Thyroid Function In Children Research Articles

Early life air pollution exposures and thyroid function in children: A prospective cohort study

Studies on early life ambient air pollution exposures and childhood thyroid function are scarce. This study aimed to evaluate the relationships between early life fine particulate matter (≤2.5 μm; PM2.5) and nitrogen dioxide (NO2) exposures and thyroid function in children. We measured the levels of thyrotropin, triiodothyronine, and free thyroxine in children (n = 684) residing in a rural Korean area at age 2, 4, 6, or 8 years from 2012 to 2020 in the Environment and Development of Children cohort. The relationship between residential average exposure levels of PM2.5 and NO2 during pregnancy and 1-year average levels before visit and thyroid function during childhood were analyzed. Inverse association between increases of 10 μg/m3 in PM2.5 during the first trimester and thyrotropin levels at aged 4 (β, −0.12; 95% CI: −0.22, −0.02) and 6 years (β, −0.16; 95% CI: −0.26, −0.06) were observed. No association was found between PM2.5 exposure during the second and third trimester and childhood TSH levels. Childhood PM2.5 exposure was positively associated with thyrotropin rise at aged 4 (β, 0.2; 95% CI: 0.06, 0.35) and 6 years (β, 0.16; 95% CI: 0.02, 0.29) and inversely related with free thyroxine levels at aged 8 years (β, −0.04; 95% CI: −0.07, −0.01). No relationship between NO2 exposure and thyroid function was found. In conclusion, association between PM2.5 exposure and childhood thyrotropin levels varied depending on exposure timing. Early gestational exposure showed an inverse relationship, whereas childhood exposure were positively associated with childhood thyrotropin levels. The long-term effects of early life air pollution exposure and underlying mechanisms should be investigated in future studies.

Evaluation of thyroid profile among children aged 1-15 years with nephrotic syndrome: An observation study.

The interaction between the kidney and the thyroid is important for normal function of both organs. In nephrotic syndrome, proteinuria leads to loss of several proteins, which in turn causes hypothyroidism. To assess the thyroid function in children with nephrotic syndrome. This cross-sectional study was conducted in a tertiary center, Bhopal, from February 2020 to January 2021. Consecutive children aged 1-15 years admitted with nephrotic syndrome (first-time diagnosed and all relapse cases) were included in the study. A thyroid profile was sent along with routine investigations, and thyroid hormone status was assessed in nephrotic syndrome children. Of the 70 patients, 39 (55.7%) showed abnormal thyroid profiles; 19 (27.1%) had overt hypothyroidism, and 20 (28.6%) had subclinical hypothyroidism. Overt hypothyroidism was seen in 16.1% of newly diagnosed cases, 40% of second relapses, and 2.7% of frequently relapsed cases (P < 0.001). The mean serum free T3 and free T4 levels in frequent relapses were 2.50 ± 0.39 ng/dL and 0.78 ± 0.12 ng/dL, respectively, which were significantly lower than in newly diagnosed cases (2.77 ± 0.37 ng/dL and 0.91 ± 0.19 ng/dL, respectively). The mean thyroid-stimulating hormone (TSH) level was significantly higher in frequent relapses 5.86 ± 1.56 µIU/mL) and second relapse (5.81 ± 1.78 µIU/mL) than in newly diagnosed cases (4.83 ± 0.76 µIU/mL) and first relapse cases (4.74 ± 1.17 µIU/mL), (P < 0.01). An abnormal thyroid profile was commonly observed in children with nephrotic syndrome, and overt hypothyroidism was more common in frequent relapse cases. Therefore, thyroid screening should be a part of the management of nephrotic syndrome so that hypothyroidism can be detected and managed at an early stage.

Impact of Prenatal Environmental Exposures on Maternal and Child Thyroid Function

Impact of Prenatal Environmental Exposures on Maternal and Child Thyroid Function

Application of health belief model to assess periodic examination of thyroid functions in children among Saudi mothers

Background: Hypothyroidism is a common concern in the development of physical and cognitive development in children. The health belief model is one of the models that examines the factors behind people’s behaviors. Aim was to assess the periodic examination of children among Saudi mothers and its association with different constructs of the health belief model. Methods: This cross-sectional study was conducted among 385 participants of Saudi mothers for three months from January to April 2024 by using a designed structured questionnaire. Results: 88.05% of mothers showed poor behavior regarding periodic examinations of thyroid functions for their children. The significant factors that determined this behavior were the older mother’s age, working status (mother working), positive family history of hypothyroidism, good perceived benefits, and good cues to action. These factors were statistically significant at p value &lt;0.05. Conclusions: Most of the mothers who participated in this study showed poor behavior regarding the regular examination of thyroid function tests of their children. Factors such as the older mother’s age, working status (working mother), positive family history of thyroid issues, good perceived benefits of the exams, and good cues to action were found to be significantly associated with mothers’ behavior towards this regular examination of thyroid function.

