Hyperthyrotropinemia at 2 weeks of age indicates thyroid dysfunction and predicts the occurrence of delayed elevation of thyrotropin in very low birth weight infants

Niwa, Fusako; Kawai, Masahiko; Kanazawa, Hoshinori; Iwanaga, Kougoro; Matsukura, Tadashi; Hasegawa, Takeshi; Heike, Toshio

doi:10.1111/j.1365-2265.2011.04323.x

Cited by 9 publications

(9 citation statements)

References 29 publications

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“…19 Niwa also adds that the hypothalamicepituitary axis in LBW infants, develops at the age of about 2 weeks, therefore, this age is recommended to be the most suitable time for repetition of the screening test. 36 Considering the studies mentioned above and this systematic review of previous studies, two weeks seems to be the best age to perform the screening test, as the hypothalamicepituitary axis development is initiated at this age and the remaining maternal T4 disappears. It is recommended that the treatment start as soon as the diagnosis of CH is confirmed.…”

Section: Discussionmentioning

confidence: 94%

“…Thus, a cutoff level of 10 mU/L can improve the screening test for congenital hypothyroidism, whether in full-term or preterm infants. 36 Another suggested approach is a repetition of the screening test in order to find cases with delayed TSH rise that were missed using the primary test. However, the most suitable time for the 2nd test is disputed.…”

Section: Discussionmentioning

confidence: 99%

“…34 In 2012, Niwa's team studied on 47 VLBW infants in Kyoto Hospital, Japan, and they proposed that measuring TSH level at the age of two weeks could be helpful in evaluating transient hypothyroxinemia of prematurity and in prediction of the occurrence of delayed rise in TSH. 36 In Delange's study on 103 newborns, it was proposed that thyroid functional capacity of pre-term infants reached the same level as full-term newborns at the age of 4e6 weeks. 16 Tylek-Lemanska's study on 3854 LBW infants in Poland had the same finding.…”

Section: Discussionmentioning

confidence: 99%

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Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates: A systematic review

Hashemipour

Hovsepian

Ansari

et al. 2018

Pediatrics & Neonatology

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Evidence from different screening programs indicated that the rate of congenital hypothyroidism (CH) was higher in pre-term and low-birth-weight (LBW) newborns than normal ones. Incomplete development of hypothalamic-pituitary axis in this group of neonates results in the delayed rise of TSH and missing cases with CH. Hence, there is a great need for a practicable systematic screening method for proper diagnosis of CH in this group of neonates. In this review, we systematically reviewed papers with the following key words ([Congenital Hypothyroidism AND Screening AND Thyroxine AND Thyroid Stimulating Hormone AND Low Birth Weight AND Premature]) in international electronic databases including PubMed, Scopus, and Google Scholar. After quality assessment of selected documents, data of finally included papers were extracted. In this review, 1452 papers (PubMed: 617; Scopus: 714; Google scholar: 121) were identified through electronic database search. One hundred and ninety four articles were assessed for eligibility, from which 36 qualified articles were selected for final evaluation. From the reviewed articles, 38.9%, 11.11% and 8.3% recommended rescreening in this group of neonates, lowering the screening cutoff of TSH and using cutoffs according to the gestational age, respectively. Some of them (13.9%) recommended using both TSH and T4 for screening of preterm infants. After reviewing available data, we recommend repeating the screening test in pre-term, LBW and very-low- birth-weight (VLBW) infants at age of two, six and ten weeks by measuring TSH and FT4 levels simultaneously and considering TSH = 10 mU/L as the cutoff level for positive and suspicious cases.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates: A systematic review

Hashemipour

Hovsepian

Ansari

et al. 2018

Pediatrics & Neonatology

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“…We evaluated not only basal‐free thyroxine (FT4) and TSH levels but also TRH stimulation tests, which are helpful in defining thyroid dysfunction in older children and full‐term neonates 27‐29 . In preterm neonates, we previously reported that the hypothalamic‐pituitary‐‐thyroid (HPT) axis could respond to TRH stimulation tests appropriately even in very low birthweight neonates born at < 30 weeks of gestation at about 2 weeks after birth 30 . Therefore, we consider that TRH stimulation tests are helpful for defining thyroid function.…”

Section: Introductionmentioning

confidence: 99%

Antenatal corticosteroids for threatened labour facilitate thyroid maturation among preterm neonates

Hanaoka

Iwanaga

Tomotaki

et al. 2020

Clinical Endocrinology

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Advances in perinatal care have improved the prognosis for preterm neonates. 1,2 Among them, the administration of antenatal corticosteroids (ANS) is one of the most effective. Since Liggins et al first reported that maternal ANS administration reduced the incidence of neonatal respiratory distress syndrome (RDS) in 1972, 3 its clinical efficacy has been verified in many studies. 4-6 The beneficial effects of ANS have been reported not only in reducing the incidence of RDS, but also in reducing the incidence of

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“…The guidelines of the American Academy of Pediatrics on newborn screening and treatment of CH define all newborns presenting with TSH serum levels persistently higher than 10 mU/L as affected by CH and requiring treatment (1). Niwa et al (11) have shown that hyperthyrotropinemia (TSH>10 mU/L) is a marker of thyroid dysfunction in premature infants aged two weeks or older. However, there is no consensus on treatment of persistent hyperthyrotropinemia with TSH levels between 5 and 10 mU/L.…”

Section: Introductionmentioning

confidence: 99%

The Role of Initial Clinical and Laboratory Findings in Infants With Hyperthyrotropinemia to Predict Transient or Permanent Hypothyroidism

Ünüvar¹,

Demir²,

Abacı³

et al. 2013

JCRPE

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Objective: Studies on the clinical course of children with hyperthyrotropinemia are scarce. We aimed to evaluate the role of presentation findings in such infants to predict eventual outcome.Methods: Files of infants diagnosed as suspicious congenital hypothyroidism (CH) in the neonatal or early infancy period in the past ten years were analyzed retrospectively, and 37 patients (M/F: 20/17) with hyperthyrotropinemia diagnosed at a median age of 3.2 months were included in the study. Criteria for inclusion were: normal free thyroxine (fT4) levels and thyrotropin (TSH) levels between 10-20 μIU/mL during the initial neonatal screening (or TSH<10μIU/mL afterwards). Cases with permanent CH (Group 1) were compared to those with transient hyperthyrotropinemia (Group 2) regarding age at the time of diagnosis, sex, gestational age, birth weight, symptoms, ultrasonographic and scintigraphic findings, initial thyroid function tests, and state of mental and motor development.Results: Of the total group, 20 patients (54%) were eventually diagnosed as permanent CH. T4 doses that maintained normal thyroid function tests were significantly higher at the end of the first and second years of life in this group. Age, TSH and fT4 levels at the time of diagnosis, sex, gestational age, birth weight, symptoms, ultrasonographic and scintigraphic findings, and the state of mental and motor development were similar in the two groups.Conclusions: T4 dose required to maintain a euthyroid state was the only parameter which distinguished between transient and permanent CH.Conflict of interest:None declared.

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Hyperthyrotropinemia at 2 weeks of age indicates thyroid dysfunction and predicts the occurrence of delayed elevation of thyrotropin in very low birth weight infants

Cited by 9 publications

References 29 publications

Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates: A systematic review

Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates: A systematic review

Antenatal corticosteroids for threatened labour facilitate thyroid maturation among preterm neonates

The Role of Initial Clinical and Laboratory Findings in Infants With Hyperthyrotropinemia to Predict Transient or Permanent Hypothyroidism

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