HH can lead to a major height deficit, and catch-up growth seems to be insufficient after treatment with HRT alone. In the most severe cases, administration of GH may enhance this catch-up.
Subject(s)
Human Growth Hormone , Hypothyroidism , Humans , Child , Retrospective Studies , Hypothyroidism/diagnosis , Hypothyroidism/drug therapy , Growth Disorders/etiology , Iodide Peroxidase , Body HeightABSTRACT
UNLABELLED: Hypothyroxinemia of prematurity (HTOP) is associated with neurodevelopmental impairment in pre-term newborns born at less than 32 weeks of gestation (WG). HTOP is not clearly defined in the literature and there is no consensus on whether or not treatment of HTOP is beneficial. OBJECTIVE: To describe the epidemiologic characteristics of HTOP and to determine the population at risk of HTOP. POPULATION AND METHODS: Ninety-seven pre-term newborns under 32 WG were prospectively included in this study. FT4 and thyroid-stimulating hormone (TSH) serum levels were assessed between day of life 5 and 7. HTOP was defined as serum level of FT4 0.80 ng/dl or less and TSH less than 20 mUI/l. RESULTS: The HTOP incidence was 29% in pre-term newborns under 32 WG and 64% in pre-term newborns 28 WG or less. FT4 levels were correlated with gestational age (P<0.001). The incidence of hypotension (61% vs 33%; P<0.05), patent ductus arteriosus (50% vs 17%; P<0.05), dopamine treatment (39% vs 16%; P<0.05), and hydrocortisone treatment (25% vs 6%; p<0.05) was higher in the HTOP group. Similarly, severe intracerebral hemorrhage (14% vs 0%; P<0.01) and hypothermic events under 36 °C (1.8 ± 1.7 vs 0.0 ± 0.4; P<0.05) were higher in the HTOP group. CONCLUSION: Incidence of HTOP is high in pre-term newborns born at less than 28 WG. Morbidity during the first week of life is higher in cases of HTOP. Whether or not treatment of all pre-term with l-thyroxin is beneficial is unknown. However, treatment of the subgroup of pre-term newborns under 28 WG with HTOP should be considered.
Subject(s)
Congenital Hypothyroidism/epidemiology , Infant, Premature , Thyroxine/deficiency , Cerebral Hemorrhage/epidemiology , Congenital Hypothyroidism/diagnosis , Gestational Age , Humans , Hypothermia/epidemiology , Infant, Newborn , Prospective Studies , Thyrotropin/blood , Thyroxine/bloodABSTRACT
The increasing prevalence of adolescent obesity justifies widespread effort and attention of the paediatrician. In order to manage, following points are to be documented: (I) weight status assessed on the basis of body mass index (BMI)split in two levels: obesity grade I: >or=97 ème centile, obesity grade 2: level IOTFC 30; (2) complete anamnesis including age at adiposity rebound and existence of overweight in family; (3) research of associated morbidity and medical risks;(4) assessment of food intake and feeding practice; (5) assessment of physical activity; (6) talk with the adolescent to assess the psychological status, looking after depressive symptoms, anxiety, loss of self esteem. Once the items are documented, it allowed making a plan to manage the obesity in alliance with the adolescent and his family.
Subject(s)
Obesity/therapy , Adolescent , Body Mass Index , Exercise , Humans , Obesity/psychology , Obesity/rehabilitation , Physician-Patient Relations , Practice Guidelines as Topic , Psychology, AdolescentSubject(s)
Esophageal Achalasia/complications , Growth Disorders/complications , Growth Hormone/deficiency , Adolescent , Deglutition Disorders/etiology , Dilatation , Esophageal Achalasia/diagnosis , Esophageal Achalasia/therapy , Esophagitis/etiology , Esophagoscopy , Female , Growth Disorders/diagnosis , Growth Disorders/drug therapy , Growth Hormone/therapeutic use , Humans , Vomiting/etiology , Weight LossABSTRACT
We report on a male adult and his son both affected with hitherto undescribed multiple congenital anomalies and mental retardation. Both have peculiar facies, cleft palate, short sature, congenital brevicollis and vertebral abnormalities. Chromosomal analysis is normal and an autosomal dominant mode of inheritance is most likely. Genetic aspects and clinical manifestations are compared with those of previous reports of Robin sequence or cleft palate, short stature and vertebral dysostosis.
