The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome

Süzen, Büşra; Gursu, Hazım Alper; Azak, Emine; Mengen, Eda; kocaay, pınar; CETIN, IBRAHIM ILKER

doi:10.5543/tkda.2023.70337

The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome

Büşra Süzen, (Ankara Çocuk Sağlığı ve Hastalıkları, Hematoloji Onkoloji Eğitimi ve Araştırma Hastanesi, Ankara, Türkiye)

Hazım Alper GURSU, (Çocuk Kardiyolojisi Bölümü, Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Ankara, Türkiye)

Emine AZAK, (Çocuk Kardiyolojisi Bölümü, Ankara Şehir Hastanesi, Ankara, Türkiye)

Eda MENGEN, (Pediatrik Endokrinoloji Anabilim Dalı, Ankara Eğitim ve Araştırma Hastanesi, Ankara, Türkiye)

Pınar KOCAAY, (Pediatrik Endokrinoloji Anabilim Dalı, Ankara Şehir Hastanesi, Ankara, Türkiye)

İBRAHİM İLKER ÇETİN (Çocuk Kardiyolojisi Bölümü, Yıldırım Beyazıt Üniversitesi, Ankara Şehri Hastane, Ankara, Türkiye)

Türk Kardiyoloji Derneği Arşivi

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Yıl: 2023 Cilt: 51 Sayı: 3 Sayfa Aralığı: 163 - 167 Metin Dili: İngilizce DOI: 10.5543/tkda.2023.70337 İndeks Tarihi: 19-05-2023

The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome

Öz:

Objective: Down syndrome is a genetic syndrome characterized with various dysmorphisms and congenital malformations such as congenital heart diseases. We aimed to evaluate the relationship between Down syndrome, hypothyroidism, and cardiac findings. Methods: Thyroid hormone profiles and echocardiographic findings were evaluated. Patients with hypothyroidism and Down syndrome were named group 1; patients with hypothyroidism without Down syndrome group 2 and group 3 was control. The echocardiographic param- eters (interventricular septum and left ventricular systolic, diastolic posterior wall thickness, left ventricular end-diastolic diameter, ejection fraction) were indexed to body surface area. Left ventricular mass index and relative wall thickness were calculated. Patients with relative wall thickness equal to or below 0.42 were classified as eccentric hypertrophy or normal geometry, while those over 0.42 as concentric remodeling or concentric hypertrophy. Results: Thyroid stimulating hormone values of groups 1 and 2 were significantly higher than those of group 3. There were no significant differences for fT4 between the groups. Interventricular septum and left ventricular posterior wall end-diastolic and end-systolic thick- ness were significantly higher in group 1 than groups 2 and 3. There was no statistically sig- nificant difference in left ventricular mass index between groups 1 and 2. In terms of relative wall thickness, 16 out of 29 patients in group 1 were revealed as concentric remodeling, 12 as normal geometry, 1 patient as eccentric hypertrophy. In group 2, 6 patients were revealed as concentric remodeling, 14 as normal geometry. There was no statistically significant difference of left ventricular end-diastolic thickness between 3 groups. Conclusion: Cardiac morphology and functions were significantly affected by hypothyroidism in patients with Down syndrome. Hypertrophy in Down syndrome may be caused by the cel- lular changes in myocardium.

Anahtar Kelime:

Down Sendromu Olan ve Olmayan Çocuklarda Hipotiroidizm ile Kardiyak Bulgular Arasındaki İlişki

Öz:

Amaç: Down sendromu, çeşitli dismorfizmler ve doğumsal kalp hastalıkları gibi doğumsal mal- formasyonlarla karakterize genetik bir sendromdur. Down sendromu, hipotiroidizm ve kardiyak bulgular arasındaki ilişkiyi değerlendirmeyi amaçladık. Yöntemler: Tiroid hormon profilleri, elektrokardiyografik ve ekokardiyografik bulgu- lar değerlendirildi. Hipotiroidi ve Down sendromlu hastalar Grup 1 olarak adlandırıldı. Down sendromlu olmayan hipotiroidili hastalar Grup 2 ve kontrol grubu Grup 3 olarak adlandırıldı. Ekokardiyografik parametreler (interventriküler septum ve sol ventrikül sistolik-diastolik arka duvar kalınlığı, sol ventrikül diastol sonu çapı, ejeksiyon fraksiyonu) vücut yüzey alanına endekslendi. Sol ventrikül kitle indeksi (SVKİ) ve rölatif duvar kalınlığı (RDK) hesaplandı. RDK’sı 0.42’ye eşit veya altında olan hastalar eksantrik hipertrofi veya normal geometri, 0.42’nin üzeri- nde olanlar ise konsantrik yeniden şekillenme veya konsantrik hipertrofi olarak sınıflandırıldı. Bulgular: Grup 1 ve 2’nin TSH değerleri Grup 3’e göre anlamlı olarak yüksekti. Grup 1 ve 2 arasında SVKİ açısından anlamlı fark yoktu. RDK açısından; Grup 1’deki 29 hastanın 16’sında konsantrik yeniden şekillenme, 12’sinde normal geometri, bir hastada eksantrik hipertrofi saptandı. Grup 2’de 6 hastada konsantrik yeniden şekillenme, 14 hastada normal geometri saptandı. Üç grup arasında sol ventrikül diastol sonu kalınlık açısından istatistiksel anlamlı fark yoktu. Sonuç: Down sendromlu hastalarda kardiyak morfoloji ve fonksiyonların hipotiroidizmden önemli ölçüde etkilendiği belirlendi. Down sedromunda hipertrofi varlığının miyokarttaki hücre- sel değişikliklerden kaynaklanabileceği düşünülmektedir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Kampmann C, Wiethoff CM, Wenzel A, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart. 2000;83(6):667-672. [CrossRef]
2. Lubec G, Engidawork E. The brain in Down syndrome (trisomy 21). J Neurol. 2002;249(10):1347-1356. [CrossRef]
3. Torfs CP, Christianson RE. Anomalies in Down syndrome individuals in a large population-based registry. Am J Med Genet. 1998;77(5): 431-438. [CrossRef]
4. Oliveira ATdA, Longui CA, Calliari EP, Ferone Ede A, Kawaguti FS, Monte O. Evaluation of the hypothalamic-pituitary-thyroid axis in children with Down syndrome. J Pediatr (Rio J). 2002;78(4): 295-300. [CrossRef]
5. Karlsson B, Gustafsson J, Hedov G, Ivarsson SA, Annerén G. Thyroid dysfunction in Down’s syndrome: relation to age and thyroid auto- immunity. Arch Dis Child. 1998;79(3):242-245. [CrossRef]
6. Van Vliet G. Longitudinal study of thyroid function in Down’s syndrome in the first two decades. J Pediatr. 2005;147(5):707-708. [CrossRef]
7. Ali FE, Bayoumy HA, Mohammad ASR, Al-Busairi WA, Al- Othman AN. Thyroid function in Kuwaiti subjects with Down’s syndrome. Med Princ Pract. 2002;11(4):206-209. [CrossRef]
8. Hatipoğlu N, Büyükkayhan D, Kurtoğlu S. Yenidoğan dönemi tiroid hastalıkları. Turk Klin J Pediatr Sci. 2006;2:63-82.
9. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7):501-509. [CrossRef]
10. Toscano E, Pacileo G, Limongelli G, et al. Subclinical hypothyroidism and Down’s syndrome; studies on myocardial structure and func- tion. Arch Dis Child. 2003;88(11):1005-1008. [CrossRef]
11. Shashi V, Berry MN, Covitz W. A combination of physical examina- tion and ECG detects the majority of hemodynamically significant heart defects in neonates with Down syndrome. Am J Med Genet. 2002;108(3):205-208. [CrossRef]
12. Narchi H. Neonatal ECG screening for congenital heart disease in Down syndrome. Ann Trop Paediatr. 1999;19(1):51-54. [CrossRef]
13. Iqbal A, Schirmer H, Lunde P, Figenschau Y, Rasmussen K, Jorde R. Thyroid stimulating hormone and left ventricular function. J Clin Endocrinol Metab. 2007;92(9):3504-3510. [CrossRef]
14. Franzoni F, Galetta F, Fallahi P, et al. Effect of L-thyroxine treatment on left ventricular function in subclinical hypothyroidism. Biomed Pharmacother. 2006;60(8):431-436. [CrossRef]
15. Varma R, Jain AK, Ghose T. Heart in hypothyroidism--an echocar- diographic study. J Assoc Physicians India. 1996;44(6):390-392.
16. Karagün K. Down sendromlu hastalarda MEF2C ve CREB1 Gen poli- morfizm İlişkisinin araştırılması [Doktora Tezi]. Eskişehir; 2015.
17. Özdemir O, Oğuz D, Okuyaz Ç, et al. Doğuştan hipotiroidili bebeklerde tiroksin tedavisi öncesi ve sonrasında sol ventrikül işlevleri. Anatol J Clin Investig. 2011;5:37-41.
18. Hsu DT, Pearson GD. Heart failure in children: part I: history, etiology, and pathophysiology. Circ Heart Fail. 2009;2(1):63-70. [CrossRef]
19. Galderisi M, Vitale G, D’Errico A, et al. Usefulness of pulsed tissue Doppler for the assessment of left ventricular myocardial function in overt hypothyroidism. Ital Heart J. 2004;5(4):257-264.
20. Mishra TK, Routray SN, Das S, Behera M. Left ventricular dysfunc- tion in patients with subclinical hypothyroidism and its reversibility after hormone therapy. J Assoc Physicians India. 2005;53:943-946.
21. Arthur EW. Left ventricule I: General considerations. 2nd ed. Phile- delphia Lea & Febiger Principles and Practice of Echocardiography; 1994, 20, 575-605.
22. Joe KO, James BS, A. Jamil T. Assessment of Ventricular Systolic Function, the Echo Manuel. 2nd ed. Philadelphia; 1999;4:37-57.
23. Yeşil S. Subklinik hipotiroidi. Turk J Endocrinol Metab. 2003;7:095.
24. Sarma JS, Venkataraman K, Nicod P, et al. Circadian rhythmicity of rate-normalized QT interval in hypothyroidism and its significance for development of class III antiarrhythmic agents. Am J Cardiol. 1990;66(12):959-963. [CrossRef]

