Height measurement: The height must be measured monthly after treatment for dwarfism.
Since the change in height within a month is relatively small, we need to measure it as accurately as possible. Accurate height measurement needs to pay attention to “four similarities”: 1. the same time, because after standing or sitting up, the vertebral space of the human spine will be compressed, so the height will be different in the morning and evening, and the measurement will be comparable only at the same time; 2. the same measuring tape; 3. the same measurer, different people, the tightness of the tape card on the head will be different; 4. the same child Standing method (require shoes off, heels, hips, shoulders and head all against the wall, chest up, abdomen in, waist as straight as possible, eyes level, head not too tilted, otherwise the highest point of the head can not be measured).
If you measure at home, you can put a piece of paper on the wall and draw a line on the paper after each measurement. You don’t need to measure the exact height of each measurement, but just distinguish the difference from the previous month. From time to time, parents will respond, “My child grew by 2CM last month, but why did he not grow at all this month?” This is mainly related to the measurement error. After a longer period of treatment, the growth rate can be averaged over several months.
Note: Don’t measure height too often, usually once a month is enough, otherwise it will easily cause psychological pressure to the child, and too much psychological pressure is not conducive to the growth of height.
Growth hormone treatment review time and items: For those who apply growth hormone treatment, after 3~6 months of treatment, thyroxine (mainly FT3, FT4 and TSH) and blood glucose need to be rechecked. Since most of the treated patients are dwarf patients, the growth rate was too slow in the past and the thyroxine requirement was low. After the growth accelerated significantly, the thyroxine requirement increased and a few people may cause a relative deficiency of thyroxine. Insufficient thyroxine, which requires oral levothyroxine tablets for a short period of time, will affect the efficacy of growth hormone (there are also a few cases of slightly high thyroxine due to over-regulation of thyroxine, in which case, as long as TSH is not too low, there is no need to deal with it, and continued use of growth hormone will often automatically drop to normal). For those with precocious puberty who apply growth hormone in combination, since the growth rate is not significantly faster than in the past, a review in about 6 months can be considered. The review of IGF is an important indicator of both the safety of the medication and the adjustment of the growth factor dose.
Recent data show that timely adjustment of growth hormone dose according to IGF-1 has significantly better therapeutic effect than traditional fixed dose. Subsequent review is usually done once every six months.
Growth hormone dose adjustment: Growth hormone generally does not need to be adjusted within a short period of time, and weight changes not exceeding 10% generally do not need to be adjusted, and even if adjusted, it is not only based on growth rate or weight. It is also necessary to consider different etiologies, the results of the growth hormone stimulation test before the initial dosing, pubertal development, bone age, and especially the results of IGF-1 and IGFBP-3 review. Regular review is also necessary! While the effectiveness of treatment is important, the safety of the medication is even more important! The range of growth hormone doses is wide. For those with small bone age and sufficient treatment time, we generally start with a smaller dose within the normal range, if the small dose is more effective, the cost is relatively low and side effects are less likely to occur. For children with older bones and limited treatment time, generally start with a medium or large dose of the normal range, as time is limited and slow observation may affect the final treatment effect.
Growth hormone discontinuation indicators: For those who start treatment at a younger age, they can temporarily stop for a period of time when their height reaches or slightly exceeds that of their peers (usually it takes 2~3 years or longer), and then use it again when their height is significantly lower than that of their peers. For those who are older, due to the limited treatment time, the indicator of discontinuation is to stop using the drug when the monthly growth rate is less than 4mm for three consecutive months (although the application may still improve 1 or 2mm per month at this time, but the available time is already very little and has no substantial significance). However, for those whose height has approached normal adult height during the period of use, discontinuation of the drug can also be considered, but a detailed assessment of whether the treatment objective has been achieved is needed before discontinuing the drug.