Hipotiroidismo adquirido en niños

  • Martín Toro Ramos Universidad de Antioquia
  • Lina Marcela Restrepo Giraldo Hospital Pablo Tobón Uribe
  • Vital Balthazar González Universidad de Antioquia
  • Nora Alejandra Zuluaga Espinosa Hospital Universitario de San Vicente Fundación
  • Germán Campuzano Maya Laboratorio Clínico Hematológico
Palabras clave: hipotiroidismo, tiroiditis de Hashimoto, hormonas tiroideas, pruebas de función tiroidea, levotiroxina.

Resumen

El hipotiroidismo es una de las enfermedades endocrinas más frecuentes, sus manifestaciones se explican por la producción insuficiente de hormonas tiroideas o por su acción inadecuada en los órganos blanco. Según la causa, el hipotiroidismo se puede clasificar como congénito o adquirido, y se puede originar de forma primaria en la glándula tiroidea por defectos en la síntesis y liberación hormonal, o de forma secundaria por alteraciones centrales en el eje hipotálamo-hipófisis-tiroides. La etiología y las características clínicas del hipotiroidismo en niños y adolescentes difieren en parte de las presentadas en los adultos; por ello, es fundamental identificar las manifestaciones particulares de la disfunción tiroidea durante la edad pediátrica, para lograr un diagnóstico y tratamiento oportunos, los cuales son esenciales para la prevención de las múltiples complicaciones, especialmente las secuelas neurológicas devastadoras y el retraso en el desarrollo. En este artículo se revisarán las principales características del hipotiroidismo adquirido en niños y adolescentes, planteándose a partir de un enfoque clínico simple y útil para la práctica médica general.

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Biografía del autor/a

Martín Toro Ramos, Universidad de Antioquia

Médico Pediatra Endocrinólogo. IPS Universitaria, Universidad de Antioquia. Medellín, Colombia.

Lina Marcela Restrepo Giraldo, Hospital Pablo Tobón Uribe

Médica Internista Endocrinóloga. Hospital Pablo Tobón Uribe. Medellín, Colombia.

Vital Balthazar González, Universidad de Antioquia

Médico Pediatra Endocrinólogo. Universidad de Antioquia. Medellín, Colombia.

Nora Alejandra Zuluaga Espinosa, Hospital Universitario de San Vicente Fundación

Médica Pediatra Endocrinóloga. Hospital Universitario de San Vicente Fundación. Medellín, Colombia.

Germán Campuzano Maya, Laboratorio Clínico Hematológico

Médico especialista en Hematología y Patología Clínica. Docente, Ad Honorem, Facultad de Medicina, Universidad de Antioquia. Médico Director, Laboratorio Clínico Hematológico. Medellín, Colombia.

Referencias bibliográficas

Bettendorf M. Thyroid disorders in children from birth to adolescence. Eur J Nucl Med Mol Imaging 2002; 29 Suppl 2: S439-446.

https://doi.org/10.1007/s00259-002-0905-3

Razvi S, Weaver JU, Pearce SH. Subclinical thyroid disorders: significance and clinical impact. J Clin Pathol 2010; 63: 379-386.

https://doi.org/10.1136/jcp.2008.057414

Counts D, Varma SK. Hypothyroidism in children. Pediatr Rev 2009; 30: 251-258.

https://doi.org/10.1542/pir.30-7-251

O'Grady MJ, Cody D. Subclinical hypothyroidism in childhood. Arch Dis Child 2011; 96: 280-284.

https://doi.org/10.1136/adc.2009.181800

Peter F, Muzsnai A. Congenital disorders of the thyroid: hypo/hyper. Pediatr Clin North Am 2011; 58: 1099-1115, ix.

https://doi.org/10.1016/j.pcl.2011.07.002

Djemli A, Van Vliet G, Delvin EE. Congenital hypothyroidism: from paracelsus to molecular diagnosis. Clin Biochem 2006; 39: 511-518.

https://doi.org/10.1016/j.clinbiochem.2006.03.015

Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams Textbook of Endocrinology. (ed 12). Philadelphia: Elsevier Saunders; 2011.

