Department of Orthopaedics and Sports Medicine, University of Washington.
Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA.
J Pediatr Orthop. 2024;44(5):303-307. doi: 10.1097/BPO.0000000000002630. Epub 2024 Feb 29.
Hypothyroidism is a known risk factor for slipped capital femoral epiphysis (SCFE), and prior studies of hypothyroid-associated SCFE have demonstrated an incidence of up to 6%. However, there is limited evidence and no formal practice guidelines regarding whether patients presenting with SCFE should undergo screening for endocrine disorders. This study aims to investigate the incidence of abnormal thyroid function studies in patients presenting with SCFE.
This was a retrospective review of all patients aged 0 to 18 years treated for SCFE at a single pediatric hospital from January 2015 to July 2022. On presentation, patients' BMI, thyroid-stimulating hormone (TSH), free T4, vitamin D, creatinine, BUN, and HbA1c levels were documented. Follow-up and treatment for any identified endocrinopathies were noted. In addition, the chronicity, stability, and severity of their slips were recorded.
Ninety-eight patients with 106 hips were included in this study. TSH was obtained at the time of initial presentation in 66% (n=65/98) of patients. Median TSH was 2.99 (range: 0.02 to 919, std dev: 132.4). The normal reference range for our institution is 0.5 to 4.5 mcIU/mL. Thirty-two percent (n=21/65) of patients with a documented TSH had an abnormal value. Of those patients who had an elevated TSH, 3 were diagnosed with clinical hypothyroidism and went on to treatment with levothyroxine (n=3/19, 16%), 2 patients had been started on levothyroxine before presentation (n=2/19, 11%), and 2 patients were followed in endocrinology clinic until their TSH levels had normalized without further intervention (n=2/19, 11%).
Screening of our SCFE population revealed a 32% incidence of thyroid abnormalities which affected treatment in 24% of those patients. This is a much higher incidence of hypothyroid-associated SCFE than previously demonstrated in the literature and has prompted us to start including thyroid screening studies as a routine part of our workup for all patients with SCFE.
Level III.
甲状腺功能减退症是股骨头骨骺滑脱（SCFE）的已知危险因素，先前关于与甲状腺功能减退相关的 SCFE 的研究表明其发病率高达 6%。然而，关于患有 SCFE 的患者是否应进行内分泌疾病筛查，目前证据有限，也没有正式的实践指南。本研究旨在调查患有 SCFE 的患者甲状腺功能异常研究的发生率。
这是对 2015 年 1 月至 2022 年 7 月期间在一家儿童医院接受治疗的所有 0 至 18 岁 SCFE 患者的回顾性研究。就诊时，记录患者的 BMI、促甲状腺激素（TSH）、游离 T4、维生素 D、肌酐、BUN 和 HbA1c 水平。记录任何已识别的内分泌疾病的随访和治疗情况。此外，还记录了他们的滑脱的慢性、稳定性和严重程度。
本研究共纳入 98 例患者的 106 髋。66%（n=65/98）的患者在初次就诊时获得了 TSH。TSH 的中位数为 2.99（范围：0.02 至 919，标准差：132.4）。我们机构的正常参考范围为 0.5 至 4.5mcIU/mL。有记录 TSH 的患者中有 32%（n=21/65）的 TSH 值异常。在这些 TSH 升高的患者中，有 3 例被诊断为临床甲状腺功能减退症，并开始接受左甲状腺素治疗（n=3/19，16%），2 例在就诊前已开始接受左甲状腺素治疗（n=2/19，11%），2 例在接受内分泌科随访，直到 TSH 水平正常而无需进一步干预（n=2/19，11%）。
对我们的 SCFE 人群进行筛查发现，甲状腺异常的发生率为 32%，其中 24%的患者因此改变了治疗方案。这一发生率远高于先前文献中报道的与甲状腺功能减退相关的 SCFE 发生率，促使我们开始将甲状腺筛查作为所有 SCFE 患者常规检查的一部分。
III 级。
