Original ArticlesReduced bone mineral density at diagnosis and bone mineral recovery during treatment in children with Graves’ disease☆
Section snippets
Patients and methods
Twenty-six children (19 girls and 7 boys) with Graves’ disease aged 3.4 to 15.3 years (mean age, 11 ± 3.4 years) (prepubertal n = 12, undergoing puberty n = 14) were studied. The diagnosis of hyperthyroidism was made on the basis of clinical evidence of hyperthyroidism confirmed by measurements of serum thyrotropin, free thyroxine, and free triiodothyronine. The duration of disease was evaluated according to the duration of symptoms as reported by the patients or their parents (mean 4.2 ± 3.6
Clinical Description of the 26 Children at Diagnosis and Follow-up of Thyroid Function
The mean height, weight, and body mass index were at +1 ± 1.5 SDS, +0.06 ± 1.1 SDS, and –0.8 ± 0.9 SDS, respectively (Table I). Normal values forEmpty Cell Mean ± SD Range Age (y) 11 ± 3.4 3.4-15.3 Advanced bone age 0.8 ± 1.1 –1.7-3.7 Height (SDS) 1 ± 1.5 –2-4.6 Weight (SDS) 0.06 ± 1.1 –2-2.6 BMI (SDS) –0.8 ± 0.9 –3.7-1.4 Growth velocity (SDS) 1.3 ± 2.2 –1.9-6.7 TSH (mU/mL) 0.05 ± 0.05 0.02-0.3 FT3 (pmol/L) 30 ± 8.1 11.5-44 FT4 (pmol/L) 67 ± 28 21.5-144
Discussion
This study clearly demonstrates that children with Graves’ disease have a significant impairment of BMD at diagnosis. Femoral and lumbar spine BMD (SDS) values of children with hyperthyroidism were significantly lower than the expected values in an age- and sex-matched reference population in both the femur and the spine, where cortical and trabecular bone, respectively, predominate. Severe osteopenia was found in 42% of the patients. During treatment a significant gain in BMD was observed, and
Acknowledgements
We thank Jean Guibourdenche for bone metabolism marker dosages.
References (26)
- et al.
Osteoporosis and fractures following thyrotoxicotis
Lancet
(1971) - et al.
Bone changes in hyperthyroidism: interrelationship between bone morphometry, thyroid function and calcium phosphorus metabolism
Acta Endocrinol
(1977) - et al.
Direct stimulation of bone resorption by thyroid hormones
J Clin Invest
(1976) - et al.
Thyroid function and bone turnover
Acta Endocrinol (Copenh)
(1983) - et al.
Osteoporosis in hyperthyroidism estimated by photon absorptiometry 1979
Acta endocrinologica
(1979) - et al.
Effect of hyperthyroidism and its treatment on bone mineral content
Arch Intern
(1985) - et al.
Bone mineral density in patients with hyperthyroidism measured by dual energy x-ray absorptiometry
Clin Endocrinol (Oxf)
(1993) - et al.
Body weight and body composition changes after treatment of hyperthyroidism
J Clin Endocrinol Metab
(1998) - et al.
Antiresorptive therapy in hyperthyroid patients: longitudinal changes in bone and mineral metabolism
J Clin Endocrinol Metab
(1997) - et al.
A longitudinal study of markers of bone turnover in Grave’s disease and their value in predicting bone mineral density
J Clin Endocrinol Metab
(1997)
Thyrotoxicosis presenting as fracture of femoral neck
Br Med J
Déminéralisation osseuse et élévation des concentrations sériques d’ostéocalcine chez les jeunes enfants atteints d’hyperthyroidie
Ann Pediatr
Bone mineralization and calciotropic hormones in children with hyperthyroidism. Effects of methimazole therapy
J Endocrinol Invest
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Low Bone Mineral Density at Initial Diagnosis in Children and Adolescents with Graves’ Disease
2021, Journal of Clinical DensitometryCitation Excerpt :The BMD at the LS and TB at diagnosis were lower than in healthy controls, with complete recovery after antithyroid treatment. Lucidarme et al (7) reported a significantly lower BMD in children with Graves’ disease than in healthy controls in the LS and proximal FN. The BMD at the FN showed a preferential loss of density rather than the lumbar spine BMD.
Osteoporosis in childhood and adolescence
2020, Marcus and Feldman’s OsteoporosisThyroid hormone, thyroid medication, and the skeleton
2020, Marcus and Feldman’s OsteoporosisGraves’ disease in children
2018, Annales d'EndocrinologieCitation Excerpt :neuropsychiatric problems including anxiety and depression, agitation, opposition, aggressiveness or even confusion [19]; bone problems, (as in adults) such as a decrease in bone mineralization (usually cortical bone) and which is corrected with hyperthyroidism treatment – [20] and, more unusually, pathological fractures or vertebral compression [21]. As in adults, hyperthyroidism may predominate on T3 levels, either initially or during evolution [22].
Diagnosis and management of hyperthyroidism from prenatal life to adolescence
2018, Best Practice and Research: Clinical Endocrinology and MetabolismCitation Excerpt :Neurological symptoms are rare [24]. As reported for adults, children with GD may have a decrease bone mass, but restoration to normal levels is frequently achieved after the maintenance of a euthyroid state for two years on ATD treatment [25]. Pretibial myxedema is rare.
Graves' disease in children
2014, Best Practice and Research: Clinical Endocrinology and MetabolismCitation Excerpt :Neurological symptoms are rare [18]. As in adults, children with GD may have a lower than normal bone mass, but bone mass is often restored to normal levels after two years of a euthyroid state on ATD treatment [19]. Pretibial myxoedema is rare.
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Reprint requests: Juliane Léger, MD, Pediatric Endocrinology and Diabetes Unit, Hôpital Robert Debré, 48, Bd Sérurier, 75019 Paris, France.