Clinical course of congenital hypothyroidism with gland in situ and necessity of L-thyroxine therapy after re-evaluation.

Clinical course and need for long-term L-thyroxine (LT4) therapy of congenital hypothyroidism (CH) with gland in situ (GIS) remain unclear. To describe the clinical history of CH with GIS and evaluate the proportion of patients who can suspend therapy during follow-up. Retrospective evaluation of patients followed at referral regional center for CH of Pisa. 77 patients with confirmed primary CH and GIS after positive neonatal screening were included. All children started LT4 at CH confirm. At 3 years of age, 55 children underwent a clinical re-evaluation after withdrawal of therapy with hormonal examinations, imaging of the thyroid gland with ultrasonography and 123-iodine with perchlorate discharge test. Subsequent periodic controls of thyroid function were executed and, when possible, a new attempt to stop LT4 was performed. Adequate follow-up data (at least 6 months after treatment suspension trial) were available for 49 patients. Among the 55 patients who were reassessed, 18 (32.7%) were euthyroid. Considering subsequent follow-up, 49% of patients were no longer treated and 51% were taking therapy. No differences in neonatal parameters were observed between the two groups; LT4 dose before the last trial off medication was higher in permanent CH (p 0.016). Monitoring of thyroid function in children with CH and GIS is necessary to evaluate the need for substitution and avoid overtreatment. Even if therapy can be suspended, patients need to be monitored because apparently normal thyroid function may decline several months after withdrawal of LT4.

The Effect of Antiseizure Medications on Thyroid Functions in Children With Epilepsy

In this study, we aimed to investigate the effects of antiseizure medications on serum thyroid-stimulating hormone (TSH), free thyroxin (fT4) levels, and the frequency of subclinical hypothyroidism in children with epilepsy. One hundred and eighty-one pediatric patients receiving valproate, phenobarbital, carbamazepine, and levetiracetam monotherapy were included. The serum TSH levels were significantly higher at 6th, 12th, and 18th months of the treatment compared with the pre-treatment levels in valproate-treated patients. Serum fT4 levels in carbamazepine group were significantly lower than levetiracetam, valproate, and phenobarbital groups at 12th and 18th months of the treatment. Serum fT4 and TSH levels in levetiracetam group showed no significant changes at any time point. The frequency of subclinical hypothyroidism at 18th month was 16% in valproate, 11% in phenobarbital, 7% in carbamazepine, and 0% in levetiracetam groups. Our data suggest that levetiracetam monotherapy does not cause thyroid dysfunction.

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and Thyroid Function in Childhood Obesity: A Vicious Circle?

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a multisystem disorder characterized by the presence of fatty liver degeneration associated with excess adiposity or prediabetes/type 2 diabetes or metabolic dysregulation. An intricate relationship between the liver and thyroid has been reported in both health and disease. Simultaneously, there is a strong correlation between obesity and both MAFLD and thyroid dysfunction. In this narrative review, we highlighted the relationship between MAFLD and thyroid function in children and adolescents with obesity in order to explore how thyroid hormones (THs) act as predisposing factors in the onset, progression, and sustainability of MAFLD. THs are integral to the intricate balance of metabolic activities, ensuring energy homeostasis, and are indispensable for growth and development. Regarding liver homeostasis, THs have been suggested to interact with liver lipid homeostasis through a series of processes, including stimulating the entry of free fatty acids into the liver for esterification into triglycerides and increasing mitochondrial β-oxidation of fatty acids to impact hepatic lipid accumulation. The literature supports a correlation between MAFLD and obesity, THs and obesity, and MAFLD and THs; however, results in the pediatric population are very limited. Even though the underlying pathogenic mechanism involved in the relationship between MAFLD and thyroid function remains not fully elucidated, the role of THs as predisposing factors of MAFLD could be postulated. A potential vicious circle among these three conditions cannot be excluded. Identifying novel elements that may contribute to MAFLD could offer a practical approach to assessing children at risk of developing the condition.

