Bridging the Gap Beyond Cyanosis: Prevalence and Predictors of Subclinical Hypothyroidism in Acyanotic Congenital Heart Disease.
DOI:
https://doi.org/10.32007/jfacmedbaghdad3403الكلمات المفتاحية:
Acyanotic congenital heart disease، Congenital، Heart Defects، Hypothyroidism، Ventricular septal defect.الملخص
Background: Thyroid dysfunction may be a hidden risk factor in children with both cyanotic and acyanotic congenital heart disease. Left and right ventricular cardiac functions may be impaired in children diagnosed with subclinical hypothyroidism (SCH). While this association with cyanotic heart disease is well documented, this issue remains underexplored in cases of acyanotic heart disease.
Objective: To estimate the prevalence of SCH and identify relevant clinical risk factors among pediatric patients with acyanotic heart disease.
Methods: In this hospital-based cross-sectional study, investigators evaluated 51 children aged 1 month to 11 years with echocardiographically confirmed acyanotic congenital heart disease. They measured serum TSH and free T4 (FT4) and defined SCH as elevated TSH with normal FT4. Standardized clinical history, medication review, physical examination, anthropometric assessment, and echocardiographic characterization of CHD type and severity were performed. Multiple risk factors were tested to identify those associated with this clinical problem.
Results: SCH affected 19.6% of the cohort. with a mean age of 1.05 ± 1.78 years. Ventricular septal defect was the most common diagnosis (37%). A younger age showed a notable link (P = 0.016). During logistic regression analysis, female sex had an odds ratio of 2.89, age <1 year had an odds ratio of 2.83, VSD diagnosis had an odds ratio of 0.67, and hemoglobin <11 g/dL had an odds ratio of 1.16, respectively. Thus, they were possible exploratory clinical predictors for thyroid dysfunction.
Conclusion: Young children with acyanotic congenital heart disease show a prevalence of subclinical hypothyroidism, with age being the most important factor according to the study. While ventricular septal defects are indeed the most prevalent congenital anomaly in non-cyanotic heart conditions, we did not observe any particular other heart defect to independently predict thyroid dysfunction, suggesting that the relationship ma y be systemic rather than tied to a particular cardiac structure. These results indicate the possible advantages of early thyroid tests for these newborns with a cyanotic heart disease.
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المراجع
1. Ortinau CM, Smyser CD, Arthur L, et al. Optimizing neurodevelopmental outcomes in neonates with congenital heart disease. Pediatrics. 2022 Nov 1;150(Supplement 2): e2022056415L. https://doi.org/10.1542/peds.2022-056415L.
2. Al-Hamash SM, Amer AN, Maerozy KAM, et al. Spectrum of Congenital Heart Diseases in Iraqi Patients. Eurasian J Med. 2026 Feb 23;58(1):1-7. https://doi.org/10.5152/eurasianjmed.2026.251236
3. Akın A, Unal E, Yildirim R, et al. Left and right ventricular functions may be impaired in children diagnosed with subclinical hypothyroidism. Scientific Reports. 2020 Nov 12;10(1):19711. https://doi.org/10.1038/s41598-020-76327-4.
4. Gawlik A, Such K, Dejner A, et al. Subclinical hypothyroidism in children and adolescents: is it clinically relevant? International Journal of Endocrinology. 2015;2015(1):691071. https://doi.org/10.1155/2015/691071.
5. Metwalley KA, Farghaly HS. Subclinical hypothyroidism in children: updates for pediatricians. Annals of Pediatric Endocrinology & Metabolism. 2021 Jun 30;26(2):80-5. https://doi.org/10.6065/apem.2040242.121.
6. Kaushik A, Agrawal M. Relationship between subclinical hypothyroidism and the risk of cardiovascular complications. Cureus.33708. 2023 Jan 12;15(1). https://doi.org/10.7759/cureus.33708.
7. Fakhari MS, Dorreh F, Davood MA, et al .Thyroid Function in Children with Cyanotic and Non-Cyanotic Congenital Heart Disease. Turk Arch Pediatr. 2023 Nov;58(6):594-599. https://doi.org/10.5152/TurkArchPediatr.2023.22277
8. López-Espíndola D, García-Aldea Á, Gómez de la Riva I, et al. Thyroid hormone availability in the human fetal brain: novel entry pathways and role of radial glia. Brain Structure and Function. 2019 Jul 1;224(6):2103-19. https://doi.org/10.1007/s00429-019-01896-8.
9. Lin WH, Zhou SJ, Chen XH, et al. Changes of serum TSH, FT3, and FT4 levels in infants received surgical correction of congenital heart disease under cardiopulmonary bypass. BMC Cardiovascular Disorders. 2023 Nov 16;23(1):562.
https://doi.org/10.1186/s12872-023-03590-4.
10. Bak P, Hjortshøj CS, Gæde P, et al. Subclinical hypothyroidism: a common finding in adult patients with cyanotic congenital heart disease. Congenital heart disease. 2018 Mar;13(2):263-70. https://doi.org/10.1111/chd.12565.
11. Szeliga K, Antosz A, Skrzynska K, et al. Subclinical hypothyroidism in children and adolescents as mild dysfunction of the thyroid gland: a single-center study. Pediatric Endocrinology Diabetes and Metabolism. 2023 Jan 1;29(2):97-103. https://doi.org/10.5114/pedm.2023.124266.
