Art Pelin.bdi Tiroida
description
Transcript of 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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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.
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14. Radetti G, Longhi S, Baiocchi M, Cassar W, Buzi F. Changes in lifestyle improve body
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15. Stichel H., l’Allemand D., Grüters A. Thyroid Function and Obesity in Children and
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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
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5.
CONCEPTION OF MECHANICAL PRODUCTS IN A MODERN PARAMETRIC
MANNER, ……………………………………………………..................................................
Ionuţ Gabriel Ghionea
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6.
THE STUDY OF SEASONAL VARIATION OF URBAN NO2 CONCENTRATIONS…
Mariana Carmelia Dragomir, Mirela Voiculescu, Daniel Eduard Constantin, Lucian
Georgescu
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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
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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
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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
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10. ANALYSIS OF THE ROMANIAN MUNICIPAL SOLID WASTE MANAGEMENT
SYSTEM, ………………………………………………………………………………………
Simona Gheorghiţa Şaşcîm (Dumitrescu), Constantin Minciu
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11. COMPARATIVE STUDIES ON THE OPTICAL PROPERTIES INTERPOLATION
FUNCTIONS FOR SOLID FABRIC. ………………………………………………………
Gabriel Murariu, Adrian Dinescu, Adrian Gabriel Murariu, Simona Condurache - Bota
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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
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13. OPTIMIZATION OF THE MANUFACTURING PROCESS PLANNING FOR A SET
OF SPUR GEARS ……………………………………………………..………………..…….
Ionuţ Gabriel Ghionea
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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
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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
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16. DESERTIFICATION - CAUSES, SOLUTIONS TO REDUCE THE PHENOMENON
AND THE BENEFITS OF AFFORESTATION…………………………………………….
Hahuie Valentin, Emilian Dănilă, Adriana Dănilă, Lucian Georgescu, Dănuţ Lefter
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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
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19. ANALYTICAL SOLUTIONS FOR FREE OSCILLATING SYSTEM USING MAPLE
SOFTWARE…………………………………..………………………………………………
Gabriel Murariu, Nicuşor Nistor, Lucian Georgescu, Cătălina Iticescu, Ciprian Vlad
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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
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21. ACUTE ABDOMINAL PAIN IN PAEDIATRIC POPULATION FROM GALATI
COUNTY……………………………………………………………………………………….
Ciprian Adrian Dinu, Michaela Dobre, Monica Elia Georgescu
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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
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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