Ferhat EKİNCİ, ARZU UZUNER, Demet MERDER COŞKUN, Bilge TURGUT, Niyazi TOSUN

Thyroid hormones and BMI in obese children: One year follow up results

Amaç: Bu çalışmanın amacı tiroid hormon düzeyleri ile obezite, lipid düzeyleri ve ağırlık değişiklikleri arasındaki ilişkiyi araştırmaktır. Hastalar ve Yöntemler: Beş ve onbir yaş aralığında normal, fazla kilolu ve obez çocukların TSH, sT4, lipid profili ve otoimmün antikor değerlerine bakılmıştır. TSH düzeyi yüksek olan çocuklar herhangi bir müdahale yapılmadan bir yıl sonra yeniden değerlendirilmiştir. Bulgular: Çalışmada 300 çocuk (126 obez, 74 fazla kilolu, 100 normal kilolu) değerlendirilmiştir. Yüksek TSH düzeyi sıklığı normal kilolu grupta %1.0, fazla kilolu grupta %9.5 ve obez grupta %11.9’dur (p=0.007). Bütün gruplarda sT4 düzeyleri normal bulunmuştur. Çocukların hiçbirinde otoimmun antikorlar pozitif değildir. Yüksek TSH’lı çocuklar normal TSH’lı çocuklara göre daha yüksek trigliserid düzeylerine sahiptir (p=0.028). Bir yıl sonra yapılan değerlendirmede, VKİ’de anlamlı düşüşle birlikte TSH düzeyinde de anlamlı bir düşüş saptanmıştır. Sonuç: TSH düzeyleri obez ve fazla kilolu çocuklarda yüksek olabilir. TSH yüksekliği olan obez ve fazla kilolu çocukların farmakolojik olarak tedavi edilmesine gerek yoktur, kilo vermek TSH düzeylerinin anlamlı olarak azalmasını sağlar.

Anahtar Kelimeler:

TSH, VKİ, Çocuk, Obezite, Fazla kilolu, Tiroid

-

Keywords:

-,

___

1. WHO: Obesity Preventing And Managing The Global Epidemic. Report of WHO Technical Report Series 894. Geneva: World Health Organization 2000. http://www. who.int/nutrition/publications/obesity/WHO_TRS_894/en/ 19/04/2015.
2. Klish WJ. Comorbidities and complications of obesity in children and adolescents. http://0210c7oi7.y.http.www. uptodate.com Literature review current through: Oct 2015.
3. Torun E, Cindemir E, Tolga Özgen İ, Öktem F. Subclinical hypothyroidism in obese children. Dicle Medical Journal 2013; 40 : 5-8. doi: 10.5798/diclemedj.0921.2013.01.0215
4. Stichel H, I’Allemand D, Gruters A. Thyroid function and obesity in children and adolescents. Horm Res 2000;54:14-9. doi:10.1159/000063431
5. Dekelbab BH, Abou Ouf HA, Jain I. Prevalence of elevated thyroid-stimulating hormone levels in obese children and adolescents. Endocr Pract 2010;16:187-90. doi: 10.4158/ EP09176.
6. Günöz H, Saner G, Demirkol M, Gökçay G, Hüner G, Garibağaoğlu M. Beslenme ve Beslenme Bozuklukları, “Pediatri” içinde Olcay Neyzi, Türkan Ertuğrul, editor. 3. Baskı, 1. Cilt. Ankara: Nobel Tıp Kitapevleri, 2002: 221-6.
7. Kapelari K, Kirchlechner C, Hogler W, et al. Pediatric reference intervals for thyroid hormone levels from birth to adulthood: a retrospective study. BMC Endocr Disord 2008;27:8-15. doi: 10.1186/1472-6823-8-15.
8. Radetti G, Kleon W, Buzi F, et al. Thyroid function and structure are affected in childhood obesity. J Clin Endocrinol Metab 2008;93:4749-54. doi: 10.1210/jc.2008-0823.
9. Grandone A, Santoro N, Coppola F, Calabrò P, Perrone L, Del Giudice EM. Thyroid function derangement and childhood obesity: an Italian experience. BMC Endocr Disord 2010;10:8. doi: 10.1186/1472-6823-10-8.
10. Bhowmick SK, Dasari G, Levens KL, Rettig KR. The prevalence of elevated serum thyroid stimulating hormone in childhood/adolescent obesity and of autoimmune thyroid diseases in a subgroup. J Nat Med Ass 2007;99:773-6. http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC2574343/ Accessed on 11.082015
11. Mutlu RG, Özsu E, Çizmecioğlu FM. Şişman çocuklarda hafif TSH yüksekliği: Nasıl bir sorun? Türk Ped Arş 2011;46:33-6.
12. Kumar H, Verma A, Muthukrishnan J, et al. Obesity and thyrotropinemia. Indian J Pediatr 2009;76:933-5.
13. Knudsen N, Laurberg P, Rasmussen LB, Bülow I, Perrild H, Ovesen L, Jørgensen T. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J. Clin Endocrinol Metab 2005;90:4019-24. doi: 10.1210/jc.2004-2225.
14. Marras V, Casini MR, Pilia S, et al. Thyroid function in obese children and adolescents. Horm Res Paediatr 2010;73:193-7. doi:10.1159/000284361
15. Reinehr T, Hinney A, de Sousa G, et al. Definable somatic disorders in overweight children and adolescents. J Pediatr 2007;150:618-22.
16. Lloyd RV, Jin L, Tsumanuma I, et al. Leptin and leptin receptor in anterior pituitary function. Pituitary 2001;4:33-47.
17. Ortiga-Carvalho TM, Oliveira KJ, Soares BA, et al. The role of leptin in the regulation of TSH secretion in the fed state: in vivo and in vitro studies, J Endocrinol. 2002;174:121-5. http://joe.endocrinology-journals.org/content/174/1/121.full. pdf Accessed on 11.08.2015
18. Fox S. C, Pencina MJ, D’Agostino RB, et al. Relations of thyroid function to body weight. Cross-sectional and longitudinal observations in a community-based sample. Arch Intern Med 2008;168:587-92. doi:10.1001/archinte.168.6.587.
19. Ross DS. Thyroid function and the metabolic syndrome. J Clin Endocrinol Metab 2007;92:491-6.
20. Reinehr T, De Sousa G, Andler W. Hyperthyrotropinemia in obese children is reversible after weight loss and is not related to lipids. J Clin Endocrinol Metab 2006;91:3088-91.
21. Holst-Schumacher I, Nuñez-Rivas H, Monge-Rojas R, Barrantes-Santamaría M. Components of the metabolic syndrome among a sample of overweight and obese Costa Rican schoolchildren. Food Nutr Bull 2009 ;30:161-70.
22. Pacifico L, Bonci E, Ferraro F, et al. Hepatic steatosis and thyroid function tests in overweight and obese children. International Journal of Endocrinology 2013:38:10-4. doi: 10.1155/2013/381014.
23. Aeberli I, Jung A, Murer SB, et al. During rapid weight loss in obese children, reductions in TSH predict improvements in insulin sensitivity independent of changes in body weight or fat. J Clin Endocrinol Metab 2010;95:5412-8. doi: 10.1210/ jc.2010-1169.
24. Eliakim A, Barzilai M, Wolach B, Nemet D. Should we treat elevated thyroid stimulating hormone levels in obese children and adolescents? Int J Pediatr Obes 2006;1:217-21.
25. Sari R, Balci MK, Altunbas H, et al. The effect of body weight and weight loss on thyroid volume and function in obese women. Clin Endocrinol 2003;59:258-62. doi: 10.1046/j.1365-2265.2003.01836.x.
26. Shalitin S, Yackobovitch-Gavan M, Phillip M. Prevalence of thyroid dysfunction in obese children and adolescents before and after weight reduction and its relation to other metabolic parameters. Horm Res 2009;71:155-61. doi: 10.1159/000197872.
27. Santos MI, Limbert C, Marques FC, Rosário F, Lopes L. Childhood obesity, thyroid function, and insulin resistance – is there a link? A longitudinal study.J Pediatr Endocrinol Metab. 2015 May;28(5-6):557-62. doi: 10.1515/jpem-2014-0319.
28. Lazar L, Frumkin RB, Battat E, Lebenthal Y, Phillip M, Meyerovitch J. Natural history of thyroid function tests over 5 years in a large pediatric cohort. J Clin Endocrinol Metab 2009;94:1678-82. doi: 10.1210/jc.2008-2615.
29. Kaptein EM, Beale E, Chan LS. Thyroid hormone therapy for obesity and nonthyroidal illnesses: a systematic review. J Clin Endocrinol Metab 2009;94:3663-75. doi: 10.1210/jc.2009- 0899