Recombinant hGH replacement therapy and the hypothalamus-pituitary-thyroid axis in children with GH deficiency: When should we be concerned about the occurrence of central hypothyroidism?

Claudia Giavoli, Silvia Porretti, Emanuele Ferrante, Vincenzo Cappiello, Cristina L. Ronchi, Pietro Travaglini, Paolo Epaminonda, Maura Arosio, Paolo Beck-Peccoz

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Recombinant hGH treatment may alter thyroid hormone metabolism and we have recently reported that 50% of patients with GH deficiency (GHD) due to organic lesions, previously not treated with thyroxine, developed hypothyroidism during treatment with recombinant human GH (rhGH).These results prompted us to evaluate the impact of rhGH treatment on thyroid function in children with GHD. DESIGN: Open study of GH treatment up to 12 months. Investigations were performed at baseline, and after 6 and 12 months of GH therapy. MEASUREMENT AND STUDY SUBJECTS: Serum TSH, FT4, FT3, AbTg and AbTPO, IGF-I, height and weight, were evaluated in 20 euthyroid children (group A) with idiopathic isolated GHD and in six children (group B) with multiple pituitary hormone deficiencies (MPHD) due to organic lesions. Among the latter, four already had central hypothyroidism and were on adequate LT4 replacement therapy, while two were euthyroid at the beginning of the study. RESULTS: Serum IGF-I levels normalized in all patients. In both groups, a significant reduction in FT4 levels (P <0.01) occurred during rhGH therapy. No patient in group A had FT4 values into the hypothyroid range, while in four of six patients in group B, fell FT4 levels into the hypothyroid range during rhGH. In particular, the two euthyroid children developed central hypothyroidism during rhGH treatment, and their height velocities did not normalize until the achievement of euthyroidism through appropriate LT4 substitution. No variation in serum FT3 and TSH levels was recorded in either groups. CONCLUSION: Contrary to that observed in patients with MPHD, rhGH replacement therapy does not induce central hypothyroidism in children with idiopathic isolated GHD, further supporting the view that in children with MPHD, as in adults, GHD masks the presence of central hypothyroidism. Slow growth (in spite of adequate rhGH substitution and normal IGF-I levels) is an important clinical marker of central hypothyroidism, therefore a strict monitoring of thyroid function is mandatory in treated children with MPHD.

Original languageEnglish
Pages (from-to)806-810
Number of pages5
JournalClinical Endocrinology
Volume59
Issue number6
DOIs
Publication statusPublished - Dec 2003

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Hypothyroidism
Hypothalamus
Thyroid Gland
Pituitary Hormones
Insulin-Like Growth Factor I
Pituitary Dwarfism
Therapeutics
Serum
Masks
Thyroxine
Thyroid Hormones
Biomarkers
Weights and Measures
Growth

ASJC Scopus subject areas

  • Endocrinology

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Recombinant hGH replacement therapy and the hypothalamus-pituitary-thyroid axis in children with GH deficiency : When should we be concerned about the occurrence of central hypothyroidism? / Giavoli, Claudia; Porretti, Silvia; Ferrante, Emanuele; Cappiello, Vincenzo; Ronchi, Cristina L.; Travaglini, Pietro; Epaminonda, Paolo; Arosio, Maura; Beck-Peccoz, Paolo.

In: Clinical Endocrinology, Vol. 59, No. 6, 12.2003, p. 806-810.

Research output: Contribution to journalArticle

Giavoli, Claudia ; Porretti, Silvia ; Ferrante, Emanuele ; Cappiello, Vincenzo ; Ronchi, Cristina L. ; Travaglini, Pietro ; Epaminonda, Paolo ; Arosio, Maura ; Beck-Peccoz, Paolo. / Recombinant hGH replacement therapy and the hypothalamus-pituitary-thyroid axis in children with GH deficiency : When should we be concerned about the occurrence of central hypothyroidism?. In: Clinical Endocrinology. 2003 ; Vol. 59, No. 6. pp. 806-810.
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AU - Porretti, Silvia

AU - Ferrante, Emanuele

AU - Cappiello, Vincenzo

AU - Ronchi, Cristina L.

