Subtle diastolic dysfunction in children with idiopathic subclinical hypothyroidism: effect of two years of l-thyroxine treatment
4 affiliations
- 1Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- 2Interdepartmental Center for Gender Medicine Research “GENESIS”, University of Naples Federico II, Naples, Italy
- 3Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II of Naples, Endo-ERN Center for Rare Endocrine Conditions, Naples, Italy
- 4Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Hospital Federico II of Naples, Naples, Italy
Abstract
Purpose: Data about clinical implications of subclinical hypothyroidism (SH) in children are scanty, and the management of this condition is still challenging particularly for mild forms (TSH levels ranging between 4.5 and 10 mU/L). Aim of this study is to compare left ventricular (LV) geometry and function in SH children and matched euthyroid controls, and to evaluate the cardiac effects of L-thyroxine (L-T4) therapy.
Methods: Thirty-six children (19 females), aged 8.3 ± 0.7 years, with persistent and idiopathic SH were enrolled in the study. Thirty-six euthyroid children comparable for sex, age and body mass index were enrolled as controls. Baseline echocardiography and biochemical assessment was performed in all subjects. Thereafter, SH children started L-T4 therapy. Both assessments were repeated after 2 years of therapy in patients and 2 year -follow-up in controls.
Results: The LV cavity size was comparable between SH and controls, at baseline, and increased similarly over time. LV systolic function was normal at baseline in both groups and remained comparable at end-study. With regard to diastolic function, SH children showed a significant prolongation of isovolumic relaxation time (IVRT) compared with controls (92.95 ± 3.74 vs 76.13 ± 2.75 msec, p = 0.0006), with normal E/A and E/E’ ratios in both populations, consistent with subclinical, mild diastolic dysfunction. After L-T4 therapy, IVRT significantly decreased (81.43 ± 4.28 msec p < 0.05) becoming similar to controls (82.20 ± 2.14 msec).
Conclusion: Long-lasting mild SH in children is associated with subtle abnormality of LV relaxation which improves with L-T4 therapy. Whether these subtle alterations may lead to significant clinical consequences require further investigation.
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BibTeX
@article{arcopinto2026subtle,
title = {{Subtle diastolic dysfunction in children with idiopathic subclinical hypothyroidism: effect of two years of l-thyroxine treatment}},
author = {M. Arcopinto and M. Salerno and R. Di Mase and A. Salzano and F. R. Rotondo and S. Vasaturo and A. Cittadini and D. Capalbo},
journal = {Journal of Endocrinological Investigation},
year = {2026},
month = jul,
doi = {10.1007/s40618-026-03002-2},
url = {https://doi.org/10.1007/s40618-026-03002-2},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Subtle diastolic dysfunction in children with idiopathic subclinical hypothyroidism: effect of two years of l-thyroxine treatment
AU - M. Arcopinto
AU - M. Salerno
AU - R. Di Mase
AU - A. Salzano
AU - F. R. Rotondo
AU - S. Vasaturo
AU - A. Cittadini
AU - D. Capalbo
PY - 2026
DA - 2026/07/30
JO - Journal of Endocrinological Investigation
DO - 10.1007/s40618-026-03002-2
UR - https://doi.org/10.1007/s40618-026-03002-2
AB - Purpose: Data about clinical implications of subclinical hypothyroidism (SH) in children are scanty, and the management of this condition is still challenging particularly for mild forms (TSH levels ranging between 4.5 and 10 mU/L). Aim of this study is to compare left ventricular (LV) geometry and function in SH children and matched euthyroid controls, and to evaluate the cardiac effects of L-thyroxine (L-T4) therapy. Methods: Thirty-six children (19 females), aged 8.3 ± 0.7 years, with persistent and idiopathic SH were enrolled in the study. Thirty-six euthyroid children comparable for sex, age and body mass index were enrolled as controls. Baseline echocardiography and biochemical assessment was performed in all subjects. Thereafter, SH children started L-T4 therapy. Both assessments were repeated after 2 years of therapy in patients and 2 year -follow-up in controls. Results: The LV cavity size was comparable between SH and controls, at baseline, and increased similarly over time. LV systolic function was normal at baseline in both groups and remained comparable at end-study. With regard to diastolic function, SH children showed a significant prolongation of isovolumic relaxation time (IVRT) compared with controls (92.95 ± 3.74 vs 76.13 ± 2.75 msec, p = 0.0006), with normal E/A and E/E’ ratios in both populations, consistent with subclinical, mild diastolic dysfunction. After L-T4 therapy, IVRT significantly decreased (81.43 ± 4.28 msec p < 0.05) becoming similar to controls (82.20 ± 2.14 msec). Conclusion: Long-lasting mild SH in children is associated with subtle abnormality of LV relaxation which improves with L-T4 therapy. Whether these subtle alterations may lead to significant clinical consequences require further investigation.
SN - 0391-4097
SN - 1720-8386
ER -