Postnatal thyroid hormone replacement in very preterm infants

Kok, Joke H.; Briët, Judy M.; Wassenaer, Aleid G. van

doi:10.1053/sper.2001.27550

Cited by 22 publications

(22 citation statements)

References 60 publications

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“…Treatment of these infants (with the exception of those with central hypothyroidism or delayed TSH increase) with L-T 4 has not yet been shown to be beneficial. 48,[57][58][59] Low T 4 and Delayed TSH Increase Many infants with low T 4 concentrations and normal TSH values on initial screening (l in 100 000 newborn infants) who are subsequently found to have an elevated TSH concentration are LBW, VLBW, or critically ill preterm and term neonates. Serum TSH values in these infants increase during the first few weeks of life to concentrations characteristic of primary hypothyroidism.…”

Section: Low T 4 and Normal Tsh Valuesmentioning

confidence: 99%

“…Currently the evidence base does not indicate cognitive benefit from thyroid therapy of hypothyroxinemia of prematurity in the absence of TSH elevation. [48][49][50][57][58][59] Administration of L-T 4 is the treatment of choice. Although T 3 is the more biologically active TH, most brain T 3 is derived from local monodeiodination of T 4 , so T 3 should not be used.…”

Section: Treatmentmentioning

confidence: 99%

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Update of Newborn Screening and Therapy for Congenital Hypothyroidism

Rose¹,

Brown²

2006

Pediatrics

582

301

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Unrecognized congenital hypothyroidism leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. The primary thyroid-stimulating hormone screening has become standard in many parts of the world. However, newborn thyroid screening is not yet universal in some countries. Initial dosage of 10 to 15 g/kg levothyroxine is recommended. The goals of thyroid hormone therapy should be to maintain frequent evaluations of total thyroxine or free thyroxine in the upper half of the reference range during the first 3 years of life and to normalize the serum thyroid-stimulating hormone concentration to ensure optimal thyroid hormone dosage and compliance.Improvements in screening and therapy have led to improved developmental outcomes in adults with congenital hypothyroidism who are now in their 20s and 30s. Thyroid hormone regimens used today are more aggressive in targeting early correction of thyroid-stimulating hormone than were those used 20 or even 10 years ago. Thus, newborn infants with congenital hypothyroidism today may have an even better intellectual and neurologic prognosis. Efforts are ongoing to establish the optimal therapy that leads to maximum potential for normal development for infants with congenital hypothyroidism.Remaining controversy centers on infants whose abnormality in neonatal thyroid function is transient or mild and on optimal care of very low birth weight or preterm infants. Of note, thyroid-stimulating hormone is not elevated in central hypothyroidism. An algorithm is proposed for diagnosis and management.Physicians must not relinquish their clinical judgment and experience in the face of normal newborn thyroid test results. Hypothyroidism can be acquired after the newborn screening. When clinical symptoms and signs suggest hypothyroidism, regardless of newborn screening results, serum free thyroxine and thyroidstimulating hormone determinations should be performed. INTRODUCTIONCongenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation. In most cases, the disorder is permanent and results from an All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.Key Words congenital hypothyroidism, thyroid hormone, thyroid-stimulating hormone, newborn screening Abbreviations CH-congenital hypothyroidism TH-thyroid hormone T 4 -thyroxine T 3 -triiodothyronine TSH-R-thyrotropin receptor TRBAb-thyrotropin receptor-blocking antibody FT 4 -free thyroxine TSH-thyroid-stimulating hormone TBG-thyroid-binding globulin LBW-low birth weight VLBW-very low birth weight L-T 4 -levothyroxine TRH-thyrotropin-releasing hormone PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

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Section: Low T 4 and Normal Tsh Valuesmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Update of Newborn Screening and Therapy for Congenital Hypothyroidism

Rose¹,

Brown²

2006

Pediatrics

582

301

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“…Thyroid hormone adequacy is crucial for normal fetal neurodevelopment and is essential for the developing fetal brain, heart, and lungs. 1 Thyroid disease is a common endocrine condition in women of reproductive age. 2 The most common thyroid disorder occurring around or during pregnancy is thyroid hormone deficiency, or hypothyroidism.…”

Section: Introductionmentioning

confidence: 99%

Gestation-Specific Thyroxine and Thyroid Stimulating Hormone Levels in the United States and Worldwide

Soldin

Soldin²,

Sastoque³

2007

Therapeutic Drug Monitoring

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Background-Euthyroid women experience dramatic changes in the demand for thyroid hormone production as early as the first trimester of pregnancy. These changes are important for fetal neurodevelopment and organ development as well as maternal health and succesful full term pregnancy. Therefore, gestation-specific reference intervals assist in appropriate clinical management of thyroid disease in pregnancy to ensure maternal and fetal health.

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“…[16] çalışmalarında, pretermlere T4 verilmesini değerlendiren çok az randomize çalışma mevcut olduğunu ve bu kanıtların tüm pretermlere T4 verilmemesini desteklediğini, yine de 27-29 gestasyon haftasından önce doğanlara nörogelişimsel durumu iyileştirecek T4 verilme endikasyonu olduğunu belirtmişlerdir. Osborn ve ark.…”

Section: Discussionunclassified

Comparison of thyroid functions in healthy term and preterm neonates

Küçük¹,

Biçer²,

Bakar³

et al. 2012

J Kartal TR

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ÖzetAmaç: Sağlıklı term ve preterm yenidoğanların tiroid fonksiyonlarının incelenmesi ve preterm ve term bebeklerin tiroid hormon düzeylerinin karşılaştırılması planlandı. Gereç ve Yöntem:