Subclinical Hypothyroidism as the Most Common Thyroid Dysfunction Status in Children With Down's Syndrome.

Kamila Szeliga,Barbara Kalina-Faska,Aleksandra Antosz,Aleksandra Januszek-Trzciakowska,Aneta Gawlik,Karolina Skrzynska

doi:10.3389/fendo.2021.782865

Kamila Szeliga, Barbara Kalina-Faska + Show 4 more

Open Access

https://doi.org/10.3389/fendo.2021.782865

Copy DOI

Abstract

IntroductionThyroid dysfunctions are one of the most common abnormalities coexisting in children with Down’s syndrome (DS) and have been reported in up to 54% of cases.Aim of the StudyThe purposes of this retrospective study were to investigate the course of subclinical hypothyroidism in children with DS, to evaluate the thyroid function of these subjects in relation to the risk of developing overt thyroid disease and autoimmunity, and to identify clinical and biochemical characteristics of patients prescribed L-T4 therapy in children and adolescents with DS and SH.Material and MethodsThe records of DS patients referred to the Endocrinology Outpatient Clinic between 2010 and 2015 for screening of thyroid function were observed till the end of 2019 June and analyzed retrospectively. The children diagnosed with congenital hypothyroidism, acute lymphoblastic leukemia, and seizures and treated with drugs that may have interfered with thyroid function like lithium, antiepileptic, or iodinated drugs and glucocorticoids were excluded from the study.ResultsThe data of 77 DS patients were collected, evaluated, and analyzed. The study group consisted of 73 patients (32 girls and 41 boys with the mean age at baseline of 3.0 ± 4.5 years). A total of 63/73 (87%) children were diagnosed with SH. The 16/63 (25.4%) patients were followed-up without the treatment (group SH-T0), and therapy with levothyroxine (L-T4) was introduced in 47/63 (74.6%) SH children with a mean dosage of 1.8 ± 1.0 μg/kg/day (group SH-T1). Thyroxine supplementation did not improve growth expressed as ΔhSDS (0.1 ± 1.3, ranged −2.1 to 3.8 in SH-T0 vs. 0.0 ± 0.7, ranged −1.7 to 1.4 in SH-T1, p = 0.96) and ΔBMI Z-score (0.3 ± 0.9, ranged −0.9 to 2.6 in SH-T0 vs. 0.3 ± 1.1, ranged −2.1 to 2.9 in SH-T1, p = 0.65). Positive anti-TPO and anti-TG antibodies were detected in 7/63 (11.1%) DS cases.ConclusionsSH is the most frequent presentation of thyroid gland dysfunction in DS children. A small percentage of patients develop an overt hypothyroidism, particularly in females with mostly positive titer of antithyroid autoantibodies.

Highlights

Thyroid dysfunctions are one of the most common abnormalities coexisting in children with Down’s syndrome (DS) and have been reported in up to 54% of cases
We excluded from the study the children who were treated with drugs that may have interfered with thyroid function like lithium, antiepileptic drugs, glucocorticoids, or iodinated drugs, as well as the patients who were diagnosed with acute lymphoblastic leukemia and seizures
Four patients were excluded from the study: 3 children diagnosed and treated because of acute lymphoblastic leukemia and 1 patient was lost to follow-up

Summary

Introduction

Thyroid dysfunctions are one of the most common abnormalities coexisting in children with Down’s syndrome (DS) and have been reported in up to 54% of cases. Thyroid dysfunctions are one of the most common abnormalities coexisting in DS children and have been reported in up to 28%–40% of the patients with the frequency increasing with age up to 54% [5,6,7]. It is suspected that in the infants and young children with DS, the subclinical thyroid dysfunction is caused by the delay in the maturation of the hypothalamic-pituitary-thyroid axis (HPT) and is probably a transitory and self-limiting process not requiring treatment [12, 13]. Receptor resistance is suspected [14]

Methods

Results

Conclusion