{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T05:00:23Z","timestamp":1747198823061,"version":"3.40.5"},"reference-count":21,"publisher":"Vilnius University Press","issue":"2","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["AML"],"abstract":"<jats:p>\u00a0Background.\u00a0Nephrotic children may develop thyroid hormone dysfunction due to urinary excretion of thyroid hormones. In contrast to the subclinical hypothyroidism that affects around 30% of children with nephrotic syndrome (NS), the patient in this case had overt hypothyroidism and severe growth retardation.Clinical case.\u00a0A 5 years and 8 months old girl with steroid-dependent NS was referred from another center due to persistent edema and decreased diuresis, being treated with mycophenolate mofetil (MMF) 250 mg once a day and\u00a0L-thyroxine 50 mcg daily since 4 months of NS onset because of\u00a0hypothyroidism. Her albumin was 12.64 g\/l, cholesterol 25.64 mmol\/l and proteinuria 5 g\/l. Severe growth retardation was observed:\u00a0patient\u2019s height was 93.5 cm (\u201313 cm &lt;3 percentile), weighted 17.2 kg (15\u201325 percentile). Her disease vintage was over 3 years. Girl\u2019s\u00a0growth velocity has slowed down from 3.5 months.\u00a0The patient received a high cumulative dose of prednisolone (approx. 7800 mg in 1 year and 8 months).\u00a0Thyroid-stimulating hormone was higher (18.04 mU\/L) with reduced FT4 11.43 pmol\/l and IGF-1 &lt; 15\u00a0\u00b5g\/L.\u00a0Kidney biopsy revealed minimal change disease, and genetic testing was negative. Intensive NS treatment with methylprednisolone pulse therapy, enlarged doses of MMF and albumin infusion were started and\u00a0L-thyroxine dose was increased to 75 mcg.\u00a0TPOAb was in normal range (12.65 IU\/ml). After 3 weeks she was discharged with no edema and after stopping methylprednisolone treatment thyroid function normalized and\u00a0L-thyroxin was discontinued. Two weeks later standard growth hormone stimulation test with clonidine showed partially insufficient growth hormone secretion. During NS remission with normalization of thyroid function (TSH 6.680 mU\/l, FT4 13.85 pmol\/l) and normalization of IGF-1 level (132 mcg\/l) partial catch-up growth was observed (height velocity increased from 3.5 cm\/year to 7.3 cm\/year, based on 4-month calculation period).Conclusions.\u00a0Clinicians should be aware of a risk of developing hypothyroidism and consider thyroid function testing during the treatment of children with NS, as well as actively treat hypothyroidism and evaluate growth.<\/jats:p>","DOI":"10.15388\/amed.2023.30.2.4","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T03:55:27Z","timestamp":1697601327000},"page":"194-202","source":"Crossref","is-referenced-by-count":0,"title":["Overt Hypothyroidism and Severe Growth Retardation in a Preschool Girl with Poorly Controlled Nephrotic Syndrome: Case Report and Literature Review"],"prefix":"10.15388","volume":"30","author":[{"given":"Joana","family":"Mikulevi\u010d","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolina","family":"Tumelien\u0117","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robertas","family":"Keme\u017eys","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7767-2102","authenticated-orcid":false,"given":"Augustina","family":"Jankauskien\u0117","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6097","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"issue":"10141","key":"ref0","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S0140-6736(18)30536-1","article-title":"Idiopathic nephrotic syndrome in children","volume":"392","author":"Noone","year":"2018","unstructured":"Noone DG, Iijima K, Parekh R. Idiopathic nephrotic syndrome in children. Lancet. 2018;392(10141):61-74.","journal-title":"Lancet"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Saffari F, Ahadi S, Dalirani R, Esfandiar N, Yazdi Z, Arad B. Thyroid Dysfunction in Children with Idiopathic Nephrotic Syndrome Attending a Paediatric Hospital in Qazvin, Iran. Sultan Qaboos Univ Med J. 2020;20(4):e332-e338. doi: 10.18295\/squmj.2020.20.04.009","DOI":"10.18295\/squmj.2020.20.04.009"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Leung AM, Brent GA. The Influence of Thyroid Hormone on Growth Hormone Secretion and Action. In: Cohen L, ed. Growth Hormone Deficiency. Springer, Cham; 2016:29-46. https:\/\/doi.org\/10.1007\/978-3-319-28038-7_4","DOI":"10.1007\/978-3-319-28038-7_4"},{"key":"ref3","unstructured":"Hajizadeh N, Marashi SM, Nabavizadeh B, Elhami E, Mohammadi T, Nobandegani NM, et al. Examine of thyroid function in pediatric nephrotic syndrome: Tehran-Iran. Int J Pediatr. 