Changes And Significance Of Thyroid Function In Children With Short Stature Before And After Treatment With Recombinant Human Growth Hormone

Objectives To observe the changes of thyroid hormone levels in children with short stature before and after treatment with recombinant human growth hormone(rh GH).Analyze the correlation between thyroid function and growth parameters and serological indicators.So as to explore the effect of rh GH on thyroid function in children with short stature,and to explore the clinical significance of follow-up thyroid function during rh GH.Methods One hundred and sixty-nine children with short stature who were treated with recombinant human growth hormone were selected as research objects,including 69 children with growth hormone deficiency(GHD)and 99 children with idiopathic short stature(ISS).Recombinant human growth hormone was administered subcutaneously before bedtime,and the therapeutic dose was 0.10-0.20IU/(kg·d).The total treatment course is at least one year,the children were monitored every 3 months,including height(Ht),weight(Wt),body mass index(BMI),height standard deviation score(Ht SDS),insulin-like growth factor-1(IGF-1),alkaline phosphatase(ALP),total three iodine thyroidic acid(TT3),total four iodine thyroidic acid(TT4),thyroid-stimulating hormone(TSH).Analysis to compare the changes of growth parameters and thyroid hormones in children with short stature before and after treatment,and to analyze the correlation between thyroid hormones and growth parameters and other metabolic indexes.Results 1 Before treatment,compared with ISS group,IGF-1 in GHD group was lower than that in ISS group(P=0.008),and other growth indexes had no statistical difference(P>0.05).2 The growth indexes,such as Ht,Ht SDS,Wt and IGF-1,of children with short stature after treatment were significantly higher than those before treatment(P<0.05).3 TT3,TT3/TT4 of children with short stature increased at 3 months,6 months and9 months after treatment compared with those before treatment(P<0.001),and about4.8% and 3.6% of patients’ TT3 increased beyond the normal range at 3 months and 9months after treatment,but TT3 returned to normal at 12 months.There was no significant difference in TT4 and TSH during treatment compared with before treatment(P>0.05).4 The change of thyroid hormone level in children in GHD group was mainly the increase of TT3 in 3 months and 9 months after treatment(P<0.05).Although about2.9% of children’s TT3 increased beyond the normal range,the proportion of abnormal children was not statistically different,and TT3 returned to the baseline level after 12 months of treatment.5 The changes of thyroid hormone level in ISS group mainly included the increase of TT3 at 3 months and 6 months after treatment(P<0.05)and the increase of TT3/TT4 at 3 months and 9 months after treatment(P<0.05).At 3 months and6 months after treatment,about 6.1% and 5.1% of the children’s TT3 increased beyond the normal range,but then TT3 gradually recovered to the level before treatment.6 TT3 in the low-dose group increased 3 months after treatment(P=0.021).At this time,about4.5%of the children had abnormal TT3,but there was no statistical difference in the abnormal ratio.At 6 months,9 months and 12 months after treatment,TT3 returned to the baseline level.TT4 and TSH did not change significantly during the treatment.7 TT3and TT3/TT4 in the high-dose group were higher than those before treatment at 3 months,6 months and 9 months(P<0.05),and about 5.1%,8.9%and 3.8%of the children had abnormal TT3,but at 12 months after treatment,TT3 and TT3/TT4 all returned to the level before treatment.TT4 has no change compared with that before treatment;TSH decreased after 12 months of treatment compared with that before treatment(P=0.012),but the decrease beyond the normal range accounted for about 1.3%of children,and there was no statistical significance.8 The changes of TT3/TT4 in children with short stature are related to Age,Ht,Wt,IGF-1 and ALP.Conclusions 1 The thyroid function of children with short stature can be changed transiently after the application of recombinant human growth hormone,and the effect is slight,so no special treatment is needed.In the course of treatment,we should pay attention to the changes of thyroid function in children with idiopathic short stature and high-dose medication.2 Considering the financial burden and follow-up compliance of the families of children with short stature,the period of monitoring thyroid function can be appropriately extended.Figure12;Table 33;Reference 121...