Recombinant human GH replacement therapy and thyroid function in a large group of adult GH-deficient patients: When does L-T 4 therapy become mandatory?

Silvia Porretti, Claudia Giavoli, Cristina Ronchi, Gaetano Lombardi, Marco Zaccaria, Domenico Valle, Maura Arosio, Paolo Beck-Peccoz

Research output: Contribution to journalArticle

Abstract

The effect on thyroid function of GH administration to 66 adult patients with severe GH deficiency was studied. Seventeen patients were euthyroid, and 49 had central hypothyroidism and were adequately treated with L-T 4. Forty patients were assigned to a low recombinant human GH (rhGH) regimen (3 μg/kg body wt·d for 3 months followed by 6 μg/kg body wt·d for another 3 months) and 26 to a higher one (6 μg/kg body wt·d for 3 months followed by 12 μg/kg body wt·d for another 3 months). Serum IGF-I, TSH, free T 4 (FT 4), free T 3 (FT 3), reverse T 3, T 4-binding globulin, and antithyroid autoantibody (TgAb and TPOAb) were measured in basal condition and after 3 and 6 months of therapy. Normalization of IGF-I levels was obtained after 6-month rhGH treatment in 67% of patients, independently from the dose, whereas a significant reduction in FT 4 and reverse T 3 levels was recorded (P <0.01), without variations in all the other parameters studied, including serum TSH, FT 3, and T 4-binding globulin circulating levels. Antithyroid autoantibodies were detected in 11 of 66 patients (16.6%). Eight of 17 (47%) euthyroid subjects and 9 of 49 (18.3%) central hypothyroid patients, despite adequate substitution at baseline, showed FT 4 levels under the normal range at the end of the study. Altogether, 17 of 66 patients (25.7%) worsened their thyroid function. This study shows that GH deficiency masks in a consistent number of adult patients a state of central hypothyroidism. Therefore, during rhGH treatment, a careful monitoring of thyroid function is mandatory to start or adjust L-T 4 substitutive therapy.

Original languageEnglish
Pages (from-to)2042-2045
Number of pages4
JournalJournal of Clinical Endocrinology and Metabolism
Volume87
Issue number5
DOIs
Publication statusPublished - 2002

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Thyroid Gland
Globulins
Insulin-Like Growth Factor I
Autoantibodies
Masks
Substitution reactions
Therapeutics
Hypothyroidism
Monitoring
Serum
Reference Values

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

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Recombinant human GH replacement therapy and thyroid function in a large group of adult GH-deficient patients : When does L-T 4 therapy become mandatory? / Porretti, Silvia; Giavoli, Claudia; Ronchi, Cristina; Lombardi, Gaetano; Zaccaria, Marco; Valle, Domenico; Arosio, Maura; Beck-Peccoz, Paolo.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 87, No. 5, 2002, p. 2042-2045.

Research output: Contribution to journalArticle

Porretti, Silvia ; Giavoli, Claudia ; Ronchi, Cristina ; Lombardi, Gaetano ; Zaccaria, Marco ; Valle, Domenico ; Arosio, Maura ; Beck-Peccoz, Paolo. / Recombinant human GH replacement therapy and thyroid function in a large group of adult GH-deficient patients : When does L-T 4 therapy become mandatory?. In: Journal of Clinical Endocrinology and Metabolism. 2002 ; Vol. 87, No. 5. pp. 2042-2045.
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AU - Porretti, Silvia

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AU - Ronchi, Cristina

AU - Lombardi, Gaetano

AU - Zaccaria, Marco

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AU - Arosio, Maura

AU - Beck-Peccoz, Paolo

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N2 - The effect on thyroid function of GH administration to 66 adult patients with severe GH deficiency was studied. Seventeen patients were euthyroid, and 49 had central hypothyroidism and were adequately treated with L-T 4. Forty patients were assigned to a low recombinant human GH (rhGH) regimen (3 μg/kg body wt·d for 3 months followed by 6 μg/kg body wt·d for another 3 months) and 26 to a higher one (6 μg/kg body wt·d for 3 months followed by 12 μg/kg body wt·d for another 3 months). Serum IGF-I, TSH, free T 4 (FT 4), free T 3 (FT 3), reverse T 3, T 4-binding globulin, and antithyroid autoantibody (TgAb and TPOAb) were measured in basal condition and after 3 and 6 months of therapy. Normalization of IGF-I levels was obtained after 6-month rhGH treatment in 67% of patients, independently from the dose, whereas a significant reduction in FT 4 and reverse T 3 levels was recorded (P <0.01), without variations in all the other parameters studied, including serum TSH, FT 3, and T 4-binding globulin circulating levels. Antithyroid autoantibodies were detected in 11 of 66 patients (16.6%). Eight of 17 (47%) euthyroid subjects and 9 of 49 (18.3%) central hypothyroid patients, despite adequate substitution at baseline, showed FT 4 levels under the normal range at the end of the study. Altogether, 17 of 66 patients (25.7%) worsened their thyroid function. This study shows that GH deficiency masks in a consistent number of adult patients a state of central hypothyroidism. Therefore, during rhGH treatment, a careful monitoring of thyroid function is mandatory to start or adjust L-T 4 substitutive therapy.

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