Increased incidence of congenital malformations in children with transient thyroid-stimulating hormone elevation on neonatal screening

Oakley, Godfrey; Muir, T; Ray, Mary Katherine; Girdwood, R. W. A.; Kennedy, Robert; Donaldson, Malcolm

doi:10.1016/s0022-3476(98)70369-5

Cited by 65 publications

(49 citation statements)

References 15 publications

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“…Studies in Italy reported the female-to-male ratio as 2:1 among newborns with thyroid dysgenesis, which accounted for 75% of all newborns with CH; 1:1 among newborns with CH with eutopic (normally positioned and normal appearing) glands; and 0.5:1.0 among newborns with transient hypothyroidism (20). In a Scottish study, the female to male sex ratio was 2.2:1.0 among 224 newborns with definite CH and 1:1 among 88 newborns with transient hypothyroidism (21). Although we found no statistical difference between patients with transient and permanent CH in terms of sex distribution, the male/female ratio was 1.08 in patients with transient CH and 1.5 in those with permanent CH.…”

Section: Discussioncontrasting

confidence: 71%

The evaluation of transient hypothyroidism in patients diagnosedwith congenital hypothyroidism

Kendırcı¹,

Aycan²,

Sağsak³

et al. 2015

Turk J Med Sci

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Children diagnosed with congenital hypothyroidism who started treatment among the newborn babies who were referred to the Dr. Sami Ulus Women and Children's Health Training and Research Hospital Pediatric Endocrinology Background/aim: Congenital hypothyroidism (CH) is divided into two groups as 'permanent' and 'transient' . We aimed to determine the rate of transient and permanent congenital hypothyroidism of the newborns referred to our clinic. Materials and methods:Of the newborns who were referred to our clinic from the neonatal screening program, those who were diagnosed with CH and started treatment were included in the study. The treatments of the patients whose required daily treatment dose was reduced to under 1 µg/kg were terminated and those who were followed monthly and whose fT 4 and thyroid-stimulating hormone (TSH) levels were normal at least 3 times without treatment were considered to have transient hypothyroidism.Results: Of the 256 newborns referred to our clinic from the neonatal screening program, 114 (44.5%) were diagnosed with CH. Of the CH patients, 70% (n = 58) were evaluated to have permanent and 30% (n = 25) transient hypothyroidism. Neonatal and serum TSH levels and treatment doses were found to be significantly lower in the transient hypothyroidism patients. Conclusion:Initial measurements of the serum TSH level and the required doses of L-thyroxine therapy for maintaining normal thyroid hormone levels, growth, and development may have a predictive role for differentiating permanent forms of CH from transient forms.

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Section: Discussioncontrasting

confidence: 71%

The evaluation of transient hypothyroidism in patients diagnosedwith congenital hypothyroidism

Kendırcı¹,

Aycan²,

Sağsak³

et al. 2015

Turk J Med Sci

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“…The reported (from studies of European, Australian, and Canadian newborns 10,11,[39][40][41] ) female-to-male sex ratio among case infants with true CH is ϳ2:1. The ratio was even higher (2.4: 1.0) among newborns with CH caused specifically by thyroid aplasia or ectopy.…”

Section: Sex Ratios and Transient Hypothyroidismmentioning

confidence: 96%

“…10,42 In a Scottish study, the femaleto-male sex ratio was 2.2:1.0 among 224 newborns with definite CH and 1:1 among 88 newborns with transient hypothyroidism. 40 In the United States there have been no systematic longterm follow-up studies to evaluate the sex ratio among newborns with transient versus permanent hypothyroidism. However, the sex ratio among newborns with CH seems to vary significantly according to race or ethnicity (see the article by Hinton et al 3 ), so deviations from the expected 2:1 ratio might be expected in the United States in contrast to that in the more homogeneous populations in Europe, Australia, and Canada.…”

