<![CDATA[Children with thalassemia are at increased risk of growth impairment and endocrine dysfunction, including thyroid abnormalities. However, the relationship between thyroid function and stunting remains unclear. This cross-sectional study included 51 children with confirmed thalassemia. Growth status was assessed using height-for-age Z-score (HAZ) and percentage height deficit relative to mid-parental target height (Mid-TPG), while thyroid function was evaluated by measuring serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4). Data were analyzed using Pearson or Spearman correlation, multivariable linear regression, locally estimated scatterplot smoothing (LOESS), generalized additive models (GAM), and k-means clustering. No significant associations were found between thyroid hormone levels and either HAZ or height deficit in multivariable analyses (all p > 0.05). FT4 showed a weak positive correlation with HAZ (ρ = 0.265), although it was not statistically significant (p = 0.06). LOESS and GAM demonstrated limited explanatory power. K-means clustering identified three distinct growth phenotypes with significant differences in HAZ and height deficit (p < 0.001), whereas TSH and FT4 levels did not differ across clusters. These findings suggest that thyroid hormone levels are not significantly associated with stunting severity in children with β-thalassemia major, highlighting the multifactorial nature of growth impairment and the need for further investigation to support targeted intervention strategies. ]]>
