Variation in thyroid hormone levels among children in Benghazi city -Libya

Abstract

Thyroid hormones play a vital part in development, of metabolism, nervous system myelination, and organ functions.
Thyroid complaints can be tough to identify clinically, but thyroid function tests can assist in making a diagnosis.
Evaluating thyroid stimulating hormone is the major step. If it is abnormal, free thyroxin should be measured. An
elevated concentration of thyroid stimulating hormone with a low concentration of free thyroxin suggests
hypothyroidism. A low concentration of thyroid stimulating hormone with a great concentration of free thyroxin
suggests hyperthyroidism. A cross sectional study was done in children attending to Pediatric hospital- Benghazi for
one year from January 2018 to December 2018. Total of 221 children, 94 (43%) were males and 127 (57%) were
females attending the hospital for thyroid hormone test were included in the study. Secondary data on gender, TSH, T3
and T4 level were analyzed. Thyroid diseases reported was found to be more prevalent in females than males. T4 was
higher in females than males by percentage 8 (4%) to 5 (2%) respectively. TSH was also has a higher rate recorded in
females than males by percentage 38 (17%) to 28 (13%) respectively. It can be concluded from the present study that
the gender has a significant effect on the levels T4, T3 and TSH. Initial analysis and treatment are important to avoid
irreparable and enduring nervous system injury and progressive interruption, specifically in newborns as they are very
in danger to thyroid dysfunction.

Full text

International Journal of Multidisciplinary Sciences and Advanced Technology Special Issue 1(2021) 294–298
294
International Journal of Multidisciplinary Sciences
and Advanced Technology
Journal home page: http://www.ijmsat.com
Variation in thyroid hormone levels among children in Benghazi
city - Libya
Noor-alhooda Milood Al-awkally1, Maree Dokally Ali2, Alreda Miloud Al-awkally3,
Nesrine Miloud Al-awkally4, Abeer Miloud Al-awkally5, Dareen El shareef
Jadullah6, 7Muftah abdulwahed Nasib7 and Khadija Saeed Ali Ghafir8
1- Medical Laboratory Department, High institutes for comprehensive professions, Suluq, Libya
2- Medical Laboratory Department, High institutes for comprehensive professions- Suluq, Libya
3- Central Pharmacy Department, Ministry of health, Darna, Libya
4- Surgery Department, Al- haowari Hospital- Benghazi
5- Livestock and Marine Department, Ministry of Agriculture, Livestock and Marine, Darna, Libya
6- Faculty of pharmacy- Benghazi University- Libya
7- Microbiology Department, Science Faculty, Omar Almukhtar University, Libya
8- Faculty of Natural Resources and Environmental Science, Omar Almukhtar University, Libya
Email: noornooor1973@gmail.com
Received 15February 2021, Accepted 10March 2021, Available online 30 March 2021
1. Introduction
The thyroid is a butterfly-shaped endocrine gland usually located in the lower front of the neck below the larynx and
develops from two embryological structures. The thyroid's job is which are secreted thyroxin (T4) and triiodothyronine
(T3) into the blood and then carried to every tissue in the body to helps the body use energy, stay warm and keep the
ABSTRACT
Thyroid hormones play a vital part in development, of metabolism, nervous system myelination, and organ functions.
Thyroid complaints can be tough to identify clinically, but thyroid function tests can assist in making a diagnosis.
Evaluating thyroid stimulating hormone is the major step. If it is abnormal, free thyroxin should be measured. An
elevated concentration of thyroid stimulating hormone with a low concentration of free thyroxin suggests
hypothyroidism. A low concentration of thyroid stimulating hormone with a great concentration of free thyroxin
suggests hyperthyroidism. A cross sectional study was done in children attending to Pediatric hospital- Benghazi for
one year from January 2018 to December 2018. Total of 221 children, 94 (43%) were males and 127 (57%) were
females attending the hospital for thyroid hormone test were included in the study. Secondary data on gender, TSH, T3
and T4 level were analyzed. Thyroid diseases reported was found to be more prevalent in females than males. T4 was
higher in females than males by percentage 8 (4%) to 5 (2%) respectively. TSH was also has a higher rate recorded in
females than males by percentage 38 (17%) to 28 (13%) respectively. It can be concluded from the present study that
the gender has a significant effect on the levels T4, T3 and TSH. Initial analysis and treatment are important to avoid
irreparable and enduring nervous system injury and progressive interruption, specifically in newborns as they are very
in danger to thyroid dysfunction.
Keywords: Hypothyroidism, Hyperthyroidism, children hospital, Benghazi.
Original article