12. Sana M, Rubab Z, Fayyaz A, et al. Thyroid Profile Abnormalities in Pediatric Population and their Correlation with Age: A Cross-Sectional Study at a Tertiary Care Hospital of South Punjab. Journal of Bahria University Medical and Dental College. 2025 Oct 24;15(04):360-4. https://doi.org/10.51985/JBUMDC2025627
13. Amr NH. Thyroid disorders in subjects with Down syndrome: an update. Acta Bio Medica: Atenei Parmensis. 2018;89(1): 132. https://doi.org/10.23750/abm.v89i1.7120.
14. Elbaz BA, Elmarsafawy HM, Laimon WN. The effect of cardiac catheterization on thyroid functions in infants with congenital heart diseases: a prospective observational study. Eur J Pediatr. 2025 Jan 15;184(2):137. https://doi.org/10.1007/s00431-024-05934-4.
15. Mirhaghjoo ZS, Rad AH, Nikpour S. Post-heart Surgery and Levothyroxine Therapy: A Narrative Review. Journal of Comprehensive Pediatrics. 2025 Aug 4;16(4):e161996. https://doi.org/10.5812/jcp-161996
16. Kubicki R, Grohmann J, Kunz KG, et al. Frequency of thyroid dysfunction in pediatric patients with congenital heart disease exposed to iodinated contrast media–a long-term observational study. Journal of Pediatric Endocrinology and Metabolism. 2020 Nov 1;33(11):1409-15. https://doi.org/10.1515/jpem-2020-0032.
17. Brown ML, Quinonez LG, Staffa SJ, DiNardo JA, Wassner AJ. Relationship of preoperative thyroid dysfunction to clinical outcomes in pediatric cardiac surgery. The Journal of Clinical Endocrinology & Metabolism. 2021 May 1;106(5):e2129-36. https://doi.org/10.1210/clinem/dgab040
18- Kapelari K, Kirchlechner C, Högler W, et al. Pediatric reference intervals for thyroid hormone levels from birth to adulthood: a retrospective study. BMC Endocrine Disorders. 2008 Nov 27;8(1):15. https://doi.org/10.1186/1472-6823-8-15.
19. Scavone M, Tallarico V, Stefanelli E, et al. Cardiac malformations in children with congenital hypothyroidism. Journal of Biological Regulators and Homeostatic Agents. 2020 Jul 1;34(4 Suppl. 2):91-7. https://europepmc.org/article/med/33000607
20-Mahmoud M, Ali N, Amir M. Evaluation of thyroid function in children with congenital heart diseases in Assiut University Hospita. Journal of Current Medical Research and Practice. 2022 Oct 1;7(4):274-9.DOI: 10.4103/jcmrp.jcmrp_22_22
21. Razvi S, Jabbar A, Pingitore A, et al. Thyroid Hormones and Cardiovascular Function and Diseases. Journal of the American College of Cardiology. 2018 Apr 1;71(16):1781–96. https://doi.org/10.1016/j.jacc.2018.02.045
22. Yamakawa H, Kato TS, Noh JY, et al. Thyroid Hormone Plays an Important Role in Cardiac Function: From Bench to Bedside. Frontiers in Physiology. 2021 Oct 18; 12:606931. https://doi.org/10.3389/fphys.2021.606931
23. Soliman A, Elsaadany L, AlYafei F, et al. Thyroid Function in Infants, Children, and Adolescents: Age-Dependent Physiology, Biochemical Patterns, and Early Markers of Pediatric Thyroid Disease: A Narrative Review. GSC Advanced Research and Reviews. 2025 Dec 24;25(3):278–90. https://doi.org/10.30574/gscarr.2025.25.3.0393
24. Walsh JP. Thyroid function across the lifespan: do age-related changes matter? Endocrinology and Metabolism. 2022 Apr 14;37(2):208-19. https://doi.org/10.3803/enm.2022.1463
25. Garofalo V, Condorelli RA, Cannarella R, et al. Relationship between iron deficiency and thyroid function: A systematic review and meta-analysis. Nutrients. 2023 Nov 15;15(22): 4790. https://doi.org/10.3390/nu15224790
26. Huang X, Mao M, Guo T, et al. Iron status, thyroid dysfunction, and iron deficiency anemia: a two-sample Mendelian randomization study. Annals of Nutrition and Metabolism. 2024 Dec 3;80(6):295-306. https://doi.org/10.1159/000539610
27. Lee J, Buck HG, Mulder P, et al. The Prevalence of Malnutrition in Children with Congenital Heart Disease: A Meta-Analysis. J Pediatr Health Care. 2026;40(3):e94-e104. https://doi.org/10.1016/j.pedhc.2025.10.011.
28. Eng L, Lam L. Thyroid function during the fetal and neonatal periods. Neoreviews. 2020 Jan 1;21(1):e30-6.https://doi.org/10.1542/neo.21-1-e30
29. Maria Cristina Vigone, Donatella Capalbo, Giovanna Weber, et al. Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?, Journal of the Endocrine Society, Volume 2, Issue 9, September 2018, Pages 1024–1039.
https://doi.org/10.1210/js.2017-00471
30. Crisafulli G, Aversa T, Zirilli G, et al. Subclinical hypothyroidism in children: when a replacement hormonal treatment might be advisable. Frontiers in Endocrinology. 2019 Feb 25; 10:109. https://doi.org/10.3389/fendo.2019.00109.
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