This study aimed to evaluate the effects of thyroid hormone supplementation on growth rate of children with idiopathic short stature (ISS) and low-normal serum free thyroxine FT4 who were receiving growth hormone therapy. We selected 64 prepubertal children with FT4 levels in the lowest third of the normal range as the lower FT4 group, and these children were divided randomly into two subgroups: L-thyroxine (L-T4)-treated subgroup was treated with L-T4 (0.5-3.0 g/(kg·d)) from the beginning of the study, and the non-L-T4-treated subgroup received placebo. We also selected 39 ISS children with FT4 in the upper two-thirds of the normal range as the higher FT4 group. During the first year, the lower FT4 group featured lower FT3, FT4, thyroid stimulating hormone (TSH), and insulin-like growth factor-I standard deviation score (IGF-I SDS) and significantly lower height velocity (HV) compared with the higher FT4 group. However, in the lower FT4 group, the L-T4-treated subgroup presented higher FT4, FT3, TSH, and IGF-I SDS concentrations and significantly higher HV compared with children in the non-L-T4-treated subgroup. In children with ISS, the negative effect of thyroid hormone deficiency on growth rate should be considered when FT4 level lies in the low-normal range prior to recombinant human growth hormone treatment.
Child ; Female ; Growth Disorders ; blood ; drug therapy ; Human Growth Hormone ; therapeutic use ; Humans ; Insulin-Like Growth Factor I ; metabolism ; Male ; Recombinant Proteins ; therapeutic use ; Thyrotropin ; blood ; Thyroxine ; blood

BACKGROUNDLittle information about the current management of patients with thyroid-stimulating hormone (TSH)-secreting pituitary adenomas or about the usefulness of the somatostatin analogue octreotide was contained in the literature. This study aimed to report the efficacy and safety of the long-acting octreotide formulation in patients with TSH-secreting pituitary adenomas after incomplete surgery and octreotide treatment failure.

METHODSFifteen patients with TSH-secreting pituitary adenomas (8 men and 7 women), who previously underwent incomplete surgical resection and/or adjuvant radiotherapy (n = 12) and failure of octreotide treatment (n = 15), followed between 2007 and 2010 in Beijing Tiantan Hospital were included in this study. All patients received 1- to 2-months of the long-acting octreotide formulation treatment after the above combination of treatment. Paired samples t-test was used to analysis the variables.

RESULTSAfter two-month duration of the long-acting octreotide formulation treatment, the mean serum free or unbound thyroxine (FT4) ((16.02 ± 1.72) pmol/L) and free triiodothyronine (FT3) ((2.87 ± 0.43) pmol/L) levels of 15 patients significantly decreased compared with those after octreotide-treatment (FT4, (35.36 ± 7.42) pmol/L, P < 0.001; FT3, (17.85 ± 7.22) pmol/L, P < 0.001). Mean TSH levels stayed in the normal range after the long-acting octreotide formulation treatment ((0.72 ± 0.21) mU/L) and were significantly lower than the pretreatment value ((5.27 ± 1.04) mU/L, P < 0.001), post-surgery value ((3.37 ± 0.31) mU/L, P < 0.001) and post-octreotide-treatment value ((4.52 ± 0.41) mU/L, P < 0.001). In these patients with TSH-secreting pituitary adenomas there was no evidence of tachyphylaxis.

CONCLUSIONThe long-acting octreotide formulation may be a useful and safe therapeutic tool to facilitate the medical treatment of TSH-secreting pituitary adenomas in patients who underwent incomplete surgery or need long-term somatostatin analog therapy.

Adult ; Female ; Humans ; Male ; Middle Aged ; Octreotide ; therapeutic use ; Pituitary Neoplasms ; blood ; drug therapy ; secretion ; surgery ; Thyrotropin ; blood ; secretion ; Thyroxine ; blood ; Triiodothyronine ; blood

OBJECTIVETo observe the therapeutic effect of Xiehuo Yangyin powder (XHYY) in treating the initial stage of toxic and diffuse goiter (Graves' disease).

METHODSSixty patients were randomly divided into two groups, the treated group (n = 30) was treated with XHYY and methimazole, while the control group (n = 30) was treated with methimazole alone. The TCM syndrome score and thyroxin level in the two groups were compared and analyzed before, and 2 weeks, 12 weeks after treatment.

RESULTSThe syndrome score and thyroxin level in the treated group 2 weeks, 4 weeks, 12 weeks after treatment were reduced in comparing with before treatment, with the improvement better than those in the control group in the corresponding stages (P < 0.05).

