Indian Pediatr 2019;56: 331
High Prevalence of Thyroid Dysfunction in Children with
Devi Dayal* and T Sugantha Kumar
Department of Pediatrics, Advanced Pediatrics Center,
PGIMER, Chandigarh, India.
Exogenous obesity is associated with physical, psychological, metabolic
and hormonal problems which contribute to the increased risk of
cardiovascular diseases and diabetes in later life [1,2]. Amongst
hormonal disturbances, thyroid dysfunction is the most common . The
underlying mechanisms are poorly understood and include an adaptive
response to increase energy expenditure, hyperleptinemia, thyroid
hormone and insulin resistance, increased cytokine concentrations and
thyroid autoimmunity . The average prevalence of obesity-related
thyroid dysfunction in children is reported as 14% . However, the
prevalence in Indian obese children is unknown .
We performed a case record review of children aged
6-12 y having exogenous obesity (BMI >2 standard deviations above the
WHO 2007 Growth Reference median). Obesity-related thyroid dysfunction
was defined as elevation of TSH (4-10 mIU/L) with or without alterations
in total T4 (normal 4.5-11.5 ug/dL) or total T3 concentrations (normal
0.8-2.0 ng/mL). Of the 204 patients registered in the Pediatric Obesity
Clinic of our hospital between January 2017 and March 2018, 82 were
excluded either due to age criteria or an endogenous cause of obesity.
Fifty one (31.4%) of the remaining 162 with simple obesity were found to
have isolated hyper-thyrotropinemia. Children with or without isolated
hyperthyrotropinemia had similar mean (SD) weight Z-scores [3.48 (1.90)
vs. 3.13 (2.41), P=value 0.36], BMI Z-scores [4.01 (1.77)
vs. 4.35 (2.29), P=0.30], total T3 [2.03 (1.18) vs.
1.94 (0.52) ng/mL, P= 0.83] and total T4 [8.95 (2.18) vs.
8.87 (2.23) µg/dL, P= 0.68] concentrations. The mean (SD) TSH
values of children with and without isolated hyperthyrotropinemia were
5.70 (1.06) and 2.84 (0.81) mIU/L, respectively.
The prevalence of thyroid dysfunction in obese
children and adolescents has been reported to range between 9.2 and
22.2% . Studies from Nigeria, Denmark and Turkey show a low
prevalence (<15%); whereas, a higher prevalence has been reported from
Germany and Israel (17% and 22.2%), respectively . The reasons for
such a high prevalence in our study are unknown. Majority of the
previous studies included preschoolers and adolescents (age range 3-18
yr) whereas our children were of school-going age. Additionally, the
still poorly understood racial and ethnic differences in the
associations of body fatness with hormones and metabolic factors in
exogenous obesity may have an underlying role that needs exploration in
further studies . Although isolated hyperthyro-tropinemia does not
need any specific treatment except weight reduction, screening for
thyroid dysfunction is important in children with exogenous obesity.
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