Relation between Antiepileptic Drugs and Thyroid Function in Children with Epilepsy

Relation between Antiepileptic Drugs and Thyroid Function in Children with Epilepsy

Effect of anti-epileptic drugs usage on thyroid profile in Egyptian epileptic children

BackgroundThe long-term use of anti-seizure medications (ASMs) adversely affects thyroid, lipid profile and other metabolic functions. Subclinical hypothyroidism and alterations in thyroid hormone serum levels are reported with older ASMs in adults with limited and conflicting data of the influence of ASMs especially newer one on thyroid function in children. This study aimed to investigate the effects of conventional and newer ASMs whether mono or polytherapy on thyroid profile in children with epilepsy and its impact on lipid profile and metabolic functions.ResultsThis study included 155 children with epilepsy (76 on monotherapy and 79 on polytherapy) with mean age of 9.677 ± 3.981 years (54.84% euthyroid, 31.61% hypothyroid, 9.68% subclinical hyperthyroid and 3.87% subclinical hypothyroid) and 78 healthy controls. Children with epilepsy whether on monotherapy or on polytherapy had a statistically significant thyroid profile abnormalities (hypothyroidism, sub-clinical hypothyroidism or sub-clinical hyperthyroidism), dyslipidemia, delayed growth and increase in DBP compared to control group. There was a statistically significant positive correlation between hypothyroidism and dyslipidemia as well as between hypothyroidism and delayed growth and increase in DBP. There was no statistically significant difference between polytherapy and monotherapy regarding thyroid and lipid parameters but children with epilepsy on polytherapy were associated with more statistically significant delay in growth and increase in DBP compared to monotherapy group. Carbamazepine had a statistically significant association with hypothyroidism, increase in DBP and higher total and LDL-cholesterol. Valproic acid had a statistically significant association with sub-clinical hypothyroidism with a positive dose correlation. Levetiracetam (LEV) was associated with a statistically significant lower HDL-cholesterol. All echocardiography data showed no abnormality.ConclusionASMs whether older or newer generations can affect thyroid and lipid profile differently through different mechanisms that are dose and duration dependent regardless of the seizure type and age of the patient. ASMs mainly conventional ones are associated with hypothyroidism, sub-clinical hypothyroidism, sub-clinical hyperthyroidism, dyslipidemia and consequently delayed growth and diastolic blood pressure abnormalities.

Assessment of thyroid function in children and adolescents with chronic liver diseases

Introduction The majority of hepatic patients are clinically euthyroid. However, liver disorders may alter thyroid hormone metabolism, including substantial abnormalities of either euthyroid sick syndrome (ESS), autoimmune thyroid disorders, or subclinical hypothyroidism (SH). But there are few studies conducted on children with chronic liver diseases (CLD) to assess thyroid functions. Aim The study aimed to evaluate thyroid profiles in patients with CLD. Patients and methods An observational, cross-sectional study including patients with CLD attending Hepatology Clinic at Alexandria University Children’s Hospital from June 2021 to June 2022. One hundred and two children were included and a history taking and clinical examination were performed. Assessment of severity using a modified Child–Pugh score was done. Laboratory investigations in the form of liver, lipid, and thyroid profiles were done. Results One hundred and two children with CLD were included in this study, 50 (49.0%) females and 52 (51.0%) males. The most common diagnosis in the studied cases was autoimmune hepatitis (24.5%), followed by glycogen storage disease. Out of 14 (13.7%) aberrant outcomes of thyroid function, seven (6.9%) patients had ESS, and seven (6.9%) individuals had SH. By univariate analysis, alkaline phosphatase and serum albumin level were significant risk factors for SH. Furthermore, melena and hepatic encephalopathy were significant risk factors for ESS. Conclusion Thyroid dysfunction might occur in CLDs either in the form of SH or ESS. The prevalence of thyroid disease in children with CLD exceeded 10%, which signifies the importance of screening for thyroid dysfunctions in this cohort.

