Keselman Ana, Chiesa Ana, Malozowski Saúl, Vieytes Ana, Heinrich Juan Jorge, de Papendieck Laura Gruñeiro
Hospital de Niños Ricardo Gutiérrez, CEDIE, Buenos Aires, Argentina.
Horm Res. 2009;72(3):167-71. doi: 10.1159/000232492. Epub 2009 Sep 1.
Fifteen percent of small for gestational age (SGA) children remain short and undergo thyroid axis evaluations.
We analyzed data on thyroid assessment of 58 SGA children. Five had primary autoimmune hypothyroidism. In the remaining 53 patients, TSH, free T4 (FT4), antithyroid antibodies and 90-min TRH test results were analyzed. Patients were grouped into G1 (n = 27; normal) and G2 (n = 26; abnormal) according to their response to the TRH test compared with 30 normal children.
No differences were found in chronological age, gestational age, or birth weight standard deviation score (SDS) between groups. G2 showed higher SDS BMI at consultation (p < 0.05). FT4 (ng/dl) levels were similar in all groups, while basal TSH levels were statistically different in G2 compared with G1 and controls. In 21 G2 patients treated with thyroxine, FT4 levels did not change, TSH normalized, BMI SDS and height remained unchanged.
These data suggest that in SGA short children thyroid abnormalities may occur. Some of them may be due to a different setting of the hypothalamic-hypophyseal-thyroid axis during intrauterine life. Intrauterine growth retardation may permanently influence endocrine systems by affecting their programming during development. Further follow-up is needed to confirm these findings and to assess their natural history and potential clinical impact.
15%的小于胎龄（SGA）儿童身材矮小，并接受甲状腺轴评估。
我们分析了58例SGA儿童的甲状腺评估数据。其中5例患有原发性自身免疫性甲状腺功能减退症。对其余53例患者的促甲状腺激素（TSH）、游离甲状腺素（FT4）、抗甲状腺抗体及90分钟促甲状腺激素释放激素（TRH）试验结果进行了分析。与30例正常儿童相比，根据患者对TRH试验的反应将其分为G1组（n = 27；正常）和G2组（n = 26；异常）。
两组之间在实际年龄、胎龄或出生体重标准差评分（SDS）方面未发现差异。G2组在就诊时的SDS体重指数较高（p < 0.05）。所有组的FT4（ng/dl）水平相似，而G2组的基础TSH水平与G1组和对照组相比有统计学差异。在21例接受甲状腺素治疗的G2组患者中，FT4水平未改变，TSH恢复正常，BMI SDS和身高保持不变。
这些数据表明，SGA身材矮小儿童可能存在甲状腺异常。其中一些可能是由于宫内生活期间下丘脑 - 垂体 - 甲状腺轴的不同状态所致。宫内生长迟缓可能通过影响发育过程中的编程而永久性地影响内分泌系统。需要进一步随访以证实这些发现，并评估其自然病程和潜在的临床影响。