CONCLUSIONThe Chinese herbal medicine XHYY plus methimazole, in treating Graves' disease, could rapidly and effectively improve the patients' clinical symptoms and lower the thyroxin level, reduce the daily taken of methimazole.

Adolescent ; Adult ; Aged ; Antithyroid Agents ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Graves Disease ; blood ; drug therapy ; Humans ; Male ; Methimazole ; therapeutic use ; Middle Aged ; Phytotherapy ; Powders ; Thyroxine ; blood

Primary hypothyroidism and type 2 diabetes are both typically associated with the increased level of triglycerides. To date, there have been only a few case reports of type 2 diabetes patients with both type V hyperlipoproteinemia and eruptive xanthomas, but there have been no reports of hypothyroidism patients associated with eruptive xanthomas. We report here on a case of a 48-yr old female patient who was diagnosed with type 2 diabetes and primary hypothyroidism associated with both type V hyperlipoproteinemia and eruptive xanthomas. We found rouleaux formation of RBCs in peripheral blood smear, elevated TSH, and low free T4 level, and dyslipidemia (total cholesterol 18.1 mM/L, triglyceride 61.64 mM/L, HDL 3.0 mM/L, and LDL 2.54 mM/L). She has taken fenofibrate, levothyroxine, and oral hypoglycemic agent for 4 months. After treatment, both TSH level and lipid concentration returned to normal range, and her yellowish skin nodules have also disappeared.
Antilipemic Agents/therapeutic use ; Diabetes Mellitus, Type 2/blood/*complications/drug therapy ; Erythrocyte Aggregation ; Female ; Humans ; Hyperlipidemia/blood ; Hyperlipoproteinemia Type V/blood/*complications/drug therapy ; Hypoglycemic Agents/therapeutic use ; Hypothyroidism/blood/*complications/drug therapy ; Middle Aged ; Procetofen/therapeutic use ; Research Support, Non-U.S. Gov't ; Skin Diseases/blood/complications/drug therapy ; Thyrotropin/blood/therapeutic use ; Thyroxine/blood ; Treatment Outcome ; Xanthomatosis/blood/*complications/drug therapy

OBJECTIVETo study the changes in hormone levels and the therapy of pituitary hyperplasia secondary to primary hypothyroidism in children.

METHODSThe clinical data of 8 children with pituitary hyperplasia secondary to primary hypothyroidism (5 girls and 3 boys) at ages of 5 to 9 years were studied retrospectively. All of the children had a short stature. They were followed up 1 to 6 years.

RESULTSThe thyroid hormone levels decreased and the serum thyroid stimulating hormone (TSH) and prolactin (PRL) levels increased in the 8 children. After 2 to 6 months thyroxine replacement therapy, the levels of free triiodothyronine (FT3), free thyroxine (FT4) and serum TSH and PRL returned to normal, and the pituitary enlargement regressed to normal in the 8 children. Of them, 6 children's height growth rate increased significantly from 3.1+/-0.5 cm per year to 11.6+/-1.7 cm per year (p<0.01). The other 2 cases had low growth rate and then received additional recombinant human growth hormone (rhGH) therapy. Their height growth rate increased by 11 cm per year. Pituitary hyperplasia did not recur in the 8 children during the follow-up.

CONCLUSIONSThe thyroid function and pituitary examinations are necessary for children with a short stature. Thyroxine substitution therapy appears to be effective for primary hypothyroidism secondary to pituitary hyperplasia. rhGH replacement therapy after regression of the pituitary enlargement can result in a satisfactory height growth in children with low thyroid hormone levels and growth hormone deficiency.

Body Height ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Human Growth Hormone ; therapeutic use ; Humans ; Hyperplasia ; Hypothyroidism ; complications ; drug therapy ; Magnetic Resonance Imaging ; Male ; Pituitary Gland ; pathology ; Thyrotropin ; blood ; Thyroxine ; therapeutic use

OBJECTIVETo study the best observation time for drug administration and withdrawal in the treatment of children with transient congenital hypothyroidism,seeking an objective basis for the safe drug withdrawal.