FRI478 Pharmacometrics-based Computer Model Utilizing Heart Rate To Monitor Thyroid Function In Children With Graves' Disease

Abstract Disclosure: B. Steffens: None. G. Koch: None. F. Claude: None. F. Bachmann: None. J. Schropp: None. M. Janner: None. D. l'Allemand: None. D. Konrad: None. M. Pfister: None. G. Szinnai: None. Graves’ disease (GD) with onset in childhood or adolescence is a pediatric rare disease (ORPHA:525731) with a ten times lower incidence than in adults. Leading clinical signs of hyperthyroidism are sinus tachycardia, weight loss, tremor, and goiter. First-line treatment are anti-thyroid drugs in order to normalize thyroid function. However, dose finding in pediatric GD is complex due to a broad spectrum of disease severity at diagnosis, and highly variable disease activity during follow-up, especially during puberty. As thyroid hormones have a strong positive chronotropic effect, heart rate (HR) turns out to be a useful clinical marker to monitor thyroid activity under treatment. Our overall aim was to provide a practical pharmacometrics-based (PMX-based) computer model characterizing both, individual FT4 dynamics and the relation between FT4 and tachycardia in children with various disease severity of GD during the first 120 days of treatment. Development of the PMX computer model was based on the non-linear mixed effects approach (i) linking FT4 kinetics with HR dynamics, (ii) accounting for inter-individual variability, and (iii) incorporating individual patient characteristics. Retrospectively collected clinical (resting heart rate during consultation) and laboratory data (FT4) from 41 children and adolescents with GD at four pediatric hospitals in Switzerland (75% female, median age 11.2 [IQR 8.5, 13.5] years) with 187 FT4 measurements and 132 HR measurements, and 124 paired measurements, were available and used for model development. Pediatric patients showed median FT4 of 59.6 [IQR 44.5, 73.0] pmol/l and median HR of 112 [IQR 100, 128] bpm at diagnosis. GD severity groups were defined based on FT4 measurement at diagnosis, resulting in equal numbers of mild (13), moderate (14) and severe (14) GD. We observed a significant difference in HR at diagnosis (p &amp;lt; 0.01) between the three GD severity groups based on FT4 at diagnosis. The final PMX computer model accounted for inter-individual variability and clinically relevant covariate effects such as age, gender, and GD severity, and was able to accurately predict FT4 and HR dynamics for each individual patient during the first 120 days of treatment. A PMX-based computer model that leverages individual HR dynamics can be applied to facilitate personalized pharmacotherapy in pediatric GD and mitigate the risk for under- or overdosing of anti-thyroid drugs in these patients. Prospective randomized validation trials are warranted to further validate and fine-tune such computer-supported personalized dosing in children with Graves’ disease. Presentation: Friday, June 16, 2023

A study of plasma proteins (serum total protein, serum albumin), and thyroid function in children with protein-energy malnutrition

Background: The study's objective was to evaluate and compare total serum protein, serum albumin, and thyroid hormones in children with PEM (protein-energy malnutrition) and healthy controls. Methods: In this cross-sectional study, 100 children with PEM served as cases, while an equal number of age and gender-matched healthy children served as controls. 4 ml of venous blood were taken (3 ml in a plain vial and 1 ml in an EDTA vial) and immediately submitted for further investigation. SPSS software (version 25) was used to analyze the data. A p value of ≤0.05 was considered statistically significant. Results: PEM children have lower serum total protein, albumin level, total T3 (TT3), and total T4 (TT4) levels compared to healthy controls (p&lt;0.0001). Mean TSH levels in cases and controls were nearly similar. There was no significant difference between serum TSH concentrations in PEM children and the controls. Grade I PEM had the highest mean total protein, serum albumin, T3, and T4 levels, followed by grades II, III, and IV. When mean total protein, serum albumin, T3, and T4 levels of each grade of PEM were compared to controls, mean total protein, serum albumin, T3, and T4 levels were substantially lower in each grade of PEM (p&lt;0.0001). Conclusions: PEM children have low serum total protein and albumin levels. This is probably due to decreased oral intake of proteins and reduced biosynthesis. Serum TT3 and TT4 levels are lower in children with PEM than in healthy controls, which is most likely due to reduction in circulating plasma proteins.

Thyroid Function in Children with Cyanotic and Non-Cyanotic Congenital Heart Disease.

