1 research outputs found
Thyroid Function Anomalies in Children with Down Syndrome: Early TSH Alteration can Predict Future Hypothyroidism Development?
Background: Subclinical hypothyroidism is a common
finding in Down syndrome (DS) patients and transition towards
overt hypothyroidism can occur, but there are no predictor factors
to identify patients that will need replacement therapy later in life.
Objective and hypotheses: This is a retrospective cohort study
on a population of DS paediatric patients. This study was designed
to evaluate possible early predictive features of hypothyroidism
development. Methods: We retrospectively evaluated 49 paediatric
DS patients (31 males and 18 females). Median (IQR) age at first
evaluation was 3.47 (0.5 \u2013 15.7) years and follow-up 4.3 years (1\u20139).
Thyroid function was described as normal (TSH 0.31\u20135.00 mUI/ml),
subclinical hypothyroidism (TSH 5.10\u201310.00 mUI/ml, normal fT4
and fT3) or overt hypothyroidism (TSH O 10.00 mUI/ml).
Autoimmune etiology was investigated through auto-antibodies
positivity (AbTPO, AbTG; TRAb). Statistical analysis was
performed using logistic regression and ROC curves, Mann-
Whitney test, chisquare test and Odd ratio. The statistical
significance was set at P!0.05. Results: In our study 38.8% of
patients (19/49) showed subclinical hypothyroidism during followup.
Therapy with L-thyroxine was initiated in 8 patients (16.3%),
who were diagnosed with overt hypothyroidism (4/8 have
autoimmune thyroiditis). We found that a TSH cut-off value of
5.07 mUI/ml at first evaluation was significantly predictive of overt
hypothyroidism development during follow-up (sensibility 100%,
specificity 43.9%). Moreover, patients who started replacement
therapy during follow-up, had significantly increased thyrotropin
values at first evaluation (P!.01). Also anti-thyroid antibodies
positivity resulted to be predictive of thyroid disease (P!.002).
Finally, we observed that TSH O 5.07 associated with anti-thyroid
antibodies positivity increased the risk of hypothyroidism of 12.6
time. Conclusion: Our study showed that an early increase of TSH
value, using as cut-off 5.07 mUI/ml, associated with auto-antibodies
positivity can identify DS patients who need a more careful followup,
since the risk of hypothyroidism seems to be higher