This study sought to find out the correlation between serum concentration of thyroid hormones and grade of malnutrition among 60 children between 1-5 year having PEM. With increasing severity of malnutrition, the serum concentration of T3 and T4 progressively decreased and that of serum TSH increased.

Keywords: Goiter, Malnutrition, Thyroid hormones.
 

In this cross-sectional hospital based study, we evaluated thyroid functions in various grades of malnutrition. Sixty children having PEM between 1-5 years were selected by simple randomization and classified by weight for age according to Gomez classification. Each of Gomez group had 20 children. Cases admitted for serious illness or having other systemic diseases were excluded from the study. Serum levels of total T4, T3 and TSH were done by Chemiluminescence technique. Serum total proteins and albumin levels were estimated by standard Bromocrisol green.

Maximum cases were in age group of 12-36 months (n=47, 78.3%) with almost equal male: female ratio. There was a significant association between the severity of malnutrition with other basic anthropometric measurements (One way ANOVA test, P=0.02).  The mean serum total protein and albumin levels were significantly lower in grade II and III cases. With progressive increase of severity of malnutrition, the T3 level decreased significantly (P=0.04). The mean serum T4 level also showed a significant fall in grade III PEM (P=0.08). Serum TSH level progressively increased with increasing severity of malnutrition (one-way ANOVA; P=0.015. Few other studies also document similar hormonal changes in PEM (2-4). Low plasma T3 concentration may be brought about by decreased peripheral conversion of T4 to T3. The reduction in T3 has also been attributed to impaired thyroid binding proteins like TBG, TBPA and Albumin(5). Fasting and caloric content of the diets are important factors in metabolic conversion of T4. However, when the malnutrition becomes more severe, the reserves are exhausted and there is decreased thyroidal secretion rate as well, leading to lowered T4 in kwashiorkor and marasmic kwashiorkor.

In our study, there was significant increase in the mean level of TSH with increasing severity of malnutrition. Orbak, et al.(4) also found TSH level elevated in PEM. In short term and mild forms of PEM, the observed changes are limited to the thyroid hormonal transport system, and appropriate feedback mechanisms allow the maintenance of euthyroid state. Whereas, in chronic, more severe forms of PEM, the reserves are depleted causing a fall in thyroidal secretion rate and the thyroid adaptation may fail.

1. Turkay S, Gokalp A, Basin E, Onal A. Effects of protein energy  malnutrition on circulating thyroid hormones. Indian Pediatr 1995; 32:193-196.

3. Kalk W, Eafman KJ, Smit AM, Drimmelen MY, Walt LA, Moore RE. Thyroid hormone and carrier protein: interrelationships in children recovering from kwashiorkor. Am J Clin Nutr 1986; 46: 406-413.

4. Orbak Z, Akin Y, Varoglue E, Tan H. Serum thyroid hormone and thyroid gland weight in protein energy malnutrition. J Pediatr Endocrinol Metab 1998; 11: 719-724.