This study aimed to investigate the influence of overweight, obesity, and endocrine disorders, i.e., medicated hypothyroidism and non-syndromic hypogrowth, on maxillary and mandibular growth in 1508 children and adolescents between 5 and 19 years. Overall, medicated hypothyroid and obese subjects had increased anthropometric measurements. In addition, at peak growth, obese subjects showed increased measurements, while medicated hypothyroid and non-syndromic hypogrowth patients presented decreased measurements.

Of the conditions studied, the most prevalent in children and adolescents in Colombia and other populations are overweight and obesity, followed by medicated hypothyroidism and non-syndromic hypogrowth (Minsalud 2022; Danze et al. 2021; Chaves et al. 2018). However, in this patient cohort, non-syndromic hypogrowth (16.6%) was the most frequent, followed by medicated hypothyroidism (14.3%) and overweight/obesity (7.2%). This marked difference could be explained by the fact that the studied population studied was undergoing treatment, and there is a lower proportion of obese children and adolescents that seek treatment at Pediatric Endocrinology services, where the sample was collected.

In this study, patients with such conditions presented with altered craniofacial anthropometry in the sagittal, transverse, and vertical planes compared to healthy controls. In addition, hypothyroid subjects showed increased head circumference, zygomatic width, nasal base width, intercommissural distance, cranial base length, and maxillary and mandibular length. These findings accord with those reported by Gunes et al. (2020), which suggest that hypothyroid individuals could present early changes in body composition parameters. In contrast, our results diverge from those of Vucic et al. (2017), who reported an association between hypothyroidism and decreased maxillary and mandibular growth, which could result in teeth impaction or delayed tooth eruption (Wassner 2017). However, it should be noted that these studies were conducted on non-treated individuals.

No significant differences were found in overweight/obese patients compared to the controls for the above anthropometric measurements. However, subnasal-interlabial and interlabial-menton distances were greater, giving them a leptoprosopic facial appearance. Some studies also indicate a relationship between overweight/obesity and bone growth stimulation (Dimitri 2019; Zhu 2017). Our findings on craniofacial growth at peak growth in patients with overweight/obesity are in agreement with other investigations, which reported a more sagittal position of pogonion, leading to prognathism (Danze et al. 2020), an increased longitudinal facial length (Cuccia et al. 2007), and early eruption in both dentitions (Sánchez et al. 2010). Finally, zygomatic width was significantly smaller in non-syndromic hypogrowth patients than in healthy subjects, which aligns with the findings from Attanasio and Shalet (2007) and Oliveira-Neto et al. (2011).

When anthropometric measurements at peak growth were analyzed, boys with medicated hypothyroidism had significantly lower values than healthy men, suggesting delayed linear growth and skeletal development, as reported in other studies (Williams 2018). Moreover, head circumference and interlabial-menton circumference in girls with medicated hypothyroidism were significantly lower than in healthy women, while no differences were observed in males. In contrast, overweight and obese patients showed significantly increased measurements than controls, indicating that the peak growth in these individuals obese patients occurs earlier, as has been shown previously (Danze et al. 2020). Finally, girls with non-syndromic hypogrowth presented significantly decreased head circumference, while boys showed a decreased zygomatic (facial) width.

Compared to healthy controls, patients with hypothyroidism (10–15-year-old males) and non-syndromic hypogrowth (5–9-year-old females and 10–15-year-old males) showed a significant delay in the skeletal age in comparison with chronological age.

The findings of this study were to establish craniofacial growth parameters by comparing facial anthropometric measurements of healthy children with patients that presented medicated hypothyroidism, overweight-obesity or non-syndromic hypogrowth, to understand how different growth disorders can influence craniofacial growth and development, as well as identifying the timing for maxillary orthopedic intervention depending on the type any underlying disorder, based on how it may influence the onset of peak growth.

The strengths of this study include (1) all patients were examined and diagnosed by a single professional, which reduces the risk of observer bias; (2) the examiner was trained and standardized to take anthropometric measurements; (3) the use of standard anthropometric measurements in both diseased and healthy individuals reduces the risk of analysis bias and facilitate their utilization in clinical practice; and (4) the craniofacial anthropometry was performed directly in the patients without the use of additional diagnostic aids, reducing measurement bias. Regarding its limitations, due to the COVID-19 pandemic, some patients were not appointed in person but virtually for a few months. Therefore, performing direct craniofacial anthropometry in those patients was impossible. In addition, the skeletal age of some patients was not available because carpal radiographs were not indicated in all cases. Hence, Tanner stages assessment was central in predicting skeletal maturation.