Is subclinical hypothyroidism increasing exogen obesity in children?

Öz

Background: We aimed to evaluate thyroid functions and subclinical hypothyroidism in obese children.

Methods: Fourty three children with exogenous obesity and 17 aged matched idiopathic short stature children (control group) were studied with anthropometric indices and basal thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), total thyroxine (TT4) and total triiodothyronine (TT3)  levels and they all underwent thyrotropin releasing hormone (TRH) stimulation test to determine TSH response.

Results: There were no significant difference in age, bone age, basal TSH, fT3, fT4, TT4 levels between obese and control group. Total triiodothyronine levels of obese group were significantly higher than control group (p=0.009). The maximum increment of TSH levels ( TSH)  and peak TSH levels in obese group were significantly lower than the control group (p=0.021, p=0.04 respectively). We evaluated obese children for TSH response and divided them into two groups; obese group 1 ( TSH response abnormally elevated) and obese group 2 (TSH response were normal), basal TSH levels of group 1 were found significantly higher than group 2 (p<0.001).

Conclusion: Thyrotropin releasing hormone stimulation test may be helpful to determine subclinical hypothyroidism in exogen obese children, if basal TSH levels were elevated.

Key words: 

Anahtar Kelimeler

• Children, obesity, subclinical hypothyroidism, thyrotropin releasing hormone stimulation test

Subklinik Hipotroidi Çocuklarda Egzojen Obeziteyi Artırıyor mu?

Öz

Amaç: Obez çocuklarda tiroid fonksiyonları ve subklinik hipotroidi değerlendirilmesi amaçlandı.

Gereç ve yöntemler: Kırküç obez çocuk ve kontrol grubu olarak benzer yaştaki 17 idiopatik boy kısalığı olan çocuk, antropometrik ölçümler, bazal tiroid stimule edici hormon (TSH), serbest triiodotronin (sT3), serbest tiroksin (sT4), total tiroksin (TT4), total triiodotronin (TT3) düzeyleri ve tirotropin salgılatıcı hormon (TRH) uyarı testine TSH yanıtı ile değerlendirildi.

Sonuçlar: Obez ve kontrol grubunun, yaş, kemik yaşı, bazal TSH, sT3, sT4, TT4 düzeyleri arasında fark saptanmadı. Obez grubun TT3 düzeyleri kontrol grubundan anlamlı olarak yüksekti(p=0.009). TSH düzeylerinin maksimum artışı ve pik TSH düzeyleri, obez grupta, kontrol grubuna göre anlamlı olarak düşüktü (sırasıyla p=0.021, p=0.04). Obez grup, TSH yanıtına göre değerlendirildiğinde; Grup 1 (Anormal artış gösteren TSH yanıtı olanlar) ve grup 2 (TSH yanıtı normal olanlar) olarak ikiye ayrıldı. Grup 1'in bazal TSH’sı, grup 2'den anlamlı olarak yüksekti (p<0.001).

Karar: Bazal TSH düzeyleri yüksek olan obez çocuklarda TRH uyarı testi subklinik hipotroidizmi belirlemede yardımcı olabilir.

 

Anahtar Kelimeler

• Çocuklar, obezite, subklinik hipotroidi, tirotropin salgılatıcı hormon uyarı testi

Kaynakça

1. Gahagan S. Overweight and Obesity. in Kliegman RM, Stanton B, Geme JS, Schor N, Behrman RE, eds. Nelson Textbook of Pediatrics, 19th Ed. United States of America: Elsevier, 2011; 179-87.
2. Dennis M, Styne MD. Childhood and adolescent obesity prevalence and significance. Pediatr Clin North Am 2001; 48 (4): 823-54.
3. Maffeis C. Aetiology of overweight and obesity in children and adolescents. Eur J Pediatr 2000;159 (s1): 35-44.
4. Rolland-Cachera MF. Childhood obesity: Current definitions and recommendations for their use. Int J Pediatr Obes, 2011; 6: 325–31.
5. Alemzahed R. Lifshitz F. Childhood obesity. In Lifshitz F. eds. Pediatric endocrinology 5th ed. New York: Informa Helthcare, 2007;1: 1-25.
6. Aypak C, Türedi O, Yüce A, Görpelioğlu S. Thyroid-stimulating hormone (TSH) level in nutritionally obese children and metabolic co-morbidity. J Pediatr Endocrinol Metab. 2013;26:703-8.
7. Stichel H, Allemand ID, Gruters A. Thyroid function and obesity in children and adolecents. Horm Res 2000; 54: 14-9.
8. Kabadi UM. Subclinical hypothyroidsim, natural cause of the syndrome during a prolonged follow up study. Arch Intern Med 1993; 153: 957-61.

