RESUMO
OBJECTIVE: To investigate the correlation between serum thyroid-stimulating hormone (TSH) concentration and nodule nature in pediatric patients with thyroid nodules, with the aim of identifying a marker able to differentiate benign and malignant nodules. STUDY DESIGN: This was a retrospective analysis of serum TSH concentrations in a multicentric case series of 125 pediatric patients with benign and malignant thyroid nodules. RESULTS: Of the 125 patients, 99 had benign thyroid nodules and 26 had differentiated thyroid cancer (24 papillary and 2 follicular). Final diagnosis was based on surgery in 57 cases and on a benign cytology plus clinical follow-up in 68 cases. Serum TSH concentration was significantly higher in patients with thyroid cancer compared with those with benign nodules (3.23 ± 1.59 mU/L vs 1.64 ± 0.99 mU/L; P < .001). Binary logistic regression analysis revealed that serum TSH was the sole predictor of malignancy (P < .001). Dividing the patient cohort into 5 groups based on serum TSH quintiles (TSH cutoffs 0.40, 1.00, 1.50, 1.80, and 2.80 mU/L), we observed that cancer prevalence increased in parallel with serum TSH (P < .001), with respective rates of 0%, 4%, 16%, 32%, and 52% in the 5 quintile groups. CONCLUSION: Because cases with malignant nodules are most likely seen in the upper normal serum TSH range (ie, >2.8 mU/L), serum TSH concentration can serve as a predictor of thyroid cancer in pediatric patients with thyroid nodules and can inform the decision of when to submit patients to further investigation by cytology.
Assuntos
Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/diagnóstico , Tireotropina/sangue , Adolescente , Biópsia por Agulha Fina , Índice de Massa Corporal , Proliferação de Células , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Prevalência , Análise de Regressão , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/epidemiologiaRESUMO
OBJECTIVE: To evaluate the effects of liquid (drops) and tablet formulations of levothyroxine in homogeneous groups of infants with congenital hypothyroidism (CH) as diagnosed through neonatal screening. STUDY DESIGN: Forty-two consecutive infants with CH were subdivided into 2 groups consisting of infants with the severe or the moderate/mild form. For each form, the infants with CH were randomly assigned to receive liquid (group 1) or tablet (group 2) formulation. In all patients, thyroid function tests were performed before the beginning of therapy and at 15 and 30 days and at 3 and 6 months after the beginning of therapy. RESULTS: In the severe form, after 15 days of treatment, serum thyrotropin (TSH) levels became normal in 8 of 9 patients in group 1 and in 5 of 9 patients in group 2; serum free triiodothyronine (fT3) levels were significantly higher in group 1 than in group 2; and serum fT4 levels were higher than the upper limit of the normal range in all patients in both groups. During the follow-up, there were significantly more patients with suppressed TSH concentrations in group 1 than in group 2. In the moderate/mild form, the patients of group 1 and group 2 showed median values of TSH, fT3, and fT4 that were not significantly different. No clinical or electrocardiographic signs of heart disease were found. There were no significant differences in the developmental quotient between group 1 and group 2 patients with severe and moderate/mild CH. CONCLUSIONS: Our data seem to indicate that there is not complete bioequivalence between drops and tablets, especially in infants with severe CH.
Assuntos
Hipotireoidismo Congênito/tratamento farmacológico , Tireotropina/sangue , Tiroxina/administração & dosagem , Tri-Iodotironina/sangue , Química Farmacêutica , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal , Comprimidos , Testes de Função Tireóidea , Tiroxina/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the long-term outcome of thyroid function and autoimmunity in a large series of children with celiac disease. STUDY DESIGN: This longitudinal, retrospective study (duration of follow-up, 8.9 +/- 4.0 years) was conducted at the Pediatric Department, University of Bologna, Italy. One hundred thirty-five consecutive patients diagnosed between June 1990 and December 2004 and followed on a gluten-free diet were examined. Inclusion criteria were good dietary compliance and duration of follow-up for at least 3 years. RESULTS: Of 101 patients who never showed positive antithyroid titers during the follow-up, 86 remained euthyroid; 15 showed high thyroid-stimulating hormone values at diagnosis that normalized in 11 cases after 12 to 18 months of gluten withdrawal. Of 31 patients with persistently positive antibody titers, 23 (74%) remained consistently euthyroid during the follow-up and 8 (26%) had a subclinical hypothyroidism. The prevalence of cases with positive antibodies was similar in children with growth retardation or gastroenterological symptoms at diagnosis and different durations of gluten exposure. CONCLUSIONS: The presence of antithyroid antibodies in children with celiac disease has a low predictive value for the development of thyroid hypofunction during the indicated surveillance period. Longer follow-up is needed.
