Department of Neurosciences and Rehabilitation, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Department of Movement Sciences and Wellbeing, University of Naples Parthenope, I-80133, Naples, Italy.
J Clin Endocrinol Metab. 2019 Jul 1;104(7):2757-2765. doi: 10.1210/jc.2018-02399.
Obesity is associated with hypothyroidism and goiter.
The aim of the study was to verify whether thyroid structure and function would improve after weight loss.
We evaluated 96 children who were overweight/obese who showed an altered parenchymal pattern at thyroid ultrasound without circulating antithyroid antibodies. At phase 1, body mass index (BMI), SD score (SDS), body composition, free T4 (fT4), TSH, high-sensitivity C reactive protein (CRPhs), white blood cells, metabolic profile, and a thyroid ultrasound were assessed. Thyroid volume was expressed as SDS on the basis of the references values for age. Alterations in echogenicity and homogeneity were graded from 0 to 5 (thyroid score). The same parameters were re-examined after a weight loss program (phase 2).
After a mean period of treatment of 0.8 ± 0.3 years, there was a significant decrease of BMI SDS, percentage fat mass, CRPhs, TSH, and thyroid volume SDS (all P < 0.0001), whereas fT4 remained unchanged. The thyroid score significantly improved (z = -9088; P < 0.0001) [i.e., it decreased in 82 individuals, was tied in 12, and worsened only in two subjects; the score completely normalized in 48 (50%) individuals]. BMI SDS reduction was a unique predictor of the decrease of TSH, thyroid volume, and structure, whereas CRPhs reduction was an independent predictor only for the TSH change. Moreover, CRPhs variations mediated the association between BMI SDS and TSH.
The alterations of thyroid function and structure in children with obesity are reversible after weight loss.
肥胖与甲状腺功能减退症和甲状腺肿有关。
本研究旨在验证体重减轻后甲状腺结构和功能是否会改善。
我们评估了 96 名超重/肥胖的儿童，他们在甲状腺超声检查中显示出甲状腺实质模式改变，但没有循环抗甲状腺抗体。在第 1 阶段，评估了体重指数（BMI）、标准偏差（SDS）、身体成分、游离 T4（fT4）、促甲状腺激素（TSH）、高敏 C 反应蛋白（CRPhs）、白细胞、代谢谱和甲状腺超声。甲状腺体积根据年龄的参考值表示为 SDS。回声和均匀性的改变从 0 到 5 级（甲状腺评分）进行分级。在减肥计划（第 2 阶段）后重新检查了相同的参数。
在平均 0.8 ± 0.3 年的治疗后，BMI SDS、体脂肪百分比、CRPhs、TSH 和甲状腺体积 SDS 均显著降低（均 P < 0.0001），而 fT4 保持不变。甲状腺评分显著改善（z = -9088；P < 0.0001）[即 82 人评分降低，12 人评分不变，仅 2 人评分恶化；48 人（50%）评分完全正常]。BMI SDS 降低是 TSH、甲状腺体积和结构降低的唯一预测因素，而 CRPhs 降低仅是 TSH 变化的独立预测因素。此外，CRPhs 变化介导了 BMI SDS 和 TSH 之间的关联。
肥胖儿童的甲状腺功能和结构改变在体重减轻后是可逆的。
