ABSTRACT
INTRODUCTION: The specific treatment of thyroid dysfunction associated with simple obesity (SO) in children is controversial. MATERIAL AND METHODS: Fifty-one children having SO (BMI ≥ 2 Z-score) aged 6-12 years with elevation of serum thyroid stimulating hormone (TSH) (4-10 mIU/l) with or without alterations in serum triiodothyronine (T3) or thyroxine (T4) were randomised to receive either routine weight management intervention (group 1, n = 25) or additional low dose levothyroxine (~0.5 µg/kg/day) (group 2, n = 26) and followed up at 3-month intervals for 6 months. RESULTS: The mean BMI Z-scores decreased in both groups from baseline to 3 and 6-month time points (group 1, 3.69 ±1.31 to 3.24 ±1.45 to 2.84 ±1.46, p = 0.03 and group 2, 4.31 ±2.11 to 4.08 ±1.92 to 3.50 ±1.93, p = 0.02). However, the decrease was similar in the 2 groups (-0.80 ±0.77 vs -0.97 ±0.69, p = 0.19). All children had isolated hyperthyrotropinemia. The mean TSH levels decreased from baseline to endpoint in group 1 (5.51 ±1.0 to 4.14 ±1.0 to 4.04 ±1.1 mIU/l, mean change -1.44 ±1.20, p = 0.001) and in group 2 (5.89 ±1.10 to 5.89 ±1.10 to 3.89 ±1.48 mIU/l, mean change -1.93 ±1.15, p = 0.001). The decrease in TSH levels was also similar in the 2 groups (p = 0.69). TSH normalized in 48% and 57.6% in group 1 and group 2 respectively. The decrease in total cholesterol and triglyc-erides was also similar in the 2 groups. CONCLUSIONS: Addition of levothyroxine to weight management interventions has no beneficial effect on BMI reduction as well as parameters of lipid and thyroid profiles, and should not be prescribed to children with obesity associated thyroid dysfunction.
Subject(s)
Obesity/complications , Thyroid Diseases/drug therapy , Thyrotropin/blood , Thyroxine/therapeutic use , Case-Control Studies , Child , Female , Humans , Male , Prospective Studies , Random Allocation , Thyroid Diseases/blood , Thyroid Diseases/etiology , Treatment Outcome , Triiodothyronine/bloodABSTRACT
A three-months boy presented with recurrent seizures. On examination, he was fair, had dilated scalp veins, sparse hypopigmented hair, and was hypotonic. X-ray of the skull showed wormian bones. The child was diagnosed with Menkes disease. The manuscript aims to emphasize dilated scalp veins in diagnosis of Menkes disease.
