Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism
Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism
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DOI：
10.1530/eje-10-0979
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发表时间：
2011-04-01
影响因子：
5.8
通讯作者：
Salerno, Mariacarolina
中科院分区：
文献类型：
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作者：
Cerbone, Manuela;Bravaccio, Carmela;Salerno, Mariacarolina
目的：亚临床甲状腺功能减退症(SH)的治疗一直存在争议，TSH值在4.5~10mU/L之间。这项横断面对照研究的目的是评估从未接受左旋甲状腺素治疗的持续性SH儿童的生长发育和智力结局。设计和方法：对36例9.7±0.6岁(4~18.0岁)持续性SH患儿的临床和发育指标、甲状腺功能和智力结局进行评估。从第一次诊断出SH到纳入研究，儿童被纵向跟踪了3.3+/-0.3年(范围2.0-9.3)年。结果：研究开始时，SH儿童身高(-0.8+/-0.2)、骨龄/骨龄(BA/CA比值0.92+/-0.6)、体重指数(BMI-0.1+/-0.2)正常。尽管SH持续时间较长，但在首次SH检测时，这些参数在身高(-0.7+/-0.2 SDS)、BA/CA(0.97+/-0.03)和BMI(-0.1+/-0.2)方面均未显示恶化。在随访期间，所有儿童均未出现明显的甲状腺功能减退症状或体征。言语智商(99.1+/-2.2)、操作智商(100.4+/-1.9)和总分智商(99.7+-1.9)正常，与对照组相当。结论：儿童持续性SH与生长发育、骨成熟、BMI和认知功能的改变或其他可归因于SH的主诉无关，即使在没有治疗干预的情况下也是如此。
Objective: The treatment of children with subclinical hypothyroidism (SH) is controversial for TSH values between 4.5 and 10 mU/l. The aim of this cross-sectional, controlled study was to evaluate growth and intellectual outcome in children with persistent SH who have never been treated with levothyroxine.Design and methods: Clinical and auxological parameters, thyroid function, and intellectual outcome were evaluated in 36 children with persistent SH at the age of 9.7 +/- 0.6 (range 4-18.0) years. Children had been followed longitudinally for 3.3 +/- 0.3 (range 2.0-9.3) years, from first diagnosis of SH until enrollment in the study. Thirty-six age-and sex-matched children were enrolled in the study as controls.Results: At study entry, height (-0.8 +/- 0.2 SDS), bone age/chronological age (BA/CA ratio 0.92 +/- 0.6), and body mass index (BMI -0.1 +/- 0.2 SDS) in SH children were normal. Despite long-term duration of SH, none of these parameters showed a worsening with respect to height (-0.7 +/- 0.2 SDS), BA/CA (0.97 +/- 0.03), and BMI (-0.1 +/- 0.2) at the time of first SH detection. None of the children showed overt signs or symptoms of hypothyroidism during the follow-up. Verbal (99.1 +/- 2.2), performance (100.4 +/- 1.9), and full-scale (99.7 +/- 1.9) intelligence quotient (IQ) scores in SH children were normal and comparable to those of controls. No relationship was detected between IQ scores and the degree or duration of SH.Conclusions: Persistent SH in children is not associated with alterations in growth, bone maturation, BMI, and cognitive function or other complaints that could be ascribed to SH even after several years without therapeutic intervention.