Congenital heart disease (CHD) is one of the common diseases of childhood, which is classified into non-cyanotic and cyanotic types. It can affect thyroid function and lead to disruptions in thyroid hormone secretion and hypofunction. This study aimed to evaluate thyroid function in patients younger than 2 years old with cyanotic and non-cyanotic CHD. In our study, 101 patients (female/male: 50/51) were included. The thyroid-stimulating hormone and thyroid hormones such as thyroxine (T4) and triiodothyronine (T3) were measured using the electrochemiluminescence method, and thyroid peroxidase antibodies were measured by an enzyme-linked immunosorbent assay. Subclinical hypothyroidism referred to normal levels of T4, with elevated levels of thyroid-stimulating hormone in the serum. The frequency of subclinical hypothyroidism and hypothyroidism in patients with cyanotic CHD was estimated at 27.5% and 10%, respectively, and 1 patient had hyperthyroidism. The majority of cyanotic and non-cyanotic CHD cases were diagnosed with tetralogy of Fallot (30%) and patent ductus arteriosus (32.79%). There were no significant differences between cyanotic and non-cyanotic groups regarding T3, T4, free T3, free T4, and anti-thyroid peroxidase antibody levels (0.389, 0.142, 0.354, 0.248, and 0.333, respectively). Based on the present findings, subclinical hypothyroidism is a common finding in cyanotic CHD patients during childhood, which is associated with increased levels of oxygen saturation, severity of cyanosis, and age.

Thyroid Function in patients with nephrotic syndrome

Nephrotic syndrome is a common pediatric kidney disease characterized by leakage of protein from the blood to the urine through damaged glomeruli. It is classically defined as nephrotic range proteinuria, hypoalbuminemia and edema. In children with nephrotic syndrome, it is probable to determine a hypothyroid state because of significant loss of thyroxine (T4) and triiodothyronine (T3) in the presence of proteinuria. This study aimed to evaluate the thyroid function in children with nephrotic syndrome and its correlation with the state of patients ( relapse or remission ). Methods: A comparative study was carried out on total of 60 patients with nephrotic syndrome (divided into two equal groups of 30 with remission and 30 with relapse ) in the age group from 1-18 years who admitted to department of nephrology in Babylon teaching hospital for Maternity and children from November 2020 to May 2021, serum albumin, serum cholesterol, thyroid stimulating hormone (TSH) and thyroxine( T4 )were done to all patients and the result compared. Result: The mean age of patients was (5.74 ± 3.77) years; most patients (N=42, 70.0%) were male. Hypothyroidism represents (N=19, 31.7%) of patients with nephrotic syndrome, while patients with normal thyroid function (euthyroid) represented (N=41, 68.3%). Significant differences existed between the means of TSH and T4 according to the patient's state (remission or relapse). There was a significant association between the state of patients and thyroid function tests. Among patients with relapse (N=19, 63.3%) presented with hypothyroidism and (N=11, 36.7%) of patients presented with normal thyroid function (euthyroid state), while among those with remission, all patients (N=30, 100%) presented with normal thyroid function (euthyroid state). In conclusion, hypothyroidism is more common in nephrotic syndrome patients during relapse, so it's important to assess thyroid function during relapse. Keywords: Thyroid, nephrotic syndrome, Nephrotic syndrome

Thyroid Function in Children with Down Syndrome

Thyroid Function in Children with Down Syndrome

Genetic determinants of thyroid function in children.

Genome-wide association studies in adults have identified 42 loci associated with thyroid stimulating hormone (TSH) and 21 loci associated with free thyroxine (FT4) concentrations. While biologically plausible, age-dependent effects have not been assessed. We aimed to study the association of previously identified genetic determinants of TSH and FT4 with TSH and FT4 concentrations in newborns and (pre)school children. We selected participants from three population-based prospective cohorts with data on genetic variants and thyroid function: Generation R (N = 2169 children, mean age 6 years; N = 2388 neonates, the Netherlands), the Avon Longitudinal Study of Parents and Children (ALSPAC; N = 3382, age 7.5 years, United Kingdom), and the Brisbane Longitudinal Twin Study (BLTS; N = 1680, age 12.1 years, Australia). The association of single nucleotide polymorphisms (SNPs) with TSH and FT4 concentrations was studied with multivariable linear regression models. Weighted polygenic risk scores (PRSs) were defined to combine SNP effects. In childhood, 30/60 SNPs were associated with TSH and 11/31 SNPs with FT4 after multiple testing correction. The effect sizes for AADAT, GLIS3, TM4SF4, and VEGFA were notably larger than in adults. The TSH PRS explained 5.3%-8.4% of the variability in TSH concentrations; the FT4 PRS explained 1.5%-4.2% of the variability in FT4 concentrations. Five TSH SNPs and no FT4 SNPs were associated with thyroid function in neonates. The effects of many known thyroid function SNPs are already apparent in childhood and some might be notably larger in children as compared to adults. These findings provide new knowledge about genetic regulation of thyroid function in early life.