2015;3:59-65. https:\/\/doi.org\/10.22038\/IJP.2015.4051"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Hunter I, Greene SA, MacDonald TM, Morris AD. Prevalence and aetiology of hypothyroidism in the young. Archives of Disease in Childhood. 2000;83(3):207-210. doi: 10.1136\/adc.83.3.207","DOI":"10.1136\/adc.83.3.207"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Brooks MJ, Post EM. Acquired hypothyroidism due to iodine deficiency in an American child. J Pediatr Endocrinol Metab. 2014;27(11-12):1233-1235. doi: 10.1515\/jpem-2014-0226","DOI":"10.1515\/jpem-2014-0226"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Vigone MC, Capalbo D, Weber G, Salerno M. Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated? J Endocr Soc. 2018;2(9):1024-1039. doi: 10.1210\/js.2017-00471","DOI":"10.1210\/js.2017-00471"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Niranjan U, Wright NP. Should we treat subclinical hypothyroidism in obese children? BMJ. 2016;352:i941. doi:10.1136\/bmj.i941","DOI":"10.1136\/bmj.i941"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Dagan A, Cleper R, Krause I, Blumenthal D, Davidovits M. Hypothyroidism in children with steroid-resistant nephrotic syndrome. Nephrol Dial Transplant. 2012;27(6):2171-2175. doi:10.1093\/ndt\/gfr665","DOI":"10.1093\/ndt\/gfr665"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Solarin A, Dada A, Akinyosoye G, Oladimeji A, Akinola I, Njokanma F. POS-463 Subclinical hypothyroidism in children with nephrotic syndrome attending Lagos State University Teaching Hospital, Ikeja. Kidney International Reports. 2022;7(2):S206. https:\/\/doi.org\/10.1016\/j.ekir.2022.01.493","DOI":"10.1016\/j.ekir.2022.01.493"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Chandurkar V, Shik J, Randell E. Exacerbation of underlying hypothyroidism caused by proteinuria and induction of urinary thyroxine loss: Case report and subsequent investigation. Endocr Pract. 2008;14(1):97-103. doi:10.4158\/EP.14.1.97","DOI":"10.4158\/EP.14.1.97"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Burch HB. Drug effects on the thyroid. N Engl J Med. 2019;381(8):749-761. doi:10.1056\/NEJMra1901214","DOI":"10.1056\/NEJMra1901214"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Jung SH, Lee JE, Chung WY. Changes in the thyroid hormone profiles in children with nephrotic syndrome. Korean J Pediatr. 2019;62(3):85-89. doi:10.3345\/kjp.2018.06891","DOI":"10.3345\/kjp.2018.06891"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Ito S, Kano K, Ando T, Ichimura T. Thyroid function in children with nephrotic syndrome. Pediatr Nephrol. 1994;8(4):412-415. doi:10.1007\/BF00856516","DOI":"10.1007\/BF00856516"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Di Mario F, Pofi R, Gigante A, Rivoli L, Rosato E, Isidori AM, et al. Hypothyroidism and nephrotic syndrome: Why, when and how to treat. Curr Vasc Pharmacol. 2017;15(5):398-403. https:\/\/doi.or g\/10.2174\/1570161115999170207114706","DOI":"10.2174\/1570161115999170207114706"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Marimuthu V, Krishnamurthy S, Rajappa M. Non-Autoimmune Subclinical and Overt Hypothyroidism in Idiopathic Steroid-resistant Nephrotic Syndrome in Children. Indian Pediatr. 2017;54(11):925-929. doi: 10.1007\/s13312-017-1183-2","DOI":"10.1007\/s13312-017-1183-2"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Rapa A, Monzani A, Moia S, Vivenza D, Bellone S, Petri A, et al. Subclinical hypothyroidism in children and adolescents: A wide range of clinical, biochemical, and genetic factors involved. J Clin Endocrinol Metab. 2009;94(7):2414-2420. https:\/\/ doi.org\/10.1210\/jc.2009-0375","DOI":"10.1210\/jc.2009-0375"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"den Hollander JG, Wulkan RW, Mantel MJ, Berghout A. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf). 2005;62(4):423-427. https:\/\/doi. org\/10.1111\/j.1365-2265.2005.02236.x","DOI":"10.1111\/j.1365-2265.2005.02236.x"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Mohan KR, Kanitkar M. Growth in Children with Steroid Sensitive Nephrotic Syndrome. Med J Armed Forces India. 2009 Jan;65(1):4-6. doi: 10.1016\/S0377-1237(09)80043-9.","DOI":"10.1016\/S0377-1237(09)80043-9"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Grimberg A, DiVall SA, Polychronakos C, Allen DB, Cohen LE, Quintos JB, Rossi WC, Feudtner C, Murad MH. Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency. Horm Res Paediatr. 2016;86(6):361-397. doi: 10.1159\/000452150","DOI":"10.1159\/000452150"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Binder G, Reinehr T, Ib\u00e1\u00f1ez L, et al. GHD Diagnostics in Europe and the US: An Audit of National Guidelines and Practice. 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