APA	Süzen B, Gursu H, Azak E, Mengen E, kocaay p, CETIN I (2023). The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. , 163 - 167. 10.5543/tkda.2023.70337
Chicago	Süzen Büşra,Gursu Hazım Alper,Azak Emine,Mengen Eda,kocaay pınar,CETIN IBRAHIM ILKER The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. (2023): 163 - 167. 10.5543/tkda.2023.70337
MLA	Süzen Büşra,Gursu Hazım Alper,Azak Emine,Mengen Eda,kocaay pınar,CETIN IBRAHIM ILKER The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. , 2023, ss.163 - 167. 10.5543/tkda.2023.70337
AMA	Süzen B,Gursu H,Azak E,Mengen E,kocaay p,CETIN I The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. . 2023; 163 - 167. 10.5543/tkda.2023.70337
Vancouver	Süzen B,Gursu H,Azak E,Mengen E,kocaay p,CETIN I The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. . 2023; 163 - 167. 10.5543/tkda.2023.70337
IEEE	Süzen B,Gursu H,Azak E,Mengen E,kocaay p,CETIN I "The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome." , ss.163 - 167, 2023. 10.5543/tkda.2023.70337
ISNAD	Süzen, Büşra vd. "The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome". (2023), 163-167. https://doi.org/10.5543/tkda.2023.70337

APA	Süzen B, Gursu H, Azak E, Mengen E, kocaay p, CETIN I (2023). The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. Türk Kardiyoloji Derneği Arşivi, 51(3), 163 - 167. 10.5543/tkda.2023.70337
Chicago	Süzen Büşra,Gursu Hazım Alper,Azak Emine,Mengen Eda,kocaay pınar,CETIN IBRAHIM ILKER The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. Türk Kardiyoloji Derneği Arşivi 51, no.3 (2023): 163 - 167. 10.5543/tkda.2023.70337
MLA	Süzen Büşra,Gursu Hazım Alper,Azak Emine,Mengen Eda,kocaay pınar,CETIN IBRAHIM ILKER The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. Türk Kardiyoloji Derneği Arşivi, vol.51, no.3, 2023, ss.163 - 167. 10.5543/tkda.2023.70337
AMA	Süzen B,Gursu H,Azak E,Mengen E,kocaay p,CETIN I The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. Türk Kardiyoloji Derneği Arşivi. 2023; 51(3): 163 - 167. 10.5543/tkda.2023.70337
Vancouver	Süzen B,Gursu H,Azak E,Mengen E,kocaay p,CETIN I The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome. Türk Kardiyoloji Derneği Arşivi. 2023; 51(3): 163 - 167. 10.5543/tkda.2023.70337
IEEE	Süzen B,Gursu H,Azak E,Mengen E,kocaay p,CETIN I "The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome." Türk Kardiyoloji Derneği Arşivi, 51, ss.163 - 167, 2023. 10.5543/tkda.2023.70337
ISNAD	Süzen, Büşra vd. "The Relationship Between Hypothyroidism and Cardiac Findings in Children With and Without Down Syndrome". Türk Kardiyoloji Derneği Arşivi 51/3 (2023), 163-167. https://doi.org/10.5543/tkda.2023.70337