Prevalence of iodine deficiency among vegan compared to vegetarian and omnivore children in the Czech Republic: cross-sectional study

BackgroundThe intake and homeostasis of iodine, an essential micronutrient that plays a vital role in thyroid physiology, is of particular concern with the increasing popularity of vegetarian (VG) and vegan (VN) diets. Children on these restrictive diets may be at risk of possible adverse effects on growth and development, but there is currently a lack of recent epidemiological studies on this topic.MethodsWe gathered clinical, anthropometric, and blood/urine data on iodine status and thyroid function from children aged 0–18 years who followed either a VG diet (n = 91), VN diet (n = 75), or omnivore diet (OM, n = 52). Cross-sectional comparison of the groups and linear regression was used. Stratified analyses were performed based on age (according to WHO): 0–5 years and 6–18 years.ResultsOur study revealed no significant differences in levels of thyroid-stimulating hormone (TSH), triiodothyronine (fT3), thyroglobulin (TG) or anti-thyroid peroxidase antibody (ATPOc) between the VG, VN, and OM groups. However, thyroxine (fT4) levels were found to be higher in the VN group compared to the OM group (15.00 ± 1.73 vs. 16.17 ± 1.82 pmol/l, p < 0.001). The presence of anti-thyroglobulin antibodies (AhTGc) was notably more common in the VG (18.2%)/VN (35.0%) groups than in the OM group (2.1%) (p < 0.001). Regarding iodine status, the concentration of iodine in spot urine (UIC) was found to be highest in the OM group (197.28 ± 105.35 vs. VG: 177.95 ± 155.88 vs. VN: 162.97 ± 164.51 µg/l, p < 0.001). Notably, the lowest (5.99 µg/l) and highest (991.80 µg/l) levels were measured in the VN group. Of the participants, 31 VN, 31 VG and 10 OM children met the criteria for iodine deficiency (i.e., UIC < 100 µg/l). We found that children with regular iodine supplementation had higher UIC (p < 0.001). Importantly, the median UIC was above 100 µg/l in all three groups, through the recommended intake (RDI) of iodine was rarely met throughout the groups.ConclusionWe have observed a trend to lower UIC values in VN as compared to OM. This trend is also reflected in the median UIC values, even though the median UIC values were above the WHO cut-off (e.g., 100 µg/l) for iodine deficiency in all dietary groups. These results suggest that VN and VG children may be more at higher risk of iodine deficiency, this theory is also supported by higher prevalence of AhTGc positivity. Further research is needed to investigate the long-term impact of these dietary patterns on iodine status and thyroid function in children. Given our findings, it may also be necessary to consider new guidelines for supplementing children following VG and VN diets to ensure their iodine needs are met.

Selenium level correlates negatively with antibodies but positively with thyroid function in children with down syndrome: an Indonesian study.

Children with Down syndrome (DS) are prone to developing autoimmune thyroid disease (AITD). Previous studies found lower selenium (Se) levels in children with AITD. Glutathione peroxidase-3 (GPx3) and selenoprotein-P (SePP) are widely used to measure Se levels. DS children tend to have lower Se levels, the main contributor to hypothyroidism in this population. This study aimed to analyze the Se's role in AITD in Indonesian children with DS. This cross-sectional study was conducted between February 2021-June 2022 at the Pediatric Outpatient Clinic of Dr Soetomo Hospital. DS children aged 1 month to 18 years were enrolled using consecutive sampling. Thyroid-stimulating hormone, free thyroxine, thyroid peroxidase (TPO-Ab) and thyroglobulin (Tg-Ab) autoantibody, GPx3, and SePP levels were measured in plasma samples using enzyme-linked immunosorbent assays. Statistical analyses used Chi-square, Mann-Whitney, and Spearman's rank correlation (r s). All results with p<0.05 were considered statistically significant. Among 62 children with DS, SePP and GPx3 levels were significantly lower in those with AITD than those without AITD (p=0.013 and p=0.018, respectively). SePP and GPx3 levels correlated significantly with lower TPO-Ab (r s=-0.439 with p=1×10-5 and r s=-0.396 with p=0.001, respectively) and Tg-Ab (r s=-0.474 with p=1×10-5 and r s=-0.410 with p=0.001, respectively) levels. SePP levels correlated significantly with lower thyroid dysfunction incidence (r s=-0.252, p=0.048) in the AITD group. Selenium deficiency contributes to autoimmune process in the thyroid and to thyroid dysfunction in children with Down syndrome. Our findings recommend increasing Se levels through Se-containing foods to reduce the risks of AITD and thyroid dysfunction in DS children with AITD.