9. Kaplowitz PB. Subclinical hypothyroidism in children: Normal variation or a sign of a failing thyroid gland? Int J Pediatr Endocrinol 2010; 281453 Available from URL: http://www.ijpeonline.com/content/2010/1/281453 [Accessed 2011 Aug 8]
10. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. California: Stanford Univercity press, 1959: 62-187
11. Nicholson JF, Pesce M.Reference ranges for laboratory tests and procedures. In Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics, 16th ed. Philadelphia: W.B.Saunders Co, 2000; 2181-2228.
12. Synder PJ, Utiger RD. Response to thyrotropin releasing hormone in normal man. J Clin Endocrinol Metab 1972; 34: 380-5.
13. Coiro V, Passeri M, Capretti L, et al..Serotonergic control of TSH and PRL secretion in obese men. Psychoneuroendocrinol 1990; 15 (4): 261-8.
14. Argenio G, Bernini G, Vivaldi MS, et al.. Effect of fenfluramine on prolactin and thyroid stimulating hormone response to thyrotropin releasing hormone in obese and normal women. Eur J Clin Pharmacol 1990; 39 (1): 13-16.
15. Lala V, Jamias P, Yogananda CS. Thyrotropin response to thyrotropin releasing hormone in children and adolescents with obesity. Pediatr Res 1984; 18 (169A): 442.
16. Lala VR, Ray A, Jamias P, Te D, Orteza N, Fiscina B, Noto R. Prolactin and thyroid status in prepubertal children with mild to moderate obesity. J Am Coll Nutr 1988; 7: 361-6.
17. Caccıari E, Frejaville E, Balsamo A, et al. Disordered prolactin secretion in obese child and adolescents. Arch Dis Child 1981; 56: 386-9.
18. Mancini A, Fiumara C, Conte G, et al.. Pyridostigmine effects on TSH response to TRH in adult and children obese subjects. Horm Metab Res 1993; 25: 309-11.
19. Marras V, Casini MR, Pilia S, Carta D, Civolani P, Porcu M, Uccheddu AP, Loche S. Thyroid function in obese children and adolescents. Horm Res Paediatr. 2010;73:193-7
20. Marhawa RK, Tandon N, Garg MK, Ganie MA, Narang A, Mehan N, Bhadra K. Impact of body mass index on throid functions in Indian children. Clin Endocrinol 2013; 79: 424-8.
21. Unüvar T, Anık A, Catlı G, Esen I, Abacı A, Büyükgebiz A, Böber E. Isolated hyperthyrotropinemia in childhood obesity and its relation with metabolic parameters. J Endocrinol Invest. 2014 Jun 12. [Epub ahead of print]
22. Emokpae MA, Adaleke SI, Uwumarongie HO. Subclinical hypothyroidism in childhood obesity and its correlation with lipoproteins. Afr J Med Sci. 2011; 40: 361-5.
23. Krotkiewski M. Thyroid hormones in the pathogenesis and treatment of obesity. Eur J Pharmacol 2002; 440: 85-98.
24. Proces S, Delgrange E, Borght TV, Jamart J,Donckier JE. Minor alterations in thyroid function tests assosiated with diabetes mellitus and obesity in outpatients without known thyroid illness. Acta Clinica Belgica 2001; 56: 86-90.
25. Reinehr T, Andler W. Thyroid hormones before and after weight loss in obesity. Arch Dis Child 2002; 87: 320-3.
26. Korbontis M. Leptin and the thyroid. A puzzle with missing pieces. Clin Endocinol 1998; 49: 569-72.
27. Pinkney HJ, Goodrick JK, Johnson BA, Lightman LS, Coppack WS, Vidya MA. Leptin and the pituitary thyroid axis: A comparative study in lean obese hypothyroid and hyperthyroid subjects. Clin Endocrinol 1998; 49: 583-8.
28. Abraham RR, Densem JW, Davies P, Davie MWJ, Wynn V. The effects of triiodothyronine on energy expenditure, nitrogen balance and rates of weight and fat loss in obese patients during prolonged caloric restriction. Int J Obes. 1985; 9: 433-42.
29. Carlson EH, Drenick JE, Chopra JI, Hersman MJ. Alterations in basal and stiumulated thyrotropin, prolactin and thyroid hormones in starved obese men. J Clin Endocrinol Metab 1977; 45: 707-13.
30. Chikunguwo S, Brethauer S, Nirujogi V, et al. Influence of obesity and surgical weight loss on thyroid hormone levels. Surg Obes Relat Dis. 2007;3:631-5.