Cardiovascular Manifestations of Childhood Onset Hypothyroidism

BACKGROUNDThyroid hormones exert a direct cellular effect on almost all the tissues of the body including the heart.Limited studies are available in the country to assess the various cardiovascular parameters in hypothyroid children and the impact of treatment on these parameters. MATERIALS AND METHODS32 newly diagnosed hypothyroid paediatric patients who presented to B. J. Wadia Hospital for Children were studied over a period of 18 months.They were clinically evaluated and underwent relevant investigations, including thyroid profile estimation, cardiac evaluation using electrocardiography (ECG) and 2D -Echocardiography/colour Doppler.29 patients were reviewed after 3 months of treatment. RESULTSThe majority (18 cases -56.3%) of the patients were above 10 years with a female preponderance (68.8% females).Mean value of TSH and Free T4 were 205.58 ± 267.33 μIU/mL and 0.67 ± 0.37 ng/dL respectively.Symptoms and signs were significantly common with TSH (thyroid stimulating hormone) above 50 μg/mL.Dyslipidaemia was found in 22 (68.75%)cases.The most common ECG abnormality observed was prolonged PR interval in 14 (43.8%)cases and the most common echocardiographic finding was septal hypertrophy, seen in 16 (50%) cases, followed by left ventricular posterior wall hypertrophy (LVPW) (43.8%),LV dilatation (25%), pericardial effusion (25%) and cardiac dysfunction in 4 cases.At 3 months follow-up of 29 subjects, significant improvement of all the deranged parameters was noted with the achievement of euthyroidism. CONCLUSIONIt was concluded that children with hypothyroidism have significant cardiovascular abnormalities proportional to TSH level and these resolve completely with treatment.Hence, early diagnosis with optimal treatment reduces the cardiac morbidity in these children.