The Complex Relationship Between Thyroxine Therapy and Growth Outcomes in Pediatric Hypothyroidism

Ashraf Soliman; Nada Alaaraj; Amal Sabt; Noor Hamed; Shayma Ahmed; Fawzia Alyafei

Introduction: Managing pediatric hypothyroidism with thyroxine therapy is crucial for children's growth and development. This presents a synthesized overview of the relationship between thyroxine therapy and growth outcomes in children with congenital and acquired hypothyroidism.

Methods: A literature review from 1987 to 2013 was conducted, selecting studies on thyroxine therapy's effects on linear growth, cognitive development, and health in children with congenital or acquired hypothyroidism.

Results: The relationship between thyroxine therapy and growth outcomes in children is complex, influenced by the type of hypothyroidism, timing of therapy initiation, dosage, and the inclusion of GH therapy. Key findings include:

Key Research on Thyroxine Therapy and Growth Outcomes


Author(s)	Year	Key Finding
Rivkees et al.	1987	Juvenile hypothyroidism can result in permanent height deficit.
Vulsma et al.	1989	Maternal-fetal thyroxine transfer suggests late gestation impact.
Rovet & Ehrlich	1995	Higher initial L-thyroxine dose improves intellect but may affect behavior.
Heyerdahl et al.	1997	Early L-thyroxine dosing impacts growth in congenital hypothyroidism.
Salerno et al.	2002	High initial L-thyroxine doses linked to better IQ in CH without affecting growth.
Connolly et al.	2003	GH therapy enhanced by T4 improves growth in burned children.
Okubo & Reddi	2003	Thyroxine stimulates bone growth via chondrocyte hypertrophy.
Davis et al.	2004	Thyroxine aids angiogenesis and tissue development.
Boersma et al.	2005	Early L-thyroxine treatment yields significant catch-up growth.
Losa et al.	2008	Monitoring thyroid function during GH therapy reduces FT4 decrease.
Alzoubi et al.	2009	Thyroxine reverses cognitive impairments in hypothyroidism.
Xu Ai-jing & L. Tang	2010	L-thyroxine therapy regresses pituitary enlargement, improving stature.
Smyczyńska et al.	2010	Euthyroidism is crucial for growth during GH therapy in GHD children.
Shin et al.	2013	L-thyroxine may delay end-stage renal disease in CKD with subclinical hypothyroidism.

Discussion: Thyroxine therapy plays a crucial role in managing pediatric hypothyroidism, impacting linear growth, cognitive development, and health outcomes. The relationship between thyroxine therapy and growth outcomes is multifaceted, with the timing, dosage, and concomitant treatments (e.g., GH therapy) influencing effectiveness.

Conclusion: This review chronologically highlights the importance of early, optimized thyroxine therapy in pediatric hypothyroidism for enhancing growth, cognitive development, and health outcomes. It underscores the need for personalized treatment plans and monitoring, especially when combined with growth hormone therapy.

ESPE Abstracts

P3-247