Tersander Beata, Olsson Roger, Aydin Banu K, Stenlid Rasmus, Ciba Iris, Manell Hannes
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden.
Pediatr Res. 2024 Nov 5. doi: 10.1038/s41390-024-03691-6.
Studies on the associations between obesity-related subclinical hypothyroidism with basal metabolic rate and risk factors of cardiovascular disease in children and adolescents are scarce.
Retrospective cohort study of children with obesity (n = 294) from the Uppsala Longitudinal Study of Childhood Obesity cohort. Differences in basal metabolic rate quantified by indirect calorimetry, and the cardiovascular risk factors; body mass index, blood lipids, fasting and 2 h oral glucose tolerance test glucose, glycated haemoglobin and insulin resistance, between subjects with and without subclinical hypothyroidism were investigated. The associations of baseline thyroid stimulating hormone (TSH) and ΔTSH with change in cardiovascular risk factors over time were assessed.
Subjects with subclinical hypothyroidism had elevated triacylglycerides but no alterations in basal metabolic rate or other measured cardiovascular risk factors. ΔTSH was positively associated with Δtriacylglycerides, Δtotal-cholesterol and ΔLDL-cholesterol, independently of age, sex, Δbody mass index and ΔT. In the subclinical hypothyroidism group, 92% of individuals normalised their TSH 0.9-2.9 years later.
Children with obesity and subclinical hypothyroidism did not have an altered basal metabolic rate but elevated triacylglycerides. During the follow-up period, TSH changed in parallel with several blood lipids. Elevated TSH often normalised without pharmaceutical intervention within 3 years.
The present study found that subclinical hypothyroidism in paediatric obesity is related to elevated triglycerides. The present study found that subclinical hypothyroidism is not associated to basal metabolic rate in paediatric obesity. TSH change over time correlated with the change in triglycerides and LDL and total cholesterol. Among subjects with subclinical hypothyroidism at baseline 92% normalised without pharmaceutical intervention within 3 years. This research adds to the knowledge of the longitudinal, natural course of elevated TSH in paediatric obesity which is expected to help to make informed decisions regarding follow-up and evaluation of this patient group.
关于儿童和青少年肥胖相关亚临床甲状腺功能减退与基础代谢率及心血管疾病危险因素之间关联的研究较少。
对乌普萨拉儿童肥胖纵向研究队列中的肥胖儿童（n = 294）进行回顾性队列研究。通过间接测热法量化基础代谢率的差异，并研究有无亚临床甲状腺功能减退的受试者之间的心血管危险因素；体重指数、血脂、空腹及口服葡萄糖耐量试验2小时血糖、糖化血红蛋白和胰岛素抵抗。评估基线促甲状腺激素（TSH）和ΔTSH与心血管危险因素随时间变化的关联。
亚临床甲状腺功能减退的受试者甘油三酯升高，但基础代谢率及其他测量的心血管危险因素无变化。ΔTSH与Δ甘油三酯、Δ总胆固醇和Δ低密度脂蛋白胆固醇呈正相关，独立于年龄、性别、Δ体重指数和ΔT。在亚临床甲状腺功能减退组中，92%的个体在0.9 - 2.9年后TSH恢复正常。
肥胖且有亚临床甲状腺功能减退的儿童基础代谢率未改变，但甘油三酯升高。在随访期间，TSH与几种血脂水平平行变化。TSH升高通常在3年内无需药物干预即可恢复正常。
本研究发现儿童肥胖中的亚临床甲状腺功能减退与甘油三酯升高有关。本研究发现儿童肥胖中的亚临床甲状腺功能减退与基础代谢率无关。TSH随时间的变化与甘油三酯、低密度脂蛋白和总胆固醇的变化相关。在基线时有亚临床甲状腺功能减退的受试者中，92%在3年内无需药物干预即可恢复正常。这项研究增加了对儿童肥胖中TSH升高的纵向自然病程的认识，有望有助于对该患者群体的随访和评估做出明智决策。
