Longitudinal Assessment of Levo-Thyroxine Therapy for Congenital Hypothyroidism: Relationship with Aetiology, Bone Maturation and Biochemical Features

Delvecchio, Maurizio; Faienza, Maria Felicia; Acquafredda, Angelo; Zecchino, C.; Peruzzi, Sonia

doi:10.1159/000100373

Cited by 19 publications

(22 citation statements)

References 71 publications

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“…While the normal 123 I imaging results did not ultimately influence the decision to start treatment in these 3 infants, 123 I imaging could result in earlier initiation of treatment in those with abnormal results. Of note, in the majority of infants in group 1 in whom dyshormonogenesis was suspected, the dose of L -T 4 was consistent with the required L -T 4 doses previously reported in children with dyshormonogenesis [28,29]. …”

Section: Discussionsupporting

confidence: 85%

The Role of <sup>123</sup>I Imaging in the Evaluation of Infants with Mild Congenital Hypothyroidism

Graber¹,

Regelmann²,

Annunziato

et al. 2014

Horm Res Paediatr

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Background/Aims: Controversy exists regarding the diagnosis and treatment of mild congenital hypothyroidism (MCH). We studied the value of ¹²³I imaging in patients with MCH. Methods: Retrospective chart review of infants and children <4 years of age who underwent ¹²³I imaging: group 1 = MCH [thyroid-stimulating hormone (TSH) <25 µIU/ml, normal free T₄/T₃], group 2 = severe congenital hypothyroidism (TSH ≥25 µIU/ml), and group 3 = MCH in infancy imaged after treatment withdrawal at age 3 years. Data collected included 4- and 24-hour ¹²³I uptake, TSH, free T₄/total T₃ at imaging, age at imaging, and levothyroxine (L-T₄) dose at 1 year of. Results: Thirty-six patients underwent ¹²³I imaging. In group 1 (n = 20, median TSH: 8.49 µIU/ml), 85% had abnormal imaging consistent with dyshormonogenesis. Two patients were referred after 1 year of age. The median age at imaging for the remaining 18 patients was 54 days. Median L-T₄ dose at 1 year of age for these 18 patients was 2.8 μg/kg, which is consistent with dyshormonogenesis. Ninety-one percent of group 2 (n = 11, median TSH: 428.03 µIU/ml) had abnormal imaging. The median age at imaging was 13 days. Four patients in group 3 had abnormal ¹²³I imaging and restarted treatment. Conclusion:¹²³I imaging is a valuable tool for evaluation, diagnosis, and treatment of MCH.

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Section: Discussionsupporting

confidence: 85%

The Role of <sup>123</sup>I Imaging in the Evaluation of Infants with Mild Congenital Hypothyroidism

Graber¹,

Regelmann²,

Annunziato

et al. 2014

Horm Res Paediatr

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“…A few studies conducted in this area found different results as clinical and laboratory prediction criteria. Although it was reported that the fT4 level at the time of diagnosis could be a criterion in the differentiation of transient and permanent PCH in one study, other studies concluded that fT4 level was not determinative (6,16,25). In the literature, studies have reported that TSH level may be a criterion in predicting transient and permanent PCH, whereas others concluded that it could not be used as a criterion (5,16,18).…”

Section: Discussionmentioning

confidence: 96%

“…When the thyroxine dosage was evaluated as a predictive criterion in the study of Hashemipour et al for the differential diagnosis of permanent and transient PCH, it was reported the thyroxine dosage given at the time of treatment initiation could be used as a criterion (18). In contrast, Delvecchio et al (25) found that the thyroxine dosagee at the time of treatment initiation was not different in the permanent and transient PCH groups. In our study, the thyroxine dose at the time of treatment initiation was similar in the permanent and transient PCH groups, in accordance with the literature.…”

Section: Discussionmentioning

confidence: 99%

“…However, etiologic investigations are mostly delayed until after the age of three years because some investigations directed to the etiology (e.g., thyroid scintigraphy) are time consuming and it is mandatory to initiate treatment early to prevent mental retardation. However, crtieria that could predict a diagnosis of permanent or transient PCH have been investigated (5,6,16,18,25). A few studies conducted in this area found different results as clinical and laboratory prediction criteria.…”