Assuntos
Doença Celíaca/epidemiologia , Tireoidite Autoimune/epidemiologia , Adolescente , Autoanticorpos/sangue , Doença Celíaca/imunologia , Criança , Pré-Escolar , Feminino , Seguimentos , Gastroenteropatias/epidemiologia , Gastroenteropatias/imunologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/imunologia , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/imunologia , Itália/epidemiologia , Masculino , Peroxidase/imunologia , Prevalência , Estudos Retrospectivos , Tireoglobulina/imunologia , Tireoidite Autoimune/imunologia , Tireoidite Autoimune/prevenção & controle , Tireotropina/sangueRESUMO
OBJECTIVE: To evaluate the adult reproductive outcome in girls with early puberty who participated in a previous random study. STUDY DESIGN: A total of 22 subjects treated with triptorelin 3.75 mg every 4 weeks (group 1), 18 subjects not treated (group 2), and 22 age-matched normal volunteers (control group) underwent a physical examination, serum hormone level determination, and pelvic ultrasonography. RESULTS: The characteristics of menstrual cycles, serum hormone levels, and ultrasound results did not differ significantly among the 3 groups examined. The mean ovarian volume and the uterine volume tended to increase in the subjects of group 2, but the differences were not significant. The percentage of subjects who reported being sexually active at the time of the examination was greater in the 2 groups with previous early puberty than in the controls (76% of cases in group 1, 72% in group 2, and 59% in the control group). CONCLUSIONS: Neither early puberty nor its treatment seems to significantly affect the normal adult function of the pituitary-gonadal axis.
Assuntos
Luteolíticos/uso terapêutico , Puberdade Precoce/tratamento farmacológico , Reprodução , Pamoato de Triptorrelina/uso terapêutico , Adulto , Criança , Feminino , Seguimentos , Humanos , Fatores de TempoRESUMO
OBJECTIVES: To test the sensitivities of recently published American recommendations predicting occult intracranial lesion (OICL) in girls with central precocious puberty (CPP), and to validate a previously derived diagnosis rule predicting OICL based on age at puberty onset and estradiol (E2) level. STUDY DESIGN: A retrospective, multicenter, hospital-based, cohort study was performed, including all girls with CPP seen in 7 centers in 6 European countries during given periods. American recommendations and the previously derived diagnosis rule were tested. RESULTS: Girls with CPP (n=443), including 35 with OICL, were recruited. American recommendations did not identify all OICL. Previously identified independent risk factors for OICL were confirmed: age <6 years (adjusted odds ratio 20.5; 95% CI, 8.1-52.1) and E2 >45th percentile (3.0; 95% CI, 1.3-7.1). The previously derived diagnosis rule had 100% sensitivity (95% CI, 90-100): all girls with OICL had either an age <6 years or an E2 level >45th percentile. The specificity was 39% (95% CI, 34-44). CONCLUSIONS: American recommendations do not seem safe to select European girls with CPP who require brain imaging. In settings where systematic brain imaging is not possible, the proposed diagnosis rule could safely help to avoid more than one third of unnecessary brain imaging.
Assuntos
Encefalopatias/epidemiologia , Árvores de Decisões , Puberdade Precoce/epidemiologia , Encefalopatias/complicações , Encefalopatias/diagnóstico , Criança , Europa (Continente) , Medicina Baseada em Evidências , Feminino , Humanos , Imageamento por Ressonância Magnética , Seleção de Pacientes , Puberdade Precoce/etiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To verify whether a reduced birth weight for gestational age was associated with a testicular dysfunction in postpubertal boys. STUDY DESIGN: Boys born small for gestational age (SGA) (n = 25) were compared to 24 born with an appropriate weight. All subjects were postpubertal (mean age 17.5 +/- 1.3 and 17.6 +/- 2.0 years, respectively). The following clinical and endocrinologic variables were evaluated: final height, target height, body mass index, testicular volume, follicle-stimulating hormone, luteinizing hormone, testosterone, and inhibin B. RESULTS: The SGA group had reduced testicular size (16.3 +/- 2.7 mL vs 22.8 +/- 3.2 mL; P <.0001) with a lower testosterone level (3.76 +/- 1.35 ng/mL vs 4.77 +/- 1.55 ng/mL; P <.05) and a higher LH value (4.41 +/- 1.61 IU/L vs 3.44 +/- 1.29 IU/L; P <.05). Among the SGA group, 54% had a mean testicular volume >2 SD below the control mean (ie, <16 mL) and in these subjects, the inhibin B level was low (143 +/- 46 pg/mL vs 229 +/- 76 pg/mL; P <.0001). SGA patients with smaller testes had lower final height relative to target height(P <.05 vs patients with larger testes) and for the SGA group, inhibin B correlated with testicular size (P <.0001). Positive correlations also were found between the reduction of final height relative to target height and testicular volume (P <.005) and inhibin B values (P <.05). CONCLUSIONS: SGA subjects have pituitary-gonadal axis function that tends toward hypogonadism. There is a disruption of the exocrine function in subjects with smaller testicular size who failed to show a complete height catch-up growth. This study supports a link between low birth weight and lower fertility in adult males.