Section: Sex Ratios and Transient Hypothyroidismmentioning

confidence: 99%

The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States

et al. 2010

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The reported incidence rate of primary congenital hypothyroidism (CH) has been increasing in the United States over the past 2 decades. We have considered the possibility that the inclusion of cases of transient hypothyroidism has inflated the reported incidence rate of CH. Assessing the effects of cases of transient hypothyroidism on the incidence rate is problematic, because the definitions, diagnostic criteria, and differentiation from transient hyperthyrotropinemia vary widely among state newborn screening programs. Among the 4 etiologies for transient hypothyroidism (maternal thyrotropin receptor-blocking antibodies, exposure to maternal antithyroid medications, iodine deficiency, and iodine excess), there is little evidence of increases in the incidence rate from thyrotropin receptor-blocking antibodies. Exposure to antithyroid drugs could contribute significantly to the incidence rate of transient CH, given the high estimated incidence of active maternal hyperthyroidism. Iodine deficiency or excess in the United States seems unlikely to have contributed significantly to the incidence rate of CH, because the secular trend toward lower iodine intake among women of reproductive age in the 1980s and 1990s seems to have plateaued, and perinatal iodine exposure has presumably declined as a result of recommendations to discontinue using iodinecontaining disinfectants. Although the female-to-male sex ratio among newborns with thyroid agenesis or dysgenesis (the most common causes of CH) is typically 2:1, analysis of the sex ratio of newborns diagnosed with presumed CH in the United States suggests that a substantial proportion might have transient hypothyroidism or hyperthyrotropinemia, because the sex ratio has been well below the expected 2:1 ratio. Combined ultrasonography and 123 I scintigraphy of the thyroid gland are effective tools for identifying cases of thyroid agenesis and dysgenesis and can help to differentiate cases of transient hypothyroidism from true CH. Imaging is also a vital component in evaluating children who, at 3 years of age, undergo a trial of discontinuation of levothyroxine treatment to test for persistence of hypothyroidism. Ultimately, thyroid gland imaging, in conjunction with longterm follow-up studies that appropriately assess and report whether there was permanence of hypothyroidism, will be necessary to address the true incidence rate of CH and any contribution to the observed rate by transient cases of hypothyroidism or hyperthyrotropinemia.

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“…Over the past two decades, attention has been drawn to the sub-optimal cognitive or behavioural functioning (which may be sub-clinical) observed in children born to mothers with even mild or moderate ID (10)(11)(12)(13)(14)(15)(16) or the developmental implications for children with slight neonatal elevations of TSH (17,18). Thyroid deficiency during the last two trimesters of pregnancy and the first few months post delivery can also result in mental and physical retardation and sometimes neurological deficits, a condition known as cretinism (19).…”

Section: Introductionmentioning

confidence: 99%

Newborn TSH concentration and its association with cognitive development in healthy boys

Freire

Ramos²,

Amaya³

et al. 2010

European Journal of Endocrinology

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Objective: An association between thyroid function during pregnancy or infancy and neurodevelopment in children has been demonstrated. We aimed to investigate whether newborn TSH concentrations are related to subsequent neurocognitive development. Design: We conducted a longitudinal study on 178 children from a general population birth cohort in Granada (Spain) born in [2000][2001][2002]. Methods: TSH concentrations were measured in umbilical cord blood, and cognitive functions were assessed at 4 years of age using the McCarthy's scales of children's abilities (MSCA). Organochlorine (OC) compound concentrations and the combined oestrogenicity (total effective xeno-oestrogenic burden (TEXB)) were also determined in the placentae. Results: Mean newborn TSH was 3.55 mU/l (rangeZ0.24-17 mU/l). In multivariate regression analyses, adjusting for maternal and child characteristics, higher newborn TSH concentrations showed a decrease of 3.51 and 3.15 points on the MSCA general cognitive and executive function scores respectively and were associated with a higher risk of scoring below the 20th percentile (P20) on the quantitative score (odds ratio (OR)Z2.64). Children with TSH in the upper quartile (4.19-17.0 mU/l) were at higher risk of scoring !P20 on span memory (ORZ5.73), whereas children with TSH in the second quartile (2.05-2.95 mU/l) were at lower risk of scoring !P20 on the verbal scale (ORZ0.24). Neonatal TSH status was also associated with general cognitive and executive function outcomes when controlling for prenatal exposure to OCs or placental TEXB. Conclusions: Newborn thyroid hormone status expressed by TSH in cord blood may adversely affect later cognitive function. A more thorough screening for neonatal thyroid deficiency is warranted.

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Increased incidence of congenital malformations in children with transient thyroid-stimulating hormone elevation on neonatal screening

Cited by 65 publications

References 15 publications

The evaluation of transient hypothyroidism in patients diagnosedwith congenital hypothyroidism

The evaluation of transient hypothyroidism in patients diagnosedwith congenital hypothyroidism

The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States

Newborn TSH concentration and its association with cognitive development in healthy boys

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