Association between non-alcoholic fatty liver disease and subclinical hypothyroidism in children with obesity.

We aimed (i) evaluating the relationship between non-alcoholic fatty liver disease (NAFLD) and thyroid function tests, (ii) testing if the relationship between NAFLD and thyroid dysfunction could be driven by the obesity and the IR degree, and (iii) exploring the influence of the patatin-like phospholipase domain-containing protein-3 (PNPLA3) I148Mand the transmembrane 6 superfamily member 2 (TM6SF2) E167K polymorphisms on the association between NAFLD and thyroid function in children. We examined 2275 children and adolescents with obesity. Subclinical hypothyroidism (SH) was defined by thyroid-stimulating hormone (TSH) > 4.2μUI/ml with normal fT3 and fT4. Children with NAFLD showed higher SH prevalence than those without NAFLD (15.7% Vs 7.4%;p = 0.001) and showed an adjusted odds ratio (aOR) to have SH of 1.68 (95% CI:1.01-2.80;p = 0.04) while patients with SH had an aOR to show NAFLD of 2.13(95% CI:1.22-3.73;p = 0.008). Patients having severe obesity and IR degree presented an aOR to show both NAFLD and SH of 3.61 (95% CI:1.78-7.33;p < 0.0001). Subjects with NAFLD carrying the TM6SF2 167K allele had lower TSH levels than non-carriers (p = 0.03) and showed an aOR to have SH of 0.10 (95% CI: 0.01-0.79;p = 0.02). No differences were found in carriers of the PNPLA3 148M allele. A general linear model for TSH variance showed a significant association of TSH with TM6SF2 genotypes only in the NAFLD group (p = 0.001). Children with obesity and NAFLD presented increase risk of SH and vice versa likely due to the adverse effect of duration of obesity, obesity degree, and IR. The TM6SF2 E167K exerts a protective role against SH in children with obesity and NAFLD.

Impacto da COVID-19 sobre a função tireoidiana de crianças e adolescentes: uma revisão integrativa

OBJECTIVE: To evaluate changes in thyroid function associated with COVID-19 in pediatric patients, their etiology, clinical and laboratory profile, as well as evolution. METHODS: A search was carried out in PubMed, Scielo, Lilacs and Google Scholar databases, between january 2020 and july 2022, through the combination of the descriptors: COVID-19, thyroid function, and pediatric population, in accordance with MeSH and DeSC, and in Portuguese, English and Spanish. RESULTS: After applying the inclusion and exclusion criteria, 8 of the 842 articles found were considered eligible for review, totalling a sample of 288 patients, aged 1 month to 18 years, affected by different forms of thyroid function disfunctions related to COVID-19, including subacute thyroiditis, TSH elevation in patients with pediatric multisystem inflammatory syndrome, euthyroid sick syndrome, and autoimmune hyper or hypothyroidism diagnosed after COVID-19 or exacerbated by the infection. The articles suggest that periodic assessment of thyroid function in children and adolescents affected by COVID-19 may allow screening of asymptomatic patients and early elucidate clinical conditions associated to thyroid pathology in the post-SARSCoV-2 infection period. CONCLUSIONS: The analysed articles, despite their small number, are relevant because they describe illustrative cases of thyroid dysfunction related to COVID-19 infection in the pediatric population. This work also points to the need for further studies in children and adolescents to define more precisely the evolution of these thyroid disfunctions, the best way to investigate them, and their most appropriate management, considering that thyroid function is essential for a full pediatric development.