Background: Pituitary lesions after traumatic brain injury (TBI) are frequent in children and adolescents, but the rate of post-TBI central hypothyroidism remains uncertain. 

Objective: To identify the long-term incidence of post-TBI CH and the clinical and laboratory characteristics of this complication in children and adolescents. 

Methods: The analysis included 31 patients (2.1-19.6-yr-old) with a history of TBI with at least 1 year of follow-up. Patients were evaluated at hospital admission and every 3 months thereafter. Assessments included clinical evaluation, brain CT and hormone assessments (basal fT4, IGF-1, cortisol and adrenocorticotropic hormone; insulin tolerance test/thyrotropin-releasing hormone test with TSH, growth hormone and cortisol measurement; and corticotropin-releasing hormone test, if indicated). The CH diagnosis was based on clinical and laboratory findings and a therapeutic trial with levothyroxine. 

Results: Overall, five patients (16%) developed CH (3 with associated adrenal insufficiency). At 3 and 12 months, median fT4 values were lower in patients with CH compared with those without anterior pituitary dysfunction (n = 18; P = 0.01). Patients with CH received levothyroxine and progressed with clinical resolution and increased median fT4 (from 0.92 to 1.47 ng/dL) and IGF-1 (from -2.08 to -0.22 standard deviation scores (SDS)) levels. Temporary suspension of levothyroxine was accompanied by decreased median fT4 (1.02 ng/dL) and IGF-1 (-1.07 SDS) levels and reappearance of clinical symptoms, which resolved once levothyroxine was reinitiated. 

Conclusions: The longer follow-up, valorization of clinical manifestations, nontraditional laboratory approach and therapeutic trial with levothyroxine in the present study revealed a higher rate of post-TBI CH in children and adolescents than that reported in the literature. 

Geraldo Miranda Graca obtained his Master in Pediatric Endocrinology at the Federal University of Paraná in 1984, Associate Professor of Pediatric Endocrinology at the Department of Pediatrics of the Pontifical Catholic University of Paraná in Curitiba since 1987, Associate Professor of Clinical Pediatrics at the Federal University of Paraná since 2009, completed his PhD in Pediatric Endocrinology in 2011. 

 

Luiz De Lacerda   was fellow in Pediatric Endocrinology at the Johns Hopkins Hospital during 1970-1972, member of the Endocrinology Society of the USA since 1974, President of the Brazilian Society of Endocrinology and Metabolism in 1995-1996, completed his PhD in Pediatric Endocrinology by the Federal University of Paraná in 2003. He has over 70 publications.