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brain, heart, muscles and other organs working as they should. However, most of the T3 in the blood is made from T4
in other body tissues.[1, 4] Conditions affecting thyroid function may cause temporary and permanent nervous system
injury and developmental delay.[2] Hypothyroidism occurs when the thyroid becomes damaged or swollen, making it
incapable to produce sufficient of the thyroid hormone thyroxin. One in 2,500 newborns has hypothyroidism at birth,
while approximately 1 in 500 school-age children has hypothyroidism and a raised TSH and a low free T4 indicate
primary hypothyroidism.[4, 15] Routine tests will generally detect hypothyroidism in newborns.[5] And newborns often do
not show symptoms at birth. Some common signs and symptoms of hypothyroidism in older children may include
fatigue, Constipation, feeling cold all over, puffy face, weight gain from fluid retention, dry or yellow skin, loss of hair,
or hair becoming coarse, loice becoming hoarse, goiter, delayed reflexes and muscular pain oddly needs but is not
producing, [3] it can change TSH levels and possibly cause symptoms. Treatment generally means a medication that
replaces the thyroid hormones your child’s.[5] This is the reverse of hyperthyroidism, a low TSH and raised free T4
indicate hyperthyroidism that is occurs due to an inappropriately high synthesis and secretion of thyroid hormone (TH)
by the thyroid.[7] Hyperthyroidism is relatively rare in children (yearly incidence of 8 per 1,000,000 children less than
15 years old and 1 per 1,000,000 children less than 4 years old). The most frequent causes are Graves’ disease (GD) and
toxic nodular goiter. GD is the most prevalent cause of hyperthyroidism in iodine replete geographical areas, with 20–
30 annual cases per 100,000 individuals.[11] GD occurs more often in women and has a population prevalence of 1–
1.5%. Approximately 3% of women and 0.5% of men develop GD during their lifetime.[12] The peak incidence of GD
occurs among patients aged 30–60 years, with an increased incidence among African Americans.[13] The complications
of untreated hyperthyroidism include weight loss, osteoporosis, fragility fractures, atrial fibrillation, embolic events, and
cardiovascular dysfunction.[8,9] Graves’ hyperthyroidism is treated by decreasing thyroid hormone synthesis with the use
of ATD, or by reducing the amount of thyroid tissue with radioactive iodine (RAI) treatment or total thyroidectomy.
Patients with newly diagnosed Graves’ hyperthyroidism are usually medically treated for 12–18 months with
methimazole (MMI) as the preferred drug. Patients with persistently high TSH-R-Ab at 12–18 months can continue
MMI treatment.[10] TSH is produced by the pituitary if it senses that the thyroid is not releasing enough thyroxin. A
healthy thyroid receives the message and responds by producing more thyroxin. This helps to keep your hormone levels
within a normal range. A TSH test can help determine if the thyroid is failing, and if it may be hypothyroidism. It is
recognized as the most reliable test of its kind.[6] TSH may remain suppressed for weeks or even months after a patient
starts antithyroid medications. It is useful to monitor free T4 and free T3 every 6–12 weeks to judge the adequacy of
treatment. A rise in TSH indicates overtreatment.[14] Study was aimed to detect the different features of disorders with
hypothyroidism and hyperthyroidism in childhood and impact of gender on the T4, T3 and TSH levels in children
pediatric hospitals-Benghazi.
2. Material and Methods
Study setting:
In a cross sectional study the serum concentrations of T4, T3 and TSH were measured in 221childern was done in
children attended to Pediatric hospital- Benghazi for one year from January 2018 to December 2018. Total 221 children
had attended the pediatric hospital for thyroid hormone test were included in the study. Secondary data on gender, TSH,
T3 and T4 level were analyzed.
Collection of blood sample: Blood samples were obtained and collected in plain tube. Serum was separated by
centrifugation at 2000 rpm for 5 minutes and stored in a freezer at -20 ºC.
Determination of hormones: The samples were analyzed for T3, T4 and TSH by Cobas 411.
Statistical analysis: - Analysis was done by the standard deviation function is STDEV, and the test uses is T- test.
3. Results
4. Distribution of the cases according to the gender.
Of 221 patients, Males were found to be 94 (43%) and females were 127(57%) respectively.