AU - Travaglini, Pietro

AU - Epaminonda, Paolo

AU - Arosio, Maura

AU - Beck-Peccoz, Paolo

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N2 - OBJECTIVE: Recombinant hGH treatment may alter thyroid hormone metabolism and we have recently reported that 50% of patients with GH deficiency (GHD) due to organic lesions, previously not treated with thyroxine, developed hypothyroidism during treatment with recombinant human GH (rhGH).These results prompted us to evaluate the impact of rhGH treatment on thyroid function in children with GHD. DESIGN: Open study of GH treatment up to 12 months. Investigations were performed at baseline, and after 6 and 12 months of GH therapy. MEASUREMENT AND STUDY SUBJECTS: Serum TSH, FT4, FT3, AbTg and AbTPO, IGF-I, height and weight, were evaluated in 20 euthyroid children (group A) with idiopathic isolated GHD and in six children (group B) with multiple pituitary hormone deficiencies (MPHD) due to organic lesions. Among the latter, four already had central hypothyroidism and were on adequate LT4 replacement therapy, while two were euthyroid at the beginning of the study. RESULTS: Serum IGF-I levels normalized in all patients. In both groups, a significant reduction in FT4 levels (P <0.01) occurred during rhGH therapy. No patient in group A had FT4 values into the hypothyroid range, while in four of six patients in group B, fell FT4 levels into the hypothyroid range during rhGH. In particular, the two euthyroid children developed central hypothyroidism during rhGH treatment, and their height velocities did not normalize until the achievement of euthyroidism through appropriate LT4 substitution. No variation in serum FT3 and TSH levels was recorded in either groups. CONCLUSION: Contrary to that observed in patients with MPHD, rhGH replacement therapy does not induce central hypothyroidism in children with idiopathic isolated GHD, further supporting the view that in children with MPHD, as in adults, GHD masks the presence of central hypothyroidism. Slow growth (in spite of adequate rhGH substitution and normal IGF-I levels) is an important clinical marker of central hypothyroidism, therefore a strict monitoring of thyroid function is mandatory in treated children with MPHD.

AB - OBJECTIVE: Recombinant hGH treatment may alter thyroid hormone metabolism and we have recently reported that 50% of patients with GH deficiency (GHD) due to organic lesions, previously not treated with thyroxine, developed hypothyroidism during treatment with recombinant human GH (rhGH).These results prompted us to evaluate the impact of rhGH treatment on thyroid function in children with GHD. DESIGN: Open study of GH treatment up to 12 months. Investigations were performed at baseline, and after 6 and 12 months of GH therapy. MEASUREMENT AND STUDY SUBJECTS: Serum TSH, FT4, FT3, AbTg and AbTPO, IGF-I, height and weight, were evaluated in 20 euthyroid children (group A) with idiopathic isolated GHD and in six children (group B) with multiple pituitary hormone deficiencies (MPHD) due to organic lesions. Among the latter, four already had central hypothyroidism and were on adequate LT4 replacement therapy, while two were euthyroid at the beginning of the study. RESULTS: Serum IGF-I levels normalized in all patients. In both groups, a significant reduction in FT4 levels (P <0.01) occurred during rhGH therapy. No patient in group A had FT4 values into the hypothyroid range, while in four of six patients in group B, fell FT4 levels into the hypothyroid range during rhGH. In particular, the two euthyroid children developed central hypothyroidism during rhGH treatment, and their height velocities did not normalize until the achievement of euthyroidism through appropriate LT4 substitution. No variation in serum FT3 and TSH levels was recorded in either groups. CONCLUSION: Contrary to that observed in patients with MPHD, rhGH replacement therapy does not induce central hypothyroidism in children with idiopathic isolated GHD, further supporting the view that in children with MPHD, as in adults, GHD masks the presence of central hypothyroidism. Slow growth (in spite of adequate rhGH substitution and normal IGF-I levels) is an important clinical marker of central hypothyroidism, therefore a strict monitoring of thyroid function is mandatory in treated children with MPHD.

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