Mild neonatal hyperthyrotrophinaemia: 10‐year experience suggests the condition is increasingly common but often transient

Oren, Asaf; Wang, Michael Ke; Brnjac, Lori; Mahmud, Farid H.; Palmert, Mark R.

doi:10.1111/cen.12228

Cited by 27 publications

(18 citation statements)

References 29 publications

(113 reference statements)

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“…The population in this study is similar to that reported in 2002 by Calaciura et al (11), in 2008 by Leonardi et al (12) and in 2013 by Oren et al (18). Our work showed a lower prevalence of PH in children with TNH, 9.2% vs 50% in the first cited authors, 43.2% in the second, and 22.3% in the third.…”

Section: Discussionsupporting

confidence: 91%

Transient neonatal hyperthyrotropinemia is a risk factor for developing persistent hyperthyrotropinemia in childhood with repercussion on developmental status

Cuestas

Gaido

Capra

2015

European Journal of Endocrinology

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Objective: Transient neonatal hyperthyrotropinemia (TNH) is defined as a neonatal abnormality of thyroid function, which reverts to normal at re-examination after 2 weeks of life. The thyroid function of these infants has not been sufficiently studied in terms of the risk of developing persistent hyperthyrotropinemia (PH) in later childhood and its impact on growth and development. Design: A prospective cohort study included all babies born in our hospital between 2001 and 2006 and screened for hypothyroidism, whose thyroid function was re-examined 6 years later. Exclusion criteria included the following conditions: preterm birth, birth weight !2500 g, Down's syndrome, descendants of mothers with immune thyroid disease, congenital malformations, cardiac, renal, hepatic, and metabolic diseases, and steroid or dopamine medication. The variables included are TSH and thyroxine at neonatal screening and 6 years later. Main outcomes are the risk of developing PH in childhood, linear growth, and development using Parents' Evaluation of Developmental Status (PEDS). Results: Out of 5040 normal-term newborns, 301 (6.0%, 95% CI 5.3-6.6%) have TSH R10 mU/l (TNH). Six years later, we re-examined 65 randomly selected children with TNH and 185 controls. In the TNH cohort, we found six out of 65 children (9.2%, 95% CI 1.4-17.0%) with PH (TSH R6.4 mU/l), and three out of 185 (1.6%, 95% CI 0.3-4.7%) among controls, relative risk 5.7 (95% CI 1.5-22.1), PZ0.0114. TSH and developmental delay were found to be significantly higher in the TNH cohort (4.7G1.3 mU/l vs 2.1G0.5 mU/l, P!0.0001 and 15/65 (23%, 95% CI 12-34.1) vs 21/185 (11.3%, 95% CI 6.5-16.2) PZ0.0348). Conclusions: Newborns with TNH have a higher risk of developing PH in childhood, with repercussion on developmental status.

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Section: Discussionsupporting

confidence: 91%

Transient neonatal hyperthyrotropinemia is a risk factor for developing persistent hyperthyrotropinemia in childhood with repercussion on developmental status

Cuestas

Gaido

Capra

2015

European Journal of Endocrinology

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“…Here, the relative diagnostic yields of technetium and ultrasound scanning need to be specifically evaluated [50], although ectopy still needs to be ruled out, as it may be associated with only mild hyperthyrotropinemia [12,16,45]. When thyroid anatomy is normal, molecular investigations should nowadays be considered.…”

Section: Expert Commentarymentioning

confidence: 99%

The changing epidemiology of congenital hypothyroidism: fact or artifact?

Deladoëy

Vliet

2014

Expert Review of Endocrinology & Metabolism

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Screening increases prevalence estimates for most diseases and congenital hypothyroidism (CH) is no exception, affecting one in 6700 children by clinical ascertainment and one in 3500 in the first surveys of systematic biochemical screening of newborns. Importantly, screening has resulted in the disappearance of intellectual disability due to CH. A further doubling in prevalence estimates has recently been reported, mostly accounted for by changes in screening algorithms; accordingly, the prevalence of overt CH has remained stable. Population-based registries that distinguish confirmed diagnoses from positive screening results have proved invaluable. These registries should include: etiology of CH based on imaging, ideally technetium scintigraphy; ethnicity; socio-educational data; input from the screening laboratories and pediatric endocrinologists. Efforts should now be directed at increasing the proportion of the world's newborns screened for overt CH (currently 30%) and at determining if neonates with mild hyperthyrotropinemia also benefit from early treatment.

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“…Also, transient hypothyroidism tends to respond to a lower dosage of L-T4 than CH. 7,15,24,25 Kashiwagura et al 26 successfully administered a suppository preparation of L-T4 in patients with hypothyroidism who could not take thyroid hormones by mouth. Because our patient was incapable of receiving oral administration of L-T4 and because intravenous and suppository preparations of L-T4 were not available at our hospital, we decided to empirically administer a rectal diluted solution of L-T4.…”

Section: Discussionmentioning

confidence: 99%

Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study

et al. 2018

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Transient hypothyroidism can present itself as clinically asymptomatic or with few symptoms. Early treatment with levothyroxine (L-T4) prevents complications related to this disorder. We report a case of a male infant with concomitant short bowel syndrome and transient hypothyroidism treated with rectal L-T4. A 4-month-and-10-day-old boy with previous gastroschisis underwent multiple surgical approaches for small bowel resection and developed short bowel syndrome. We suspected hypothyroidism because of jaundice (direct bilirubin up to 59 mg/dL), the absence of evacuation, oral diet intolerance, and intestinal dysmotility. Because of a thyrotropin level of 34.45 μIU/mL and a free thyroxine level of 0.64 ng/dL, the diagnosis was confirmed. Because fasting was demanding, we started the patient on rectal diluted L-T4. After 4 weeks, the patient had spontaneous peristalsis, improvement of jaundice (direct bilirubin: 4.6 mg/dL), and normalized free thyroxine and thyrotropin values. In the present case, the patient was diagnosed with hypothyroidism and was on absolute fasting. An alternative route of drug administration was warranted. We empirically prescribed rectal diluted L-T4 when intravenous and suppository L-T4 were not available. This method was proven to be safe and effective in improving the patient's clinical and biochemical status. Rectal L-T4 is a possible alternative route of administration to treat hypothyroidism in patients who are unable to take the medication orally.

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Mild neonatal hyperthyrotrophinaemia: 10‐year experience suggests the condition is increasingly common but often transient

Cited by 27 publications

References 29 publications

Transient neonatal hyperthyrotropinemia is a risk factor for developing persistent hyperthyrotropinemia in childhood with repercussion on developmental status

Transient neonatal hyperthyrotropinemia is a risk factor for developing persistent hyperthyrotropinemia in childhood with repercussion on developmental status

The changing epidemiology of congenital hypothyroidism: fact or artifact?

Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study

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