art pelin.bdi tiroida

MINISTERUL EDUCAŢIEI ŞI CERCETĂRII ŞTIINŢIFICE

FINANTAT PRIN PROIECTUL

POSDRU/159/1.5/S/138963

Performanţa sustenabilă ȋn cercetarea

doctorală şi post doctorală

PERFORM

MINISTRY OF EDUCATION AND RESEARCH

YEAR VI (XXXVII) 2014, Special Issue

ANNALS OF “DUNAREA DE JOS” UNIVERSITY OF GALATI – FASCICLE II

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159

ANNALS OF “DUNAREA DE JOS” UNIVERSITY OF GALATI

MATHEMATICS, PHYSICS, THEORETICAL MECHANICS

FASCICLE II, YEAR VI (XXXVII) 2014, Special Issue

THYROID STRUCTURE ABNORMALITIES -

A PROGNOSIS INDICATOR IN OBESE CHILDREN?

Ana Maria Pelin1, Victorița Ștefănescu

2, Michaela Dobre

2, Monica Elia

Georgescu3

1Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, Dunarea de Jos University of

Galati, Romania 2Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, Dunarea de Jos

University of Galati, Romania. e-mail: [email protected] 3Centre Hospitalier Universitaire Trousseau, Chambray-lès-Tours, Tours, France

Abstract

This study aimed to identify correlations between ultrasonically identified thyroid structure

abnormalities and thyroid hormone levels in obese children, as well as to evaluate the potential use

of these modifications as prognosis indicators for the evolution of obesity. The study lot was made

up of 120 obese school-age children from the Romanian county of Galati. Only 28.5% of children

with hyperthyrotropinemia, i.e. increased thyroid stimulating hormone (TSH) levels, showed

thyroid structure modifications under ultrasound exploration. Increased frequencies of thyroid

structure modifications were identified in females (23%), in severely obese children, in children

with abdominal circumference above the 90th

percentile (15.7%), without significant differences vs.

the rest of the group. Findings revealed that modified thyroid functions were not associated with

thyroid structure abnormalities, therefore the latter cannot be used as indicators of obesity

evolution, but seem to be only adaptive consequences of obesity.

Keywords: hyperthyrotropinemia, TSH, obesity, thyroid ultrasound.

1. INTRODUCTION

Excessive weight and obesity are a major risk for chronic diseases such as type 2 diabetes,

cardiovascular disease, high blood pressure, stroke and some forms of cancer [1]. The study of the

hypothalamus-hypophysis-thyroid axis in obese patients has been a constant clinical pursuit,

considering its involvement in the body’s energy balance. Childhood obesity may coexist with

subclinical hypothyroidism, which may, in time, impact multiple organs. Obesity plays upon the

hypothalamus-hypophysis-thyroid axis, causing changes detectable via TSH dosing and thyroid tests

[2]. Endocrine and metabolic disturbances associated to obesity seem to be its consequences and not

its causes. Studies demonstrate that a moderate increase in TSH may be encountered in obese

children, but this parameter does not directly associate with increased metabolic risk factors [3]. As

increased TSH seems to be a consequence of obesity, thyroid hormone treatment is redundant in

obese children [4]. Increases in TSH may be associated with increased freeT4 (FT4) or freeT3 (FT3)

levels, but the interaction mechanism thereof is little known [5]. Thyroid structure seems to also be

affected. Whether it is only thyroid function or also structure which is affected, both seem to return to

normal after weight loss [6]. In obese children, the most frequent abnormality is hyperthyrotropinemia

[7,8,9,10]. Some studies show an association between obesity and increased thyroid volume, but it

was recently suggested that the thyroids of obese children and adolescents typically display

ultrasound readings similar to those seen in Hashimoto thyroiditis. These findings do not, however,


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also identify corresponding increases in thyroid antibody production [11]. Similar observations were

made on obese adult study lots [12].

