Medscape article on Thyroid

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Thyroid Treatment Rarely Effective in Achieving Weight Loss in Obese Children

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NEW YORK (Reuters Health) Jan 15 - As a treatment for obesity in childhood,

correction of acquired hypothyroidism seldom results in weight loss, even

among the most severe cases, study findings suggest.

" The effect of hypothyroidism on weight has been vastly blown out of

proportion to reality, " lead author Dr. Jefferson P. Lomenick is quoted in a

press

release from the University of Kentucky in Lexington.

Parents of overweight children often request thyroid tests, Dr. Lomenick and

associates note in the January issue of the Journal of Pediatrics, and

physicians often prescribe levo-thyroxine even for mild cases of hypothyroidism

in

hopes of inducing weight loss.

To determine the benefits of normalizing thyroid stimulating hormone (TSH)

levels, Dr. Lomenick's team determined outcomes for 68 children treated for

acquired hypothyroidism at their clinic between 1995 and 2006.

The degree of hypothyroidism was highly variable, with initial TSH levels

ranging from 5.5 to 1600 U/mL. Thirty-nine patients (57%) were overweight or

obese.

At the first follow-up visit, at an average of 4.4 months after starting

treatment with levo-thyroxine, mean TSH had decreased from 147 to 5.0 U/mL, but

there was no association between change in TSH and changes in weight or body

mass index (BMI).

The 21 patients who lost weight tended to have more severe hypothyroidism

(TSH 349 U/mL) compared to those who did not lose weight (TSH 56.8 U/mL). Even

so, the degree of weight loss (mean 2.3 kg) was not statistically

significant.

During follow-up for up to 4 years, " near-normalization of TSH levels did not

significantly alter weight percentile, BMI percentile, weight z score, or

BMI z score, " the authors report, either in the group overall or among those

who were overweight or obese at baseline.

" Most experts agree thyroid function tests are generally unnecessary in an

overweight child if he/she has normal linear growth and no other symptoms of

hypothyroidism, " Dr. Lomenick stated. " The results of our study support this. "

J Pediatr 2008;152:96-100.

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