Section: Discussionmentioning

confidence: 99%

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Etiological evaluation of primary congenital hypothyroidism cases

et al. 2017

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Aim: Primary congenital hypothyroidism is frequently seen endocrine disorder and one of the preventable cause of mental retardation. Aim of study was to evaluate the frequency of permanent/transient hypothyrodism, and to detect underlying reason to identfy any marker which carries potential to discriminate permanent/transient form. Material and Methods:Forty eight cases older than 3 years of age, diagnosed as primary congenital hypothyroidism and started thyroxin therapy in newborn-period, and followed up between January 2007-June 2013 were included in the study. Thyroid hormon levels were evaluated and thyroid ultrasonography was performed in cases who are at the end of their 3 years of age, after 6 weeks of thyroxine free period. Thyroid sintigraphy was performed if serum thyroid-stimulating hormone was high (≥ 5 mIU/mL) and perchlorate discharge test was performed if uptake was normal or increased on sintigraphy. Cases with thyroid-stimulating hormone levels ≥ 5 mIU/mL were defined as permanent primary congenital hypothyroidism group and as transient primary congenital hypothyroidism group with normal thyroid hormones during 6 months. Results:The mean age was 3.8±0.7 years. Mean diagnosis age was 16.6±6.5 days and 14 cases (29.2%) were diagnosed by screening program of Ministry of Health. There were 23 cases (14F, 9M) in permanent primary congenital hypothyroidism group and 12 (52.2%) of them were dysgenesis (8 hypoplasia, 4 ectopia), and 11 (47.8%) dyshormonogenesis. In transient primary congenital hypothyroidism group, there were 25 cases (17M, 8F). The mean thyroid-stimulating hormone levels at diagnosis were similar in two groups. The mean thyroxin dose in permanent primary congenital hypothyroidism group was significantly higher than transient group at the time of thyroxin cessation (2.1±0.7, 1.5±0.5 mg/ kg/d, respectively, p=0.004). Thyroxin dose ≥1.6 mcg/kg/d was 72% sensitive and 69.6% specific for predicting permenant primary congenital hypothyroidism. Conclusions:Transient primary congenital hypothyroidism is more frequent than expected and found often in males in the primary congenital hypothyroidism cases, started thyroxin therapy in neonatal period. While fT4, thyroid-stimulating hormone, Tg levels at diagnosis do not predict transient/permenant primary congenital hypothyroidism, thyroxin dose before the therapy cessation at the age of 3 may make the distinction between transient/permenant primary congenital hypothyroidism. (Turk Pediatri Ars 2017; 52: 85-91)

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“…A controversial issue is the optimal initial dose of levothyroxine (LT4) for avoiding mental retardation with the minimum side effects. Several studies conclude that a high initial dose is beneficial and harmless [6,14,15,16,17]. But this statement is questioned in other papers [18,19,20].…”

Section: Introductionmentioning

confidence: 99%

Episodes of Overtreatment during the First Six Months in Children with Congenital Hypothyroidism and Their Relationships with Sustained Attention and Inhibitory Control at School Age

Álvarez¹,

C²,

A³

et al. 2010

Horm Res Paediatr

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Background/Aims: Contradictory results regarding the optimal initial dose of levothyroxine in children with congenital hypothyroidism (CH) hamper the clinical management of these children during their early infancy. We explore the relationships between the initial dose of levothyroxine and endocrine control during the first 6 months and cognition at school age. Subjects and Methods: Fifty children with CH, 14 boys (10 ± 3.1 years) and 36 girls (9.7 ± 2.6 years), at the Pediatric Endocrine Unit of the Hospital Gregorio Marañón in Madrid were studied. Neurocognitive evaluation was carried out exploring alertness and inhibitory control. The number of episodes of overtreatment during the first 6 months, the initial dose of levothyroxine, etiology and sex were the predictor variables. Results: Inhibitory control was significantly lower in children with CH than in controls. An interaction with gender and etiology was obtained. Alertness had an inverse relationship with the number of episodes of overtreatment with no interaction with gender or etiology. Conclusion: Episodes of overtreatment and not the initial dose of levothyroxine are a risk factor for deficit in alertness whereas subtle inhibitory control deficit seems to be a permanent problem with the current therapeutic approach.

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Longitudinal Assessment of Levo-Thyroxine Therapy for Congenital Hypothyroidism: Relationship with Aetiology, Bone Maturation and Biochemical Features

Cited by 19 publications

References 71 publications

The Role of <sup>123</sup>I Imaging in the Evaluation of Infants with Mild Congenital Hypothyroidism

The Role of <sup>123</sup>I Imaging in the Evaluation of Infants with Mild Congenital Hypothyroidism

Etiological evaluation of primary congenital hypothyroidism cases

Episodes of Overtreatment during the First Six Months in Children with Congenital Hypothyroidism and Their Relationships with Sustained Attention and Inhibitory Control at School Age

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