The fatty tissue of obese patients secretes inflammatory cytokines and some of these (e.g. NF-

α, IL-1, IL-6) cross over into the blood stream and may trigger systemic modifications [13]. These

cytokines determine the appearance of an exudate which may, in turn, be correlated with the abnormal

thyroid image. This mechanism may be used to also explain how the thyroid returns to its normal

aspect after weight loss [14].

2. MATERIALS AND METHODS

The study lot was made up of 120 obese children of school age (7-18 years old) from Galati.

Children with known thyroid conditions were not included in this study. Hormonal dosing (TSH, FT3,

FT4) and thyroid ultrasounds were performed on all the study lot patients. Endocrine and metabolic

abnormalities expected as consequences of obesity were evaluated through clinical and paraclinical

investigations and compliance frequencies were tallied for each monitored parameter. The presence of

thyroid modifications was investigated alongside thyroid hormone levels to estimate correlation

between abnormal findings. Isolated hyperthyrotropinemia is defined as TSH values above 3.5 mUI/L,

with normal FT3 and FT4 values (reference intervals for children: TSH: 0.89-3.5 mIU/L, FT3: 2.6-6.2

pmol/L, FT4: 1-1.87 ng/L).

3. RESULTS AND DISCUSSION

Only 28.5% of children with hyperthyrotropinemia showed micronodular structure

modifications on a thyroid ultrasound. Investigations revealed that both the right and left thyroid lobes

were typically in the above average size ranges in the study lot (avg. left lobe: 17.13 mm (p=0.0023),

avg. size right lobe 17.39 mm (p=0.007), reference size for both lobes at normal thyroid structure: 16

mm). Average isthmus size was also slightly elevated in children exhibiting micronodular thyroid

structure, but without significant deviations from reference values (p=0.164) (Table I). Micronodular

structure occurred significantly more frequently in children with BMI above the 96 percentile (61.7%

rate of occurrence, p=0.0042) (Fig. 4).

Increased TSH values (above 3.5 mIU/L) were found in 17.5% of the study lot. TSH increases

relate directly to BMI (r =+0.022) and abdominal waist (AW) circumference (r = +0.0054) and

indirectly to age (r = -0.015), without significant statistical impact.

In the group which had micronodular thyroid structure, FT3 was slightly elevated (avg. 4.0

pmol/L vs. avg. 3.53 pmol/L in the non-afflicted group, p=0.151), while FT4 values were slightly

reduced (avg. 1.10 ng/L vs avg. 1.17 ng/L, p=0.351), but without significant differences vs. the rest of

the group.

Table 1. Thyroid dimensions in the study lot - statistical overview

Thyroid ultrasound No. Mean Std. Dev. Std. Err. 95% Confid. Interval for Mean

Min Max p Lower Bound Upper Bound

Left lobe

0.023 Homogenous 93 15.63 2.79 0.29 15.06 16.21 6.8 22.5

Micronodular 27 17.13 3.50 0.67 15.74 18.51 11.0 24.3

Total 120 15.97 3.01 0.28 15.43 16.51 6.8 24.3

Right lobe

0.007 Homogenous 93 15.72 2.51 0.26 15.20 16.23 10.0 22.0

Micronodular 27 17.39 3.61 0.69 15.96 18.82 10.0 25.0

Total 120 16.09 2.86 0.26 15.58 16.61 10.0 25.0

Isthmus

0.164 Homogenous 93 2.49 1.19 0.12 2.25 2.74 1.0 11.3

Micronodular 27 2.84 0.91 0.17 2.48 3.19 1.9 5.1

Total 120 2.57 1.14 0.10 2.36 2.77 1.0 11.3


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Thyroid ultrasound imagery in the study lot:

Fig.1. Thyroid ultrasound of male patient (13 years old), suggestive of autoimmune thyroiditis

a. non-homogeneous structure; b. hypervascularization

Fig.2. Thyroid ultrasound of female patient (12 years old)

a. left lobe cross-sectional imaging with nodules of up to 2.8 mm

b. right lobe longitudinal section, slightly inhomogeneous with hypoechoic pattern nodules up to 2.5/5 mm

alternating with echogenic nodules

Fig.3. Thyroid ultrasound in male patient (13 years old)

