Cristina Mihaela Cepeha

Childhood obesity is a growing public health concern with long-term metabolic and cardiovascular consequences. It results from a complex interplay of genetic, environmental, and behavioral factors, leading to systemic inflammation, insulin resistance, dyslipidemia, and endothelial dysfunction—key contributors to early-onset atherosclerosis. Beyond excess adiposity, multiple risk factors influence vascular health, including maternal obesity, gestational diabetes, birth weight abnormalities, family history of cardiometabolic disease, smoking exposure, hypertension, physical inactivity, and sleep deprivation. Maternal health during pregnancy can impact fetal cardiovascular programming, while postnatal influences such as sedentary lifestyles and poor sleep further exacerbate metabolic dysfunction and vascular alterations. Carotid intima-media thickness (CIMT) is a well-established, non-invasive marker for subclinical atherosclerosis, offering valuable insights into early vascular changes in obese children. Studies demonstrate significant correlations between CIMT and metabolic parameters, making it a promising tool for cardiovascular risk stratification. However, its interpretation should consider the broader spectrum of obesity-related risk factors. A comprehensive approach to childhood obesity management must address metabolic dysfunction, vascular health, and early intervention strategies. Public health initiatives, maternal health optimization, and lifestyle modifications play a critical role in preventing long-term complications. Integrating CIMT assessment with clinical and biochemical evaluations enhances early risk detection, ultimately improving long-term cardiovascular outcomes in obese children.

This paper aims to assess the usefulness of shear-wave elastography (SWE) and strain elastography (SE) for identifying and monitoring thyroid gland changes in children diagnosed with chronic autoimmune thyroiditis (CAT). Our study included 77 children between the ages of six and eighteen. Of these, 45 were diagnosed with CAT, while 32 had no thyroid pathology. Following a clinical examination and laboratory tests, an ultrasound was carried out, and then a SE (using a Hitachi Preirus machine) and SWE (using an Aixplorer Mach 30, Supersonic imagine, France) were performed in the same session. The median thyroid elastic index (EI) in the CAT group was 13.8 (13.3–17) kPa compared to 10.1 (9.3–11.2) kPa in healthy children (p < 0.0001). We found a median strain ratio (SR) of 1.2 (1.2–1.3) for CAT compared to 0.7 (0.6–0.9) for healthy thyroid tissue (p < 0.0001). The optimal cut-off value for predicting the presence of CAT in children using SR was >1 (Se = 82.2%, Sp = 87.5%, PPV = 90.2%, and NPV = 77.8%, AUROC = 0.850), while using SWE, the optimal cut-off value for predicting the presence of CAT in children was >12 kPa (Se = 88.9%, Sp = 93.7%, PPV = 95.2%, and NPV = 85.5%, AUROC = 0.943). Both techniques are useful for measuring thyroid tissue elasticity, and their diagnostic accuracy and reliability are comparable.

Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the 4.5 m/s and cSBP > 115 mmHg for the 12–15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.

Childhood obesity speeds up the development of arterial stiffness and progressively increases the values of arterial pressure. The purpose of this study is to investigate the value of using pulse wave analysis (PWA) to measure arterial stiffness as a sign of vascular wall impairment in obese children. The research was focused on 60 subjects: 33 obese and 27 normal-weight. Ages ranged from 6 to 18 years old. PWA includes parameters such as pulse wave velocity (PWV), augmentation index (AIx), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP), heart rate, and central pulse pressure (cPP). The device used was a Mobil-O-Graph. Blood parameters were taken from the subject’s medical history, not older than 6 months. A high BMI and a large waist circumference are linked to a high PWV. The levels of LDL-c, triglycerides (TG), non-HDL-c, TG/HDL-c ratio, and total cholesterol-HDL-c ratio significantly correlate to PWV, SBP, and cSBP. Alanine aminotransferase is a reliable predictor of PWV, AIx, SBP, DBP, and cDBP, while aspartate aminotransferase is a significant predictor of AIx, mean arterial pressure (MAP), cSBP, and cPP. 25-OH-Vitamin D negatively correlates with PWV, SBP, and MAP and significantly predicts the MAP. Cortisol and TSH levels are not significant to arterial stiffness in obese children without specific comorbidities and neither is fasting glucose in obese children without impaired glucose tolerance. We conclude that PWA contributes valuable data regarding patients’ vascular health and should be considered a reliable tool in the management of obese children.