Dreimane D, Varma SK. Common childhood thyroid disorders. Indian J Pediatr 1997; 64: 3-10.

https://doi.org/10.1007/BF02795770

Rastogi MV, LaFranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis 2010; 5: 17.

https://doi.org/10.1186/1750-1172-5-17

Devriendt K, Vanhole C, Matthijs G, de Zegher F. Deletion of thyroid transcription factor-1 gene in an infant with neonatal thyroid dysfunction and respiratory failure. N Engl J Med 1998; 338: 1317-1318.

https://doi.org/10.1056/NEJM199804303381817

Macchia PE, Lapi P, Krude H, Pirro MT, Missero C, Chiovato L, et al. PAX8 mutations associated with congenital hypothyroidism caused by thyroid dysgenesis. Nat Genet 1998; 19: 83-86.

https://doi.org/10.1038/ng0598-83

Deladoey J, Vuissoz JM, Domene HM, Malik N, Gruneiro-Papendieck L, Chiesa A, et al. Congenital secondary hypothyroidism due to a mutation C105Vfs114X thyrotropin-beta mutation: genetic study of five unrelated families from Switzerland and Argentina. Thyroid 2003; 13: 553-559.

https://doi.org/10.1089/105072503322238818

Muthukrishnan J, Harikumar KV, Verma A, Modi K. Central hypothyroidism. Indian J Pediatr 2010; 77: 94-96.

https://doi.org/10.1007/s12098-009-0248-1

República de Colombia, Instituto Nacional de Salud, Grupo de vigilancia y control de enfermedades crónicas no transmisibles. Protocolo de vigilancia y control de hipotiroidismo congénito. 2010. http://secretariaseccionaldesaluddelmeta.gov.co/wp-content/uploads/2012/05/PRO-R02.003.0000-045-HIPOTIROIDISMO-CONGENITO.pdf Consultado en junio de 2012.

Rallison ML, Dobyns BM, Keating FR, Rall JE, Tyler FH. Occurrence and natural history of chronic lymphocytic thyroiditis in childhood. J Pediatr 1975; 86: 675-682.

https://doi.org/10.1016/S0022-3476(75)80350-7

Fava A, Oliverio R, Giuliano S, Parlato G, Michniewicz A, Indrieri A, et al. Clinical evolution of autoimmune thyroiditis in children and adolescents. Thyroid 2009; 19: 361-367.

https://doi.org/10.1089/thy.2008.0239

Hanna CE, LaFranchi SH. Adolescent thyroid disorders. Adolesc Med 2002; 13: 13-35, v.

Gopalakrishnan S, Chugh PK, Chhillar M, Ambardar VK, Sahoo M, Sankar R. Goitrous autoimmune thyroiditis in a pediatric population: a longitudinal study. Pediatrics 2008; 122: e670-674.

https://doi.org/10.1542/peds.2008-0493

Wasniewska M, Salerno M, Cassio A, Corrias A, Aversa T, Zirilli G, et al. Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence. Eur J Endocrinol 2009; 160: 417-421.

https://doi.org/10.1530/EJE-08-0625

Zaletel K, Gaberscek S. Hashimoto's Thyroiditis: From Genes to the Disease. Curr Genomics 2011; 12: 576-588.

https://doi.org/10.2174/138920211798120763

McLachlan SM, Rapoport B. Why measure thyroglobulin autoantibodies rather than thyroid peroxidase autoantibodies? Thyroid 2004; 14: 510-520.

https://doi.org/10.1089/1050725041517057

Zaletel K. Determinants of thyroid autoantibody production in Hashimoto's thyroiditis. Expert Rev Clin Immunol 2007; 3: 217-223.

https://doi.org/10.1586/1744666X.3.2.217

Passeri E, Frigerio M, De Filippis T, Valaperta R, Capelli P, Costa E, et al. Increased risk for non-autoimmune hypothyroidism in young patients with congenital heart defects. J Clin Endocrinol Metab 2011; 96: E1115-1119.

https://doi.org/10.1210/jc.2011-0057

Marwaha RK, Tandon N, Desai AK, Kanwar R, Aggarwal R, Sastry A, et al. Reference range of thyroid hormones in healthy school-age children: country-wide data from India. Clin Biochem 2010; 43: 51-56.

https://doi.org/10.1016/j.clinbiochem.2009.03.001

Seth A, Aggarwal V, Maheshwari A. Hypothyroidism in children beyond 5 y of age: delayed diagnosis of congenital hypothyroidism. Indian J Pediatr 2012; 79: 891-895.

https://doi.org/10.1007/s12098-011-0678-4

Nicoletti A, Bal M, De Marco G, Baldazzi L, Agretti P, Menabo S, et al. Thyrotropin-stimulating hormone receptor gene analysis in pediatric patients with non-autoimmune subclinical hypothyroidism. J Clin Endocrinol Metab 2009; 94: 4187-4194.

https://doi.org/10.1210/jc.2009-0618

Koch L. Thyroid gland: TSH reference limits specific for age, sex and ethnicity. Nat Rev Endocrinol 2011; 7: 61.