METHODSLevothyroxine was prescribed for 1 144 children diagnosed with congenital hypothyroidism (CH) and according to the results levothyroxine was adjusted to a maintenance dosage. Examinations were performed periodically including physical and mental development, thyroid ultrasonography,and blood levels of T3, T4, TSH. For the patients with a small maintenance dosage of levothyroxine (15.0 - 16.6 g/d) and all the examinations normal, levothyroxine was withdrawn at 2 - 3 years, and the children were followed up and reexamined after 1 month, 2 months, and 10 months, respectively. Permanent drug withdrawal was determined for children with all the examinations normal. Once abnormal TSH occurred, levothyroxine was prescribed again, and followed up continuously.

RESULTLevothyroxine was withdrawn from 157 children. During the follow up, for 15 children (9.55%) levothyroxine were prescribed continuously, and for 142 children permanent drug withdrawal (confirmed with transient CH) was determined. Abnormal TSH of various degrees was detected in 48 cases: 25.48 % (40/157),4.46 % (7/157), and 0.64 % (1/157) were detected at 1, 2 and 10 months after drug withdrawal, respectively. In 15 children levothyroxine was prescribed again for the remarkably high TSH, and the other 33 with mildly abnormal TSH finished the treatment since TSH normalized during follow-up.

CONCLUSIONAfter 2 - 3 years of regular treatment, levothyroxine can be withdrawn from children with normal T3, T4, TSH, physical and mental development, and thyroid function. The best observation time for drug withdrawal should be 2 - 3 months. If T3, T4 and TSH levels are in the normal range, drug can be withdrawn safely. Once abnormal results were detected during follow-up, levothyroxine should be administrated continuously.

Child ; Child, Preschool ; Congenital Hypothyroidism ; blood ; drug therapy ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Thyrotropin ; blood ; Thyroxine ; administration & dosage ; blood ; therapeutic use ; Time Factors ; Triiodothyronine ; blood ; Withholding Treatment

We report a case of neonatal thyrotoxicosis with concurrent respiratory failure in an infant born to a mother with Graves' disease and review the published literature describing neonatal hyperthyroidism. The male infant who was born by spontaneous delivery at 35 weeks of gestational age presented with fever, tachycardia and tachypnea at rest on day 11 after birth, and developed severe apnea on day 14. Thyroid function studies revealed hyperthyroidism in the infant, and his mother was confirmed to have Grave's disease during pregnancy. Literature review showed that among the 33 infants with similar conditions, tachycardia, tachypnea and poor weight gain were the most distinct clinical features of congenital hyperthyroidism. Accurate diagnosis of Graves' disease in the mother during pregnancy and awareness of the clinical presentations of neonatal hyperthyroidism are key to reducing missed diagnosis or misdiagnosis of neonatal hyperthyroidism.
Antithyroid Agents ; therapeutic use ; Apnea ; etiology ; Female ; Graves Disease ; blood ; Humans ; Hyperthyroidism ; blood ; complications ; diagnosis ; drug therapy ; Infant, Newborn ; Infant, Newborn, Diseases ; blood ; diagnosis ; drug therapy ; Infant, Premature ; Male ; Maternal-Fetal Exchange ; Pregnancy ; Pregnancy Complications ; blood ; Propylthiouracil ; therapeutic use ; Thyrotropin ; blood ; Thyroxine ; blood ; Triiodothyronine ; blood

OBJECTIVETo study the clinical therapy and prognosis in children with transient congenital hypothyroidism (CH).

METHODSFifty-seven children with CH diagnosed after neonatal screening were treated with low-dosage levothyroxine (L-T4). Follow-up evaluation included the determination of TT3, TT4 and TSH serum levels and the assessment of thyroid gland morphology, bone age, growth development and development quotients (DQ). A full check-up was performed at age 2, when the affected children first discontinued the L-T4 treatment for 1 month, and one year later. Development quotients were compared with a control group of 29 healthy peers.

RESULTSThe initial L-T4 dosage administered was 3.21-5.81 microg/(kg.d) with an average of (16.25+/-3.87) microg/d. Mean duration of therapy was (28.09+/-9.56) months. No significant difference was found between study group and control group in the DQ test (average score (106.58+/-14.40) vs (102.4+/-8.6), P>0.05) and 96.49% of the CH children achieved a test score above 85. Bone age, 99mTc scans and ultrasonographic findings were all normal, and evaluation of physical development was normal too, as were the serum levels of TT3, TT4 and TSH after one year of follow-up.

CONCLUSIONA L-T4 dosage of 3.21-5.81 microg/(kg.d) was found sufficient for the treatment of transient CH. The treated children showed satisfactory overall mental and physical development at age 2. So it is possible for CH children to stop taking medicine if their laboratory findings and physical development are all normal after regular treatment and 2-3 years of follow-up.