Strain elastography (SE) determines the level of tissue stiffness and thus helps in the diagnosis and differentiation of various pathologies. This paper aims to study the elastographic differences between healthy thyroid parenchyma and ones affected by chronic autoimmune thyroiditis (CAT) in children. We included in our study 52 children diagnosed with CAT and 22 children with no thyroid pathology. After clinic examination and biological tests, an ultrasound was performed followed by SE using a Hitachi Preirus machine with a 5–15 multi-frequency linear probe. The mean strain ratio (SR) values were significantly lower in the control group compared with the CAT group (0.68 ± 0.2 vs. 1.19 ± 0.25; p < 0.0001). A mean value above 0.9 was found predictive for CAT with 84.62% Sensitivity(Se), 95.45% Specificity (Sp), 97.8% Positive Predictive Value (PPV), 72.4% Negative Predictive Value (NPV), and area under receiver operating characteristic (AUROC), 0.9. No differences were found between the two thyroid lobes. Also, we found no differences between girls and boys. Out of the 52 children with CAT, 39 were on therapy with levothyroxine. No differences were found between SR values in preexisting hypothyroid cases compared to euthyroid cases (1.24 ± 0.26 vs. 1.18 ± 0.25; p = 0.4615). Our results show that SE is a useful examination technique of children diagnosed with CAT, in accordance with other studies conducted on adults. This study lays the foundation for elastographic examination among children.

Early detection of all complications of childhood obesity is imperative in order to minimize effects. Obesity causes vascular disruptions, including early increased arterial stiffness and high blood pressure. This study’s aim is to assess the reliability of pulse wave analysis (PWA) in obese children and how additional risk factors influence the evaluated parameters. We analyzed 55 children aged 6–18 years old by measuring their pulse wave velocity (PWV), augmentation index (AIx), peripheral blood pressure (SBP, DBP), heart rate, central blood pressure (cSBP, cDBP) and central pulse pressure (cPP). We used the oscillometric IEM Mobil-O-Graph and performed a single-point brachial measurement. The subjects were divided into two groups: obese (n = 30) and normal-weight (n = 25) and were clinically and anamnestically assessed. BMI and waist circumference are significantly correlated to higher values for PWV, SBP, DBP, cSBP, and cDBP. Weight significantly predicts PWV, SBP, DBP and cPP. The risk factors that significantly influence the PWA and BP values are: a cardiometabolically risky pregnancy (higher PWV, AIx, SBP), active and passive smoking (higher PWV, SBP, cSBP, cDBP), sleep deprivation (higher PWV, SBP, cSBP) and sedentariness (higher PWV, AIx, peripheral and central BP). We conclude that obese children with specific additional cardiometabolic risk factors present increased arterial stiffness and higher blood pressure values.

Chronic autoimmune thyroiditis (CAT) is the most common thyroid disorder in the pediatric population. Ultrasound evaluation may suggest the diagnosis. Additionally, shear-wave elastography (SWE) proved to be a valuable additional diagnosis tool in adults with CAT by assessing thyroid stiffness (TS). This study aims to assess its use also in detecting children with CAT. The study group consisted of 50 children with confirmed diagnosis of CAT, who were compared to the control group, consisting of 50 children with no thyroid pathology and with an adult group of 50 subjects with CAT. The evaluation included, besides bioimmunochemical evaluation, also thyroid ultrasound evaluation and elastography measurements in the same session (Aixplorer Mach 30, Supersonic imagine, France). The mean TS values were significantly lower for children in the CAT group compared to adults with CAT (15.51 ± 4.76 kPa vs. 20.96 ± 6.31 kPa; p < 0.0001) and higher compared to the healthy aged matched controls (15.51 ± 4.76 kPa vs. 10.41 ± 2.01 kPa; p < 0.0001). SWE elastography definitely seems a promising technique in the evaluation of children with autoimmune thyroid pathology.

Chronic autoimmune thyroiditis (CAT) defines a diffuse intrathyroidal lymphocytic infiltration associating a destructive process of the thyroid follicles, most commonly in evolution developing hypothyroidism. Typical ultrasound changes may suggest the presence of the disease. This study aims to evaluate the performance of strain elastography in detecting autoimmune thyroiditis as an additional tool to the conventional ultrasound examination. A total of 250 patients were enrolled in the study; 180 had biochemical confirmation of CAT, the other 70 healthy subjects represented the control group. All patients were examined clinically and by means of conventional thyroid ultrasound (US) and real-time elastography using a Hitachi Preirus machine (5–15 MHz linear probe). Five valid measurements for the parenchyma/muscle strain ratios (SR) were taken for each subject, considering the mean value for analysis. A mean SR value above 1.64 was found to predict the presence of CAT with sensitivity (Sen) 69%, specificity p92%, positive predictive value (PPV) 95.4%, negative predictive value (NPV) 54% and area under receiver operating characteristic (AUROC) 0.87. Moreover, when comparing the mean values for SR, significantly higher values were found in CAT patients compared with the controls (2.81 ± 2.11 vs. 1.03 ± 0.51; p < 0.0001). Of the 180 CAT subjects, 92 were on thyroid hormone replacement therapy; significantly higher values were detected for patients under therapy compared with asymptomatic cases (3.45 ± 2.53 vs. 2.15 ± 1.27, p < 0.0001). A cut-off value of 2.94 was established for identifying CAT patients who needed hormonal treatment (Sen 52.3%, Sp 83.7%, PPV 75.4%, NPV 64.7% and AUROC 0.66). No correlation was found between stiffness and antibody titers nor for functional status. Elastography does add valuable information to the US evaluation of cases with autoimmune thyroiditis.

