From the Guidelines
Short stature due to thyroid hormone deficiency is typically disproportionate, with the body growing in a disharmonious manner, featuring relatively short limbs compared to the trunk. This occurs because thyroid hormones are essential for normal bone growth and development, especially in the long bones. A prolonged deficiency of thyroid hormones during childhood slows down linear growth and skeletal maturation in a non-uniform manner. According to the study by 1, hypothyroidism in children with congenital nephrotic syndrome occurs due to urinary loss of thyroxine-binding proteins, and measuring free thyroxine and thyroid-stimulating hormone (TSH) at disease onset is recommended, with treatment of hypothyroidism as indicated by laboratory testing.
Key points to consider in the management of short stature due to thyroid hormone deficiency include:
- Early treatment with levothyroxine can normalize growth and improve body proportions if initiated promptly
- The dose should be personalized based on the child's age and weight, with close monitoring of hormonal levels to optimize growth
- Growth hormone therapy may also be considered in children with height below the 10th percentile who have a low height velocity, provided that other potentially treatable risk factors for growth failure have been adequately addressed, as suggested by 1
- Regular monitoring of ionized calcium, 25-OH-D3, and parathyroid hormone (PTH) levels is crucial in children with congenital nephrotic syndrome, with supplementation of vitamin D and calcium as needed, to prevent further growth impairment.
In clinical practice, it is essential to prioritize the management of hypothyroidism and other potentially treatable risk factors for growth failure to optimize growth and development outcomes in children with short stature due to thyroid hormone deficiency.
From the Research
Short Stature Due to Thyroid Hormone Deficiency
- Short stature due to thyroid hormone deficiency can be disproportionate, as evidenced by studies that show a significant impact of thyroid hormone levels on growth rate and height velocity 2, 3.
- Thyroid hormone deficiency can lead to a slow rate of growth, delayed dental and skeletal ages, and a lower height velocity compared to individuals with normal thyroid hormone levels 3.
- Replacement therapy with levothyroxine or human growth hormone can help improve growth rates in individuals with thyroid hormone deficiency, but the response to treatment can vary depending on the underlying cause of the deficiency 3, 4.
Effects of Thyroid Hormone Supplementation
- Thyroid hormone supplementation can have a positive effect on growth rate and height velocity in children with idiopathic short stature and low-normal serum free thyroxine levels 2.
- Studies have shown that children with thyroid hormone deficiency tend to have lower height standard deviation scores, lower free thyroxine levels, and lower insulin-like growth factor-1 standard deviation scores compared to children with normal thyroid hormone levels 5.
- The diagnostic value of thyroid function tests, such as free thyroxine levels, can be useful in identifying children with isolated pituitary hypoplasia and growth hormone deficiency 5.
Growth Patterns and Thyroid Hormone Deficiency
- Growth patterns in children with thyroid hormone deficiency can be characterized by a slow rate of growth, delayed puberty, and a lower adult height potential 4, 6.
- Thyroid hormone deficiency can also lead to skeletal disproportion, which can be evident on skeletal surveys and can help guide diagnosis and treatment 6.
- Molecular testing can be an important component of confirming the diagnosis of pseudohypoparathyroidism type 1A, a condition that can present with short stature, congenital hypothyroidism, and multiple hormone resistance 6.