Persistent hyperthyrotropinaemia since the neonatal period in clinically euthyroid children

Tyfield, Linda; Abusrewil, S. S.; Jones, Steven R.; Savage, D. C. L.

doi:10.1007/bf01955927

Cited by 24 publications

(23 citation statements)

References 8 publications

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“…O importante é escolher o que melhor se adapta às condições de saúde pública local (4,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37).…”

Section: Discussionunclassified

“…Esse valor segue tendência de redução dos pontos de corte inicialmente sugeridos (4,6,(23)(24)(25)(26)(27). Foi considerada a faixa de segurança mais ampla para evitar ao máximo os falso-negativos (4,(28)(29)(30)(31)(32). A criança é encaminhada ao ambulatório multiprofissional do HU/UFS para seguimento, devendo ser confirmado o HC.…”

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Programa de triagem neonatal para hipotireoidismo congênito no nordeste do Brasil: critérios diagnósticos e resultados

Ramalho

Oliveira

et al. 2008

Arq Bras Endocrinol Metab

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RESUMOAvaliamos as concentrações do TSH em papel-filtro colhido no calcanhar (TSHneo) de 48.039 crianças triadas do programa de triagem neonatal (PTN) para o hipotireoidismo congênito (HC) de Sergipe, as concentrações de TSH, T4 total e T4 livre colhidas em sangue periférico nas crianças convocadas suspeitas de HC, a idade nas diversas fases do programa, a cobertura e a freqüência do PTN de janeiro de 2005 a agosto de 2006, comparando-as com dados da literatura. Utilizamos para análise os seguintes parâmetros: média, mediana, coeficiente de variação e distribuição de freqüência. A idade da criança por ocasião da coleta em papel filtro no calcanhar foi 10 ± 9 dias (média ± desvio-padrão) e a idade na realização do ensaio do TSHneo foi de 31 ± 13 dias. Em 2005, a cobertura do PTN, para o interior e para a capital de Sergipe, foi de 77% e 73%, respectivamente. Verificamos que em 99,484% das crianças triadas as concentrações do TSH coletado em papel-filtro encontravam-se entre 0,01 e 5,20 µU/mL. As concentrações do TSH decrescem com o aumento da idade até estabilizar entre 11 e 15 dias de vida. ABSTRACT Neonatal Screening Program for Congenital Hypothyroidism in Northeast of Brazil: Criteria, Diagnosis and Results.It was evaluated the concentration of TSH in blood spot (TSHneo) of 48.039 children included in the Neonatal Screening Program (NSP) for Congenital Hypothyroidism (CH) of Sergipe (SE), a state in the northeast of Brazil. It was also evaluated the concentration of serum TSH, total T4 and free T4 in the recalled children suspicious of having CH, their age in several phases of the program, the covering and frequency of the NSP in the cases from January 2005 to August 2006, comparing them with literature data. The following parameters were used or the analysis: mean, standard deviation, median, coefficient of variation and frequency distribution. The children´s age at the collection in filter-paper specimen was 10 ± 9 days (Mean±SD) and the TSHneo execution assay was done in the period of 31 ± 13 days. In 2005 the covering by the NSP was about 77% in the countryside and 73% in Aracaju, the capital of Sergipe. It was verified that in 99,484% of the children included in the screening, the TSHneo varied from 0,01 to 5,20µU/ml, decreasing according to the age and stabilizing when they were between 11 and 15 days. 248 children were recalled from the TSHneo (1/194).The concentrations of TSH, T4 and free T4 collected by venous puncture were normal in 119 children (1/404). The frequency of suspected CH was 1/485 (99 cases), of CH was 1/6005 (8 cases) and of hypothyroxinemia was 1/16013 (3 cases). Therapy for CH began within 51 ± 12 days.

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“…O importante é escolher o que melhor se adapta às condições de saúde pública local (4,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37).…”

Section: Discussionunclassified

Programa de triagem neonatal para hipotireoidismo congênito no nordeste do Brasil: critérios diagnósticos e resultados

Ramalho

Oliveira

et al. 2008

Arq Bras Endocrinol Metab

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“…There is considerable controversy regarding the long-term effects of TNH in the neonatal period on the development of persistent hyperthyrotropinemia (PH) during later childhood (age, 6 years), defined as a serum TSH level above the upper limit of the statistically defined reference range while the serum T 4 level is within the reference range, without clinical manifestations (8). Miki et al (9) and Tyfield et al (10) claim that TNH has no long-term adverse consequences, whereas Calaciura et al (11) and Leonardi et al (12) state that, in newborns with hyperthyrotropinemia (normal T 4 levels and elevated TSH levels on confirmatory test), this condition requires a considerable time frame to distinguish between permanent and transient cases, compared with normal controls having significantly higher TSH values in childhood; but unfortunately, these studies do not consider the question in appropriate epidemiological terms of the risk of developing PH in later childhood, and its potential impact on growth and development (13). In practice, our study addresses a question about the health of children who are diagnosed during neonatal screening programs with a mild transient form of thyroid dysfunction and for whom no clear evidence for treatment indications exists today.…”

Section: Introductionmentioning

confidence: 99%

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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“…The clinical significance of neonatal HT is in debate. Several small-size studies have shown normal growth and school achievements in children with neonatal HT (2,13,14,15). In three of the studies, however, cognitive development was assessed qualitatively, based on caregivers, reports (2, 14, 15), whereas only one study reported normal psychomotor development based on validated tests (13).…”

Section: Discussionmentioning

confidence: 96%

Neonatal hyperthyrotropinemia is associated with low birth weight: a twin study

Zung

Yehieli

Almashanu

2013

European Journal of Endocrinology

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Objective: Contradictory reports ascribe neonatal hyperthyrotropinemia (HT) to prematurity or small weight for gestational age. We aimed to evaluate the association between neonatal HT and birth weight (BW), recovery rate of the disorder, and possible association with perinatal stress. Design: Based on a neonatal screening database, a retrospective twin study was designed where withinpair differences in thyroid function were evaluated while controlling for differences in gestational age and thyroid-affecting environmental confounders. Methods: Two thousand five hundred and ninety-five twin pairs that were screened both for TSH and thyroxine (T 4 ) over 3 years were included. TSH and T 4 levels were evaluated along with BW, birth order, gender, and 17-hydroxyprogesterone (17OHP) that was considered as a surrogate marker for stress. Results: Of all the twin pairs, 7.2% had neonatal HT. Among 156 pairs, HT was more prevalent in the smaller twins (64%; P!0.001), especially in the discordant pairs (76%; PZ0.001). Seventy-five percent of the twins demonstrated a recovery within the first few weeks of life. 17OHP levels were similarly distributed between twins with and without HT. In a cohort of 1534 twin pairs with normal thyroid function, mean TSH levels were significantly higher in the smaller than in the larger twin in the whole group (4.1G3.2 vs 3.8G2.9 mIU/l; P!0.001) and especially among discordant twins (4.7G3.4 vs 3.8G3.0 mIU/l; P!0.001). Conclusions: Elevated TSH levels are associated with low BW, both in infants with HT and in normal neonates. A rapid recovery rate is expected in most cases.

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Persistent hyperthyrotropinaemia since the neonatal period in clinically euthyroid children

Cited by 24 publications

References 8 publications

Programa de triagem neonatal para hipotireoidismo congênito no nordeste do Brasil: critérios diagnósticos e resultados

Programa de triagem neonatal para hipotireoidismo congênito no nordeste do Brasil: critérios diagnósticos e resultados

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

Neonatal hyperthyrotropinemia is associated with low birth weight: a twin study

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