Estudio longitudinal y retrospectivo del desarrollo puberal en mujeres con hipotiroidismo congénito primario

Resumo

Objective To study the relationship between certain aspects of pubertal development in a group of women with primary congenital hypothyroidism diagnosed before the introduction of neonatal screening programs and in a control group of healthy women. Patients and measurements Longitudinal retrospective study of 15 women with primary congenital hypothyroidism and 26 healthy women. Height, chronological and bone age, and growth velocity during puberty were studied. Height and growth velocity are expressed in centimeters and centimeters per year, respectively. Bone age was analyzed by the Greulich and Pyle atlas. Bone and chronological age are expressed in decimal year. Statistical data were expressed as the means and as the maximum and minimum standard deviations. The Student-Fisher t-test was used to compare the two groups. Results 1. Evolution of mean height measurements in the hypothyroid and control group respectively were as follows: 154.5 ± 5.11 and 156.4 ± 5.28 for genetic height; 140.0 ± 5.21 and 138.9 ± 5.95 in Tanner's B2, and 153.7 ± 3.32 and 155.0 ± 5.93 at menarche. Final height was 157.8 ± 3.71 and 158.9 ± 5.95. The difference between final and genetic height was 3.25 ± 4.17 and 2.16 ± 4.18. The increase in height after menarche was 4.12 ± 1.61 and 3.92 ± 1.81. The total increase in height during puberty was 17.74 ± 4.32 and 20.46 ± 5.30. The percentage of height reached during puberty compared with final height was 11.24 ± 2.70 and 12.82 ± 3.18. 2. Evolution of mean chronological age was respectively: 11.57 ± 1.01 and 10.75 ± 1.36 in Tanner's B2 (p < 0.05); 13.48 ± 0.88 and 13.18 ± 1.12 at menarche, and 16.25 ± 1.33 and 14.91 ± 1.12 at reaching final height (p < 0.01). Time between Tanner's B2 and B3, B3 and B4 and B2 and B4 were 0.61 ± 0.23 and 0.98 ± 0.60 (p < 0.01), 0.71 ± 0.33 and 0.70 ± 0.33, 1.32 ± 0.51 and 1.65 ± 0.70. Time between B2 and menarche was 1.92 ± 0.55 and 2.46 ± 1.05 (p < 0.05) and between menarche and final height was 2.89 ± 1.04 and 1.70 ± 0.63 (p < 0.001). 3. Evolution of mean bone age measurements was respectively: 10.57 ± 1.51 and 10.67 ± 1.26 in Tanner's B2, and 13.60 ± 0.97 and 13.27 ± 0.65 at menarche. Development of bone age between Tanner's B2 and B3, B3 and B4 and B2 and B4 was 1.02 ± 0.60 and 0.91 ± 0.65, 1.12 ± 0.76 and 0.96 ± 0.59, and 2.13 ± 1.29 and 1.74 ± 1.04, respectively, and between B2 and menarche it was 3.17 ± 1.25 and 2.66 ± 1.38. 4. Mean growth velocity in real time elapsed between different intervals and in centimeters per year was as follows: between B2 and B3: 5.05 ± 2.09, 5.75 ± 2.80 and 8.40 ± 1.80, 6.24 ± 1.74 (p < 0.01); between B3 and B4: 4.74 ± 1.54, 4.97 ± 2.82 and 7.31 ± 2.14, 7.14 ± 1.68; between B2 and B4: 9.40 ± 3.70, 10.90 ± 4.13 and 7.40 ± 2.18, 6.75 ± 1.34 and between B2 and menarche: 13.62 ± 4.41, 15.96 ± 5.42 and 7.20 ± 1.57, 6.90 ± 1.27 respectively. Conclusions In women with hyperthyroidism puberty was normal, except that onset was delayed, development was faster and the post-menarche growth period was longer than in the control group. Bone maturation and growth velocity were similar in both groups, and both of them reached a normal final height compared with their target height.