ECE2019 Poster Presentations Thyroid 2 (70 abstracts)
Levothyroxine treatment of subclinical (SH) and overt (OH) hypothyroidism in children with autoimmune hashimoto thyroiditis (AHT): defining the TSH cut-off level
Sofia Leka-Emiri 1 , Vassilios Petrou 1 , Caterina Evangelopoulou 1 , Aspasia Fotinou 2 , Elpis Vlachopapdopoulou 1 & Stefanos Michalacos 1
1Department of Endocrinology, ‘P&A KYRIAKOU’ Children’s Hospital, Athens, Greece; 2Department of Biochemistry-Hormonology, ‘P&A KYRIAKOU’ Children’s Hospital, Athens, Greece.
Objectives: Assess the dose of levothyroxine in relation to TSH and FT4 at diagnosis of AHT in children with SH and OH.
Methods: Two hundred one children (155 girls) with AHT were devided according to TSH and FT4 levels at diagnosis of hypothyroidism [SH-FT4 >1.0 ng/dl: Group 1: TSH: 5–7.5 mU/l, Group 2: TSH: >7.5 mU/l, OH: Group 3: TSH>7.5 mU/l and FT4 ≤1.0 ng/dl]. Mean L-T4 dose was reported in μg/Kg per day at diagnosis and at 2.9 years of follow up and TSH targeted levels under treatment were 1–4 mU/l.
Results: Mean age at diagnosis was 9.6 yrs (SD, 2.6). Main characteristics are shown in table 1. At diagnosis, TSH, FT4 levels and L-T4 dose were significantly different (P<0.05) between SH (groups 1 and 2) as opposed to OH (group 3). At follow-up all patients were euthyroid and TSH and FT4 levels did not differ significantly between groups. L-T4 dose was significantly higher in OH as opposed to group 1 but not group 2. Table 1. Data are shown as means (S.D.).
| Group 1 (n=70) | Group2 (n=72) | Group 3 (n=59) | *P | |
| AT DIAGNOSIS | ||||
| Age (yrs) | 10.4 (2.6) | 8.9 (2.6) | 9.6 (2.4) | |
| Height z-score | 0.55 (0.9) | 0.52 (1.0) | 0.43 (0.9) | |
| BMI z-score | 0.87 (0.9) | 0.93 (0.9) | 0.92 (1.1) | |
| TSH (mU/l) | 6.1 (0.7) | 10.9 (5.6) | 47.9 (74.2) | * |
| FT4 (ng/dl) | 1.2 (0.2) | 1.3 (0.16) | 0.85 (0.1) | * |
| L-T4 (μg/Kg/day) | 1.1 (0.4) | 1.3 (0.51) | 1.5 (0.6) | * |
| AT FOLLOW UP (yrs) | 2.8 (1.4) | 3.16 (1.6) | 2.98 (1.6) | |
| Age (yrs) | 13.2 (2.4) | 12.1 (2.7) | 12.6 (2.4) | |
| Height z-score | 0.56 (1.0) | 0.59 (0.9) | 0.43 (0.8) | |
| BMI z-score | 0.82 (0.8) | 0.76 (0.9) | 0.92 (0.9) | |
| TSH (mU/l) | 2.2 (1.2) | 2.6 (1.2) | 2.2 (1.1) | |
| FT4 (ng/dl) | 1.4 (0.2) | 1.4 (0.4) | 1.3 (0.2) | |
| L-T4 (μg/Kg per day) | 1.1 (0.3) | 1.4 (0.4) | 1.6 (0.7) | * |
| *One-Way Analysis of variance (ANOVA), P<0.05. | ||||
Conclusions: At diagnosis, L-T4 needs are significantly lower in subclinical hypothyroidism patients as opposed to overt hypothyroidism patients. At 2.9 yrs, children with overt hypothyroidism receive significantly higher LT-4 doses than those with SH and TSH < 7.5 mU/l but similar with those of SH and TSH > 7.5 mU/l.
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