Abstract
Long term growth was assessed in 17 girls (F) and 6 boys (M) presenting with hypothyroidism at ages 11.4±2.6 (m±SD) and 10.2±4.7 yrs. Bone ages (F 6.2±3 and M 6.1±2.7 yrs, GreulichPyle) and growth pattern suggested duration of hypothyroidism >3 yrs. Pre-illness heights were 0.27±.12(7F) and 0.39±.15 (4M) SD scores (SDS) above average. At diagnosis height SDS had fallen to −4.04±.5 (F) and −4.15±.5 (M) (height ages 7 and 7.1 yrs) but predicted heights (Bailey-Pinneau) were normal (F 155±7.5 and M 177 ± 7.7 cm). Serum T4 was 1.1 ± 0.3 ug/dl and TSH 570±255 mIU/ml at diagnosis. On T4 therapy (3.4±.3 ug/kg/day) serum T4 averaged 9.6±2.5 ug/dl and TSH 2.9±3.9 mIU/ml. Concomitant with onset or progression of puberty during the first 18 mos of therapy change in skeletal maturation (ΔBA) exceeded that of height age (ΔHA) resulting in loss of predicted mature height;ΔBA/ΔHA ratio 1.73±3.5 (F) and 2.1±.46 (M). This loss was proportional to duration of hypothyroidism. Adult height SDS were lower than pre-illness SDS (7F=−2.62±.16 and 4 M=−1.9±.19) and mature heights were also lower than predicted height at diagnosis. Adult females stood 149±5 cm (HA 11.6 yrs) and males 168±5.1 cm (HA 14.7yrs).
Conclusion: Prolonged juvenile hypothyroidism results in permanent height deficit. This loss is proportional to duration of illness and is not due to excessive T4 therapy. The data tempt speculation that delay of puberty might ameliorate the height deficit.
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Rivkees, S., Crawford, J. & Bode, H. LONG TERM GROWTH IN JUVENILE ACQUIRED HYPOTHYROIDISM. Pediatr Res 21 (Suppl 4), 253 (1987). https://doi.org/10.1203/00006450-198704010-00514
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DOI: https://doi.org/10.1203/00006450-198704010-00514