Echogenic halo hypoechogenic nodular images in the periphery and distributed in both lobes of thyroid isthmus

(sizes from 2.5 mm to 12 mm)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Females Males BMI 95th BMI 96th BMI 97th AW <90th AW ≥90th

homogenous structure micronodular structure

Fig. 4. Distribution of thyroid structural abnormalities in obese children


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4. CONCLUSIONS

TSH values above 3.5 mIU/L were found in 17.5% of the study lot. A correlation was

observed between elevated TSH values and BMI. Similar percentages of hyperthyrotropinemia in

obese children study lots were identified by other studies [15], while other investigations put the rate

of occurrence of hyper TSH in children of normal weight at 2% [16]. Obese children frequently

display thyroid structure abnormalities, without necessarily associating impaired thyroid function.

Literature suggests moderate increases in TSH are likely in obese children, without being associated

with metabolic risk factors, and hormone treatment is redundant, as the condition is reversed by

weight loss.

Ultrasound investigations showed size abnormalities in 22.5% of the study lot (both right and

left lobes sizes, on average, larger than reference values). Obese children show correlations between

the occurrence of a micronodular structure of the thyroid and increased thyroid size, but not between

abnormal structure and increased thyroid hormone levels.

BMI values relate directly to the occurrence of hyperthyrotropinemia, but not to abnormal

ultrasound imagery. We suppose that abnormalities in thyroid structure and size dimensions are

adaptive mechanisms which occur in early and moderate childhood obesity, but do not seem to carry

over into more advanced stages. Therefore, these observations cannot be used as prognosis

instruments for the evolution of childhood obesity.

Learnings from this study suggest that a useful follow up on a similar study lot may be to

confirm TSH level reductions as a result of weight loss for hyper TSH patients as well as to measure

thyroid antibody levels to confirm potential autoimmune implications for children displaying

micronodular thyroid structure. Thyroid function investigation in obese patients remains mandatory,

in order to highlight potential hypothyroidism, a rare hormonal cause of obesity.

References

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indexfor-age in US children and adolescents overall and by race-ethnic group, Am J Clin

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3617, 2010.

9. Aeberli I, Jung A, Murer SB, Wildhaber J, Wildhaber-Brooks J, Knopfli BH, Zimmermann

MB. 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.

95:5412–5418, 2010.

10. Reinehr T. Obesity and thyroid function. Mol Cell Endocrinol. 316:165-171, 2010.


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11. Radetti G, Kleon W, Buzi F, Crivellaro C, Pappalardo L, di Iorgi N, Maghnie M. Thyroid

function and structure are affected in childhood obesity. J Clin Endocrinol Metab. 93:4749–

4754, 2008.

12. Rotondi M, Cappelli C, Leporati P, Chytiris S, Zerbini F, Fonte R, Magri F, Castellano M,

Chiovato L. A hypoechoic pattern of the thyroid at ultrasound does not indicate autoimmune

thyroid diseases in patients with morbid obesity. Eur J Endocrinol. 163:105–109, 2010.

13. Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab.

89:2548–2556, 2004.

14. Radetti G, Longhi S, Baiocchi M, Cassar W, Buzi F. Changes in lifestyle improve body

composition, thyroid function and structure in obese children. J Endocrinol Invest. 35:281–

285, 2012.

15. Stichel H., l’Allemand D., Grüters A. Thyroid Function and Obesity in Children and

Adolescents, Horm Res 2000;54:14–19, 2000.

16. Cetinkaya, E., Aslan AT, Vidinlisan S, Ocal G. Height improvement by L-thyroxinetreatment

in subclinical hypothyroidism. Pediatrics International, 45(5): p. 534-537, 2003.