Introduction: Chronic kidney disease is a rising cause of morbidity and mortality in developed countries, including end-stage renal disease (ESRD). Endocrine disorders are highly common endocrine complications among patients with chronic kidney disease, including those receiving dialysis. The prevalence of thyroid comorbidities in patients with chronic kidney disease is documented higher than in normal population. Materials and methods: A cross-sectional observational single-center study was carried out in the Dialysis Center from May 2019- June 2019. One hundred twenty-three subjects were enrolled in this study. All patients were on chronic hemodialysis treatment with different primary causes of renal failure, with a mean duration of hemodialysis therapy 5.6 ± 4.89 years. A complete clinical and biochemical profile was obtained for each patient. Conventional B-mode thyroid ultrasound was performed in all cases on Aixplorer Mach 30 (SuperSonic Imagine, France).The study aims to investigate the prevalence of morphological and functional thyroid disorders in patients with chronic kidney disease, with renal replacement therapy (hemodialysis). Results: We evaluated 123 patients with end stage renal disease, with renal replacement therapy, with hemodialysis three times a week, mean age 62.2 ± 11.01 years. The mean duration of hemodialysis therapy was 5.6 ± 4.89 years. According to laboratory results we have found that 74.5% of patients from our study group were euthyroid, 24.4% percent were hypothyroid (16 females and 14 males),and 4 patients (3.3%) had subclinical hyperthyroidism. According to ultrasound results, 48.7% of patients have a normal thyroid appearance, 51.2% have a nodular goiter, defined as the presence of minimum one node in any thyroid lobe and 17.8% had autoimmune thyroiditis, with positive antibodies. The mean diameter of the nodules was 4.7 ± 11.1 mm, the maximum size found on ultrasound was 24.6 mm and the minimum dimension was 2 mm. Thyroid disease was more prevalent among female patients, who present a 3.4 fold higher risk. We have also found that an increase of BMI with one unit raises the risk of developing thyroid disease with 1.083 times (P = 0.018). Conclusion: Chronic kidney disease and hemodialysis therapy have an impact on thyroid echo texture and morphology of thyroid gland. We have found that thyroid disease has a prevalence of 61.3% among patients with ESRD on hemodialysis, with a higher chance of developing thyroid disease for female gender, and the increase of body mass index raises the risk of developing thyroid disease by 1.083 times.

Fine needle aspiration (FNA) is recommended for diagnosing thyroid nodules with suspicious ultrasound (US) features. Bethesda categories III and IV have conflicting management approaches: follow-up or thyroidectomy. This study aimed to evaluate a multimodal US assessment of the lesions in order to clarify the therapeutic strategy in intermediate cytology cases. 64 successive Bethesda III or IV cases were included. US evaluation consisted of greyscale US, qualitative strain elastography (SE) and three-dimensional (3D) Color-Doppler. A linear multifrequency probe and a linear volumetric probe (Hitachi Preirus Machine, Hitachi Inc. Japan) were used. The nodules were described usingconventional US criteria: taller-than-wide shape, marked hypoechogenicity, irregular borders, inhomogeneity, microcalcifications and the presence/absence of suspicious lymph nodes. Lesions presenting with increased stiffness on SE (scores 3 and 4) and moderate/intense perinodular vascularization were consideredto associate an increased risk of malignancy. Based on these criteria, lesions were classified as low, intermediate, or high risk. The outcomes were compared to the pathology report post-thyroidectomy. Thyroid cancer was identified in 25% (16 cases) and borderline follicular neoplasia was found in five cases. Given the recommendation of watchful waiting in this category, it was considered together with the malignant lesions, resulting in a number of 21 cancer cases. SE alone detected thyroid cancer with an accuracy of 82.81% (54/64 cases), a proportion of 80% of the nodules displaying score 4 and 66.6% of score 3 cases proved malignant. Most of the proven malignant nodules (15/21) showed important vascularization in the surrounding tissue. The prevalence of cancergrew with the degree of stiffness (9.0%–15.0%–66.6%–80.0%), but also with the intensification of vascular perinodular pattern (18.2%–27.7%–35.29%–50.0%). The multimodal US evaluation of intermediate cytology cases, including B-mode, SE, and volumetric Doppler demonstrated a sensitivity of 85.7%, a specificity of 88.3%, and an accuracy of 90.3% in identifying thyroid malignancy. The detection ofhighly suspicious featuresusing qualitative SE, and 3D Doppler in addition to the conventional ones, did increase the risk of cancer.