Bone Development ; drug effects ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; blood ; congenital ; diagnosis ; drug therapy ; Infant ; Infant, Newborn ; Male ; Prognosis ; Thyroid Gland ; drug effects ; Thyroxine ; therapeutic use ; Time Factors ; Treatment Outcome ; Triiodothyronine ; blood

No abstract available.
Adult ; Biological Markers/blood ; Female ; Humans ; Mouth Floor ; *Neck/radiography/radionuclide imaging/ultrasonography ; Predictive Value of Tests ; Radiopharmaceuticals/diagnostic use ; Sodium Pertechnetate Tc 99m/diagnostic use ; Thyroid Dysgenesis/blood/*diagnosis/drug therapy ; Thyroid Function Tests ; *Thyroid Gland/drug effects/metabolism/radiography/radionuclide imaging/ultrasonography ; Thyrotropin/blood ; Thyroxine/blood/therapeutic use ; Tomography, X-Ray Computed

BACKGROUNDThe proliferative activity and penetration into the hypothalamic structures in children craniopharyngiomas (CP) often make radical resection difficult. Therefore, complete resection of CP often results in permanent multiple pituitary hormone deficiency (MPHD). This study aimed to elucidate the postoperative pituitary hormonal disturbances, and hormone replacement therapy (HRT) time and dosage in children with CP.

METHODSTwenty patients with growth retardation and CP after resection, comprising 14 boys and 6 girls, with a mean age of (10.63 +/- 3.18) years (Group A) and 10 male patients of group A aged > 10 years (Group B) were entolled. Thirty age-, sex- and Tanner stage-matched normal children (control Group A), and 44 male older children > 10 years (control Group B) served as controls. The serum concentrations of insulin-like growth factor-1 (IGF-1), growth hormone (GH), free thyroxine (FT4), thyroid-stimulating hormone (TSH), adrenocorticortropic hormone (ACTH), cortisol (COR), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), testosterone (T) and estradiol (E2) were measured in the CP patients after resection and in controls. The appropriate time and dosage of HRT were investigated. Linear correlation analysis was made between levothyroxine (L-T4) dosage and primary FT4 in CP patients after resection.

RESULTSAll cases had MPHD. The serum peak GH, IGF-1, FT4 and COR levels of Group A were significantly lower than that of the control Group A. The serum IGF-1 concentration increased to the normal level after 3 months of rhGH therapy; the serum FSH, LH, and T levels were significantly decreased (P < 0.001); however, E2 and PRL were significantly increased (P < 0.001) in Group B compared with the control Group B; 18 cases were found to have central diabetes insipidus (DI) by water deprivation test and MRI. There was a significant negative linear regression (r = -0.8, P < 0.001) between L-T4 and primary FT4 in Group A patients with CP after resection, giving a regression equation of L-T4 dosage (microg.kg(-1).d(-1)) = 3.5-0.2 x FT4 (microg.kg(-1).d(-1)). The time and corresponding dosage of HRT for CP after resection were: rhGH started 1 year after resection and no recurrence of CP on MRI, when IGF-1 reached the normal range, the rhGH dosage was (0.13 +/- 0.04) U.kg(-1).d(-1); hydrocortisone (H-C) was started as soon as possible, and was kept in the lower normal range, at a dosage of (12.6 +/- 4.8) mg/m2; levothyroxine started after H-C or at the same time to maintain FT4 in the higher normal range, at a dosage of (1.65 +/- 0.70) microg.kg(-1).d(-1); Minirin (DDAVP) was started as soon as possible, elicited no symptoms, and maintained normal electrolyte levels; the dosage was (0.16 +/- 0.04) mg/m2.

CONCLUSIONPatients with CP after resection often displayed MPHD, and needed total HRT at appropriate time and dosage to improve the quality of life and normal growth.

Adolescent ; Child ; Craniopharyngioma ; blood ; surgery ; Female ; Hormone Replacement Therapy ; Human Growth Hormone ; blood ; therapeutic use ; Humans ; Hydrocortisone ; blood ; Hypothalamo-Hypophyseal System ; physiopathology ; Insulin-Like Growth Factor I ; analysis ; Magnetic Resonance Imaging ; Male ; Pituitary Hormones ; blood ; Pituitary Neoplasms ; blood ; surgery ; Thyrotropin ; blood ; Thyroxine ; blood