https://doi.org/10.1038/nrendo.2010.218

Rapa A, Monzani A, Moia S, Vivenza D, Bellone S, Petri A, et al. Subclinical hypothyroidism in children and adolescents: a wide range of clinical, biochemical, and genetic factors involved. J Clin Endocrinol Metab 2009; 94: 2414-2420.

https://doi.org/10.1210/jc.2009-0375

Laurberg P, Andersen S, Carle A, Karmisholt J, Knudsen N, Pedersen IB. The TSH upper reference limit: where are we at? Nat Rev Endocrinol 2011; 7: 232-239.

https://doi.org/10.1038/nrendo.2011.13

Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87: 489-499.

https://doi.org/10.1210/jcem.87.2.8182

Duprez L, Parma J, Van Sande J, Rodien P, Dumont JE, Vassart G, et al. TSH receptor mutations and thyroid disease. Trends Endocrinol Metab 1998; 9: 133-140.

https://doi.org/10.1016/S1043-2760(98)00036-8

Asvold BO, Vatten LJ, Nilsen TI, Bjoro T. The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study. Eur J Endocrinol 2007; 156: 181-186.

https://doi.org/10.1530/eje.1.02333

Cerbone M, Bravaccio C, Capalbo D, Polizzi M, Wasniewska M, Cioffi D, et al. Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism. Eur J Endocrinol 2011; 164: 591-597.

https://doi.org/10.1530/EJE-10-0979

Kung AW, Pang RW, Janus ED. Elevated serum lipoprotein(a) in subclinical hypothyroidism. Clin Endocrinol (Oxf) 1995; 43: 445-449.

https://doi.org/10.1111/j.1365-2265.1995.tb02616.x

Liu D, Jiang F, Shan Z, Wang B, Wang J, Lai Y, et al. A cross-sectional survey of relationship between serum TSH level and blood pressure. J Hum Hypertens 2010; 24: 134-138.

https://doi.org/10.1038/jhh.2009.44

Razvi S, Weaver JU, Butler TJ, Pearce SH. Levothyroxine treatment of subclinical hypothyroidism, fatal and nonfatal cardiovascular events, and mortality. Arch Intern Med 2012. [Epub ahead of print].

https://doi.org/10.1001/archinternmed.2012.1159

Walsh JP, Bremner AP, Bulsara MK, O'Leary P, Leedman PJ, Feddema P, et al. Thyroid dysfunction and serum lipids: a community-based study. Clin Endocrinol (Oxf) 2005; 63: 670-675.

https://doi.org/10.1111/j.1365-2265.2005.02399.x

Hoogwerf BJ, Nuttall FQ. Long-term weight regulation in treated hyperthyroid and hypothyroid subjects. Am J Med 1984; 76: 963-970.

https://doi.org/10.1016/0002-9343(84)90842-8

Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29: 76-131.

https://doi.org/10.1210/er.2006-0043

de Moura Souza A, Sichieri R. Association between serum TSH concentration within the normal range and adiposity. Eur J Endocrinol 2011; 165: 11-15.

https://doi.org/10.1530/EJE-11-0261

Pirich C, Mullner M, Sinzinger H. Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants. J Clin Epidemiol 2000; 53: 623-629.

https://doi.org/10.1016/S0895-4356(99)00187-0

Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004; 291: 228-238.

https://doi.org/10.1001/jama.291.2.228

Devdhar M, Ousman YH, Burman KD. Hypothyroidism. Endocrinol Metab Clin North Am 2007; 36: 595-615, v.

https://doi.org/10.1016/j.ecl.2007.04.008

Schmidt NC, Kolch M, von Schnurbein J, Pfalzer AK, Cario H, Debatin KM, et al. Central hypothyroidism due to malnutrition in a 6-year old girl. Klin Padiatr 2010; 222: 315-316.

https://doi.org/10.1055/s-0030-1249062

Knobel RB. Thyroid hormone levels in term and preterm neonates. Neonatal Netw 2007; 26: 253-259.

https://doi.org/10.1891/0730-0832.26.4.253

Rose SR, Brown RS, Foley T, Kaplowitz PB, Kaye CI, Sundararajan S, et al. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics 2006; 117: 2290-2303.

https://doi.org/10.1542/peds.2006-0915

Guan H, Shan Z, Teng X, Li Y, Teng D, Jin Y, et al. Influence of iodine on the reference interval of TSH and the optimal interval of TSH: results of a follow-up study in areas with different iodine intakes. Clin Endocrinol (Oxf) 2008; 69: 136-141.

https://doi.org/10.1111/j.1365-2265.2007.03150.x

Boucai L, Hollowell JG, Surks MI. An approach for development of age-, gender-, and ethnicity-specific thyrotropin reference limits. Thyroid 2011; 21: 5-11.

https://doi.org/10.1089/thy.2010.0092

Marwaha RK, Tandon N, Desai A, Kanwar R, Grewal K, Aggarwal R, et al. Reference range of thyroid hormones in normal Indian school-age children. Clin Endocrinol (Oxf) 2008; 68: 369-374.

Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab 2007; 92: 4575-4582.

https://doi.org/10.1210/jc.2007-1499

Surks MI, Boucai L. Age- and race-based serum thyrotropin reference limits. J Clin Endocrinol Metab 2010; 95: 496-502.

https://doi.org/10.1210/jc.2009-1845

Solberg HE. International Federation of Clinical Chemistry (IFCC), Scientific Committee, Clinical Section, Expert Panel on Theory of Reference Values, and International Committee for Standardization in Haematology (ICSH), Standing Committee on Reference Values. Approved Recommendation (1986) on the theory of reference values. Part 1. The concept of reference values. J Clin Chem Clin Biochem 1987; 25: 337-342.

https://doi.org/10.1016/0009-8981(87)90224-5

Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003; 13: 3-126.

https://doi.org/10.1089/105072503321086962

Spencer CA, Hollowell JG, Kazarosyan M, Braverman LE. National Health and Nutrition Examination Survey III thyroid-stimulating hormone (TSH)-thyroperoxidase antibody relationships demonstrate that TSH upper reference limits may be skewed by occult thyroid dysfunction. J Clin Endocrinol Metab 2007; 92: 4236-4240.

https://doi.org/10.1210/jc.2007-0287

Wartofsky L, Dickey RA. The evidence for a narrower thyrotropin reference range is compelling. J Clin Endocrinol Metab 2005; 90: 5483-5488.

https://doi.org/10.1210/jc.2005-0455

Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995; 43: 55-68.

https://doi.org/10.1111/j.1365-2265.1995.tb01894.x

Fatourechi V, Klee GG, Grebe SK, Bahn RS, Brennan MD, Hay ID, et al. Effects of reducing the upper limit of normal TSH values. JAMA 2003; 290: 3195-3196.

https://doi.org/10.1001/jama.290.24.3195-b

Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. Consensus Statement #1: Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society. Thyroid 2005; 15: 24-28; response 32-23.

https://doi.org/10.1089/thy.2005.15.24

Hamilton TE, Davis S, Onstad L, Kopecky KJ. Thyrotropin levels in a population with no clinical, autoantibody, or ultrasonographic evidence of thyroid disease: implications for the diagnosis of subclinical hypothyroidism. J Clin Endocrinol Metab 2008; 93: 1224-1230.

https://doi.org/10.1210/jc.2006-2300

Surks MI, Goswami G, Daniels GH. The thyrotropin reference range should remain unchanged. J Clin Endocrinol Metab 2005; 90: 5489-5496.

https://doi.org/10.1210/jc.2005-0170

Aziz DC. Use and interpretation of tests in endocrinology. Santa Monica: Specialty Laboratories; 1997.

Liwanpo L, Hershman JM. Conditions and drugs interfering with thyroxine absorption. Best Pract Res Clin Endocrinol Metab 2009; 23: 781-792.

https://doi.org/10.1016/j.beem.2009.06.006

Cooper DS, Biondi B. Subclinical thyroid disease. Lancet 2012; 379: 1142-1154.

https://doi.org/10.1016/S0140-6736(11)60276-6

Fleming ID, Black TL, Thompson EI, Pratt C, Rao B, Hustu O. Thyroid dysfunction and neoplasia in children receiving neck irradiation for cancer. Cancer 1985; 55: 1190-1194.

https://doi.org/10.1002/1097-0142(19850315)55:6<1190::AID-CNCR2820550609>3.0.CO;2-6

Salerno M, Militerni R, Bravaccio C, Micillo M, Capalbo D, Di MS, et al. Effect of different starting doses of levothyroxine on growth and intellectual outcome at four years of age in congenital hypothyroidism. Thyroid 2002; 12: 45-52.

https://doi.org/10.1089/105072502753451968

Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 2002; 8: 457-469.

https://doi.org/10.4158/1934-2403-8.6.457

Cómo citar
1.
Toro Ramos M, Restrepo Giraldo LM, Balthazar González V, Zuluaga Espinosa NA, Campuzano Maya G. Hipotiroidismo adquirido en niños. Med. Lab. [Internet]. 1 de septiembre de 2012 [citado 5 de octubre de 2022];18(9-10):443-58. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/305
Publicado
2012-09-01
Sección
Endocrinología