Graca Geraldo Miranda, Aguiar Luiz Roberto, De Lacerda Luiz
Eur Thyroid J. 2025 Jan 9;14(1). doi: 10.1530/ETJ-24-0184. Print 2025 Feb 1.
Pituitary lesions after traumatic brain injury (TBI) are frequent in children and adolescents, but the rate of post-TBI central hypothyroidism remains uncertain.
To identify the long-term incidence of post-TBI CH and the clinical and laboratory characteristics of this complication in children and adolescents.
The analysis included 31 patients with a history of TBI with at least 1 year of follow-up. Patients were evaluated at hospital admission and every 3 months thereafter. Assessments included clinical evaluation, brain CT and hormone assessments (basal fT4, IGF-1, cortisol and adrenocorticotropic hormone; insulin tolerance test/thyrotropin-releasing hormone test with TSH, growth hormone and cortisol measurement; and corticotropin-releasing hormone test, if indicated). The CH diagnosis was based on clinical and laboratory findings and a therapeutic trial with levothyroxine.
Overall, five patients (16%) developed CH (3 with associated adrenal insufficiency). At 3 and 12 months, median fT4 values were lower in patients with CH compared with those without anterior pituitary dysfunction (n = 18; P = 0.01). Patients with CH received levothyroxine and progressed with clinical resolution and increased median fT4 (from 0.92 to 1.47 ng/dL) and IGF-1 (from -2.08 to -0.22 standard deviation scores (SDS)) levels. Temporary suspension of levothyroxine was accompanied by decreased median fT4 (1.02 ng/dL) and IGF-1 (-1.07 SDS) levels and reappearance of clinical symptoms, which resolved once levothyroxine was reinitiated.
The longer follow-up, valorization of clinical manifestations, nontraditional laboratory approach and therapeutic trial with levothyroxine in the present study revealed a higher rate of post-TBI CH in children and adolescents than that reported in the literature.
创伤性脑损伤（TBI）后垂体病变在儿童和青少年中很常见，但TBI后中枢性甲状腺功能减退的发生率仍不确定。
确定TBI后中枢性甲状腺功能减退（CH）的长期发生率以及儿童和青少年该并发症的临床和实验室特征。
分析纳入31例有TBI病史且至少随访1年的患者。患者在入院时及此后每3个月进行评估。评估包括临床评估、脑部CT和激素评估（基础游离甲状腺素（fT4）、胰岛素样生长因子-1（IGF-1）、皮质醇和促肾上腺皮质激素；胰岛素耐量试验/促甲状腺激素释放激素试验，同时测定促甲状腺激素（TSH）、生长激素和皮质醇；如有指征，进行促肾上腺皮质激素释放激素试验）。CH的诊断基于临床和实验室检查结果以及左甲状腺素治疗试验。
总体而言，5例患者（16%）发生CH（3例伴有肾上腺功能不全）。在3个月和12个月时，CH患者的fT4中位数低于无垂体前叶功能障碍的患者（n = 18；P = 0.01）。CH患者接受左甲状腺素治疗后临床症状缓解，fT4中位数升高（从0.92 ng/dL升至1.47 ng/dL），IGF-1升高（从-2.08标准差评分（SDS）升至-0.22 SDS）。左甲状腺素暂时停药后，fT4中位数（1.02 ng/dL）和IGF-1（-1.07 SDS）水平下降，临床症状再次出现，重新开始使用左甲状腺素后症状缓解。
本研究中更长时间的随访、对临床表现的重视、非传统的实验室检查方法以及左甲状腺素治疗试验显示，儿童和青少年TBI后CH的发生率高于文献报道。
