PEDIATRICS Vol. 81 No. 5 May 1988, pp. 674-679
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Alain, N.
Right arrow Articles by Zipf, W. B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Alain, N.
Right arrow Articles by Zipf, W. B.

Short Stature and Thyroxine-Binding Globulin Excess: Improvement With Triiodothyronine Treatment

Nikola Alain MD1 and William B. Zipf MD1

1 From the Department of Pediatrics, Children's Hospital, Ohio State University, Columbus

Thyroxine-binding globulin (TBG) excess with increased total thyroxine (T4) and triiodothyronine (T3) levels has not been thought to produce symptoms. We report on a white boy, initially seen at 4.3 years of age and observed for 4 years, who has short stature caused by the excess thyroxine binding. At his initial examination his thyroxine-binding globulin (TBG) levels were elevated (17 mg/dL), and he had a T4 level of 25.8 µg/dL, short stature, a bone age of 19 months, normal vital signs, and hyperthyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) testing (maximal value 58 µIU/mL). Results of tests obtained during the next 6 months showed other abnormalities related to thyroid function. Tests showed the following values: T3 412 ng/dL, thyroid uptake 24%, and low T3 resin uptake. They also showed these values: an elevated basal TSH of 8.7 µIU/mL, a slightly low preejection period to left ventricular ejection time ratio of 0.29 (normal 0.35 ± 0.04), and WISC-R IQ within normal limits. Because of the persistent short stature, T3 supplementation was started at age 7 years and gradually increased to 35 µg/d. The patient showed no thyrotoxic symptoms. Serum T4 level decreased from 25.8 to 4.2 µg/dL, T3 increased to 1,240 ng/dL, the TRH/TSH test result was suppressed (maximal level 1.8), and the preejection period to left ventricular ejection time ratio decreased to 0.24. Growth velocity increased by 65%. Both of the child's parents had normal thyroid test results. A younger brother also showed similar elevations of TBG level and even greater T4 values (36 µg/dL). His height has remained at the 25th percentile. This observation is the first report of the recessive transmission of TBG excess and suggests an associated thyroid-dependent short stature that is correctable with treatment.

Key Words: thyroxine-binding globulin excess • short stature • hyperthyroxinemia • hypothyroidism

Submitted on April 27, 1987
Accepted on July 21, 1987