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ANNALS OF “DUNAREA DE JOS” UNIVERSITY OF GALATI

MATHEMATICS, PHYSICS, THEORETICAL MECHANICS

FASCICLE II, YEAR VI (XXXVII) 2014, Special Issue

SUMMARY

1.

THE ATMOSPHERIC POLLUTION COMPONENTS. STATISTICAL

ANALYSIS OF CENTRAL AREA IN TULCEA CITY ……………..………….….

Mihaela Cudălbeanu, Florin Panaitescu, Gabriel Murariu, Lucian Georgescu

3

2.

DETERMINATION OF POLAR PHARMACEUTICAL RESIDUES IN WATER

USING GAS CHROMATOGRAPHY–MASS SPECTROMETRY, ……………………..

Carmen Lidia Chițescu, Loredana Dumitrașcu, Daniela Borda

10

3.

NUMERICAL APPROACHING OF A STIRLING ENGINE

SYSTEM,……………………………………………………………………………………….

Gabriel Murariu, Adrian Gabriel Murariu, Nicușor Nistor

17

4.

MULTIVARIATE STATISTICAL ANALYSIS OF AIR POLLUTION

PARAMETRES. CASE STUDY FOR BRAILA

CITY,………………………………..........................................................................................

Claudiu Iulian Cojocaru, Gabriel Murariu, Lucian Georgescu, Adrian - Gabriel Murariu, Nicu

- Iulian Savin

23

5.

CONCEPTION OF MECHANICAL PRODUCTS IN A MODERN PARAMETRIC

MANNER, ……………………………………………………..................................................

Ionuţ Gabriel Ghionea

29

6.

THE STUDY OF SEASONAL VARIATION OF URBAN NO2 CONCENTRATIONS…

Mariana Carmelia Dragomir, Mirela Voiculescu, Daniel Eduard Constantin, Lucian

Georgescu

37

7.

RESEARCHES REGARDING THE INFLUENCE OF PELLETS WITH

PROBIOTICS ON THE GROWTH PERFORMANCE OF JUVENILE CARP

(Cyprinus Carpio, L. 1758) IN A RECIRCULATING AQUACULTURE

SYSTEM,…………………………………………………………………………………….

Elena Bocioc, Victor Cristea, Neculai Patriche, Iulia Grecu, Săndiţa Plăcintă, Mirela (Creţu)

Mocanu, Marian Tiberiu Coadă

45

8.

CONTRIBUTIONS TO THE VEGETATION STUDY OF HABITAT 92A0 POPULUS

ALBA AND SALIX ALBA GALLERIES IN ROSCI0315 LUNCA CHINEJA,

GALATI,……………………………………………………………………………………..

Ana – Maria Lapteacru, Lucian Georgescu

52

9.

COMPARISONS BETWEEN LYOPHILIZED AND CLASSIC DRIED SAMPLES OF

CURLY PONDWEED (POTAMOGETON CRISPUS L.) FOR IN VITRO

ANTIOXIDANT AND ANTIMICROBIAL EVALUATION, ……………………………..

Paul Lupoae, Victor Cristea, Gabriela Gurău, Carmen Chiţescu, Rodica Dinică, Mariana

Lupoae, Tomas Kovalczuc

58

10. ANALYSIS OF THE ROMANIAN MUNICIPAL SOLID WASTE MANAGEMENT

SYSTEM, ………………………………………………………………………………………

Simona Gheorghiţa Şaşcîm (Dumitrescu), Constantin Minciu

66

11. COMPARATIVE STUDIES ON THE OPTICAL PROPERTIES INTERPOLATION

FUNCTIONS FOR SOLID FABRIC. ………………………………………………………

Gabriel Murariu, Adrian Dinescu, Adrian Gabriel Murariu, Simona Condurache - Bota

74

12.

SPATIAL CORRELATION ANALYSIS OF TROPOSPHERIC NO2 VCD USING

SATELLITE OBSERVATIONS FOR SEVERAL URBAN AREAS FROM ROMANIA Daniel-Eduard Constantin, Mirela Voiculescu, Carmelia Dragomir, Lucian-Puiu Georgescu

80


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13. OPTIMIZATION OF THE MANUFACTURING PROCESS PLANNING FOR A SET

OF SPUR GEARS ……………………………………………………..………………..…….

Ionuţ Gabriel Ghionea

85

14.

THE EVALUATION OF HEAVY METALS CONTENT BY ANALYZING

SEASONAL VARIATION OF HEAVY METALS FROM WATER IN THREE LAKES

SITUATED IN THE DANUBE DELTA …………………………………………..……..…

Maria Cătălina Ţopa, Adrian Burada, Lucian P. Georgescu, Cătălina Iticescu, Gabriel

Murariu

94

15.

ALGORITHM TO FIND THE GENERAL LAW OF MOTION OF THE DOUBLE

OSCILLATOR, BY USING ADVANCE VECTOR TRANSFORMATIONS ON 1-

PARAMETRIC, VECTOR SPACE……………………………………….………………...

Nicușor Nistor, Constantin Gheorghies, Nelu Cazacu

99

16. DESERTIFICATION - CAUSES, SOLUTIONS TO REDUCE THE PHENOMENON

AND THE BENEFITS OF AFFORESTATION…………………………………………….

Hahuie Valentin, Emilian Dănilă, Adriana Dănilă, Lucian Georgescu, Dănuţ Lefter

106

17.

MONITORING AND PREDICTION OF SOIL POLLUTION IN GALATI AREA……..

Dănuţ Lefter, Lucian P. Georgescu, Daniela L. Buruiană, Ina I. Humeniuc, Valentin Hahuie,

Cătălina M. Topa

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18. ANALYSIS OF SLUDGE DRYING GENERATED BY THE ACTIVITY OF AN

INTEGRATED STEEL PLANT………………………………………………….…………

Dănuţ Lefter, Daniela L. Buruiană, Lucian P. Georgescu, Ina I. Humeniuc

130

19. ANALYTICAL SOLUTIONS FOR FREE OSCILLATING SYSTEM USING MAPLE

SOFTWARE…………………………………..………………………………………………

Gabriel Murariu, Nicuşor Nistor, Lucian Georgescu, Cătălina Iticescu, Ciprian Vlad

137

20.

CHARACTERIZATION OF VASCULAR TREE: RESPONSES OF BLOOD

PRESSURE AND FLOW TO BRANCHING PATTERNS WITH VARIOUS

GEOMETRIES………………………………………………………………………………..

Luminiţa Moraru, Cristian-Dragoş Obreja, E. Monica Georgescu, Simona Moldovanu

142

21. ACUTE ABDOMINAL PAIN IN PAEDIATRIC POPULATION FROM GALATI

COUNTY……………………………………………………………………………………….

Ciprian Adrian Dinu, Michaela Dobre, Monica Elia Georgescu

150

22. STUDY ON SENSITIVITY TO ANTIBIOTICS OF KLEBSIELLA STRAINS IN

PAEDRIATIC PATHOLOGY……………………………………….………………………

Gabriela Gurău, Michaela Dobre, Monica Elia Georgescu, Camelia Bușilă, Manuela Arbune

153

23. THYROID STRUCTURE ABNORMALITIES - A PROGNOSIS INDICATOR IN

OBESE CHILDREN?...............................................................................................................

Ana Maria Pelin, Victorița Ștefănescu, Michaela Dobre, Monica Elia Georgescu

159

24. FRONT TEETH DENTAL TRAUMA …………………………………………………..….

Cristian Dan Ionel, Rodica Luca 164

25.

LOW POWER AUTONOMOUS WIND SYSTEM SIMULATION IN

MATLAB/SIMULINK……………………………………………………………………..….

Ciprian Vlad, Toader Munteanu, Gabriel Murariu, Lucian Georgescu

168

art pelin.bdi tiroida

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