Department of Pediatrics, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
Eur J Endocrinol. 2011 Apr;164(4):591-7. doi: 10.1530/EJE-10-0979. Epub 2011 Feb 3.
The treatment of children with subclinical hypothyroidism (SH) is controversial for TSH values between 4.5 and 10 mU/l. The aim of this cross-sectional, controlled study was to evaluate growth and intellectual outcome in children with persistent SH who have never been treated with levothyroxine.
Clinical and auxological parameters, thyroid function, and intellectual outcome were evaluated in 36 children with persistent SH at the age of 9.7±0.6 (range 4-18.0) years. Children had been followed longitudinally for 3.3±0.3 (range 2.0-9.3) years, from first diagnosis of SH until enrollment in the study. Thirty-six age- and sex-matched children were enrolled in the study as controls.
At study entry, height (-0.8±0.2 SDS), bone age/chronological age (BA/CA ratio 0.92±0.6), and body mass index (BMI -0.1±0.2 SDS) in SH children were normal. Despite long-term duration of SH, none of these parameters showed a worsening with respect to height (-0.7±0.2 SDS), BA/CA (0.97±0.03), and BMI (-0.1±0.2) at the time of first SH detection. None of the children showed overt signs or symptoms of hypothyroidism during the follow-up. Verbal (99.1±2.2), performance (100.4±1.9), and full-scale (99.7±1.9) intelligence quotient (IQ) scores in SH children were normal and comparable to those of controls. No relationship was detected between IQ scores and the degree or duration of SH.
Persistent SH in children is not associated with alterations in growth, bone maturation, BMI, and cognitive function or other complaints that could be ascribed to SH even after several years without therapeutic intervention.
对于 TSH 值在 4.5 至 10mU/l 之间的亚临床甲状腺功能减退症（SH）患儿，治疗方法存在争议。本横断面对照研究的目的是评估从未接受过左甲状腺素治疗的持续性 SH 患儿的生长和智力结局。
对 36 例持续性 SH 患儿（年龄为 9.7±0.6 岁，范围为 4-18.0 岁）进行临床和体格参数、甲状腺功能和智力结局评估。这些患儿从首次诊断为 SH 到入组本研究时，已经接受了 3.3±0.3 年的纵向随访（范围为 2.0-9.3 年）。选择 36 名年龄和性别匹配的儿童作为对照组。
在研究入组时，SH 患儿的身高（-0.8±0.2 SDS）、骨龄/实际年龄（BA/CA 比值 0.92±0.6）和体质指数（BMI）（-0.1±0.2 SDS）正常。尽管 SH 持续时间较长，但与首次检测到 SH 时的身高（-0.7±0.2 SDS）、BA/CA（0.97±0.03）和 BMI（-0.1±0.2）相比，这些参数均无恶化。在随访期间，无患儿出现甲状腺功能减退的明显症状或体征。SH 患儿的言语（99.1±2.2）、操作（100.4±1.9）和全量表（99.7±1.9）智商（IQ）正常，与对照组相当。SH 患儿的 IQ 评分与 SH 的严重程度或持续时间之间未检测到相关性。
即使在未经治疗数年之后，儿童持续性 SH 也不会引起生长、骨成熟、BMI 和认知功能的改变，也不会出现任何可归因于 SH 的其他不适。