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Figure. 1: Distribution of the cases according to the gender.
4.1 Distribution of the cases during the seasons.
The data indicated that number of the patients were lowest in the winter (44%) while highest in summer (57%).
Table1: Distribution of the children during the seasons.
Seasons
Winter
Spring
Summer
Autumn
Total
Children
44 (20%)
52 (24%)
125 (57%)
0 (0%)
221 (100%)
4.2Comparison between the gender according to high level of T3, T4 and TSH hormones.
According to TSH, high level was more observed in females than males by 38 (17%) to 28 (13%) respectively.
4.3 Comparison between T3, T4 and TSH levels between the cases.
According to the levels of the hormones, the lowest level of T3 was 4 (2%), while T4 level was 9 (4%) and TSH level
was 8 (4%). Also the normal level of hormone in the children, T3 was with normal level in 173 (78%) child, while T4
was normal in187 (85%) child and TSH in 152 (69%) child. The highest level of the hormone, 58 (26%) child had a
high level of T3, while T4 in 9 (4%) child and TSH in 58 (26%) child.
Table 2: Comparison between T3, T4 and TSH levels between the cases
Hormone Level
T3
(0.95-2.5 (ηmol/L))
T4
(60-180 (ηmol/L))
TSH
(0.27-4.70μU/L)
Level of less than
normal range
4 (2%)
9 (4%)
8 (4%)
Normal level
173 (78%)
187 (85%)
152 (69%)
Level of more than
normal range
33 (15%)
4 (2%)
58 (26%)
Not available/
11 (5%)
21 (10%)
2 (1%)
4.4 Comparison of the sexes according to abnormal levels of T3, T4 and TSH hormones.
The ratio of the sexes was close to the rate of T3 hormone, where the ratio of females to males was 19 (9%) to
18 (8%) respectively. T4 was higher in females than males by percentage 8 (4%) to 5 (2%) respectively. TSH was also
has a higher rate recorded in females than males in the rate of 38 (17%) to 28 (13%) respectively.
Table 3: Comparison of the sexes according to abnormal levels of T3, T4 and TSH hormones.
Gender
High level of
T3
High level of
T4
High level of
TSH
Male
18 (8%)
5 (2%)
28 (13%)
Female
19 (9%)
8 (4%)
38 (17%)
43%
57%
Male
Female

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5. Discussion
The pituitary cells link with your thyroid by distribution their specific hormone, TSH into the blood. When
your T4 levels are at your set point, the pituitary gland sends out abundant TSH to say the thyroid to retain production
the similar quantity of T4. If the T4 levels become low, the pituitary sends out extra TSH to tell the thyroid to create
extra T4. The lesser the T4 levels go, the higher the TSH goes. The contrary is also right: if the T4 levels become too
high, the pituitary sends out fewer TSH, telling the thyroid to create fewer T4. The normal hormonal levels are different
for different genders.[18] We found the prevalence of thyroid diseases reported was found to be more prevalent in
females than males, that agree with many studies, thyroid disease in general and hypothyroidism in particular are very
common in women [16, 17]. Studies that worked on the effect of sex on thyroid function, where they concluded that the
level of T4, it was higher in females than males. [19, 20]. It can be concluded from the present study that the gender has
a significant effect on the levels T4, T3 and TSH.
6. Conclusion
The increase of district characteristics of thyroid function and dysfunction in childhood is requiring Pediatric
medical care. Early diagnosis and treatment are needed to avoid irreversible and permanent nervous system injury and
developmental delay, especially in newborns as they are very in danger to thyroid dysfunction. It can be concluded from
the present study that the gender has a significant effect on the levels T4, T3 and TSH.
7. Acknowledgment
Above all, praise is to ALLAH Almighty, The Merciful, may anything in our life bring us closer to Him. We
wish to express our deepest appreciation and gratefulness to all staff of Pediatric laboratory who gave us the opportunity
to provide ours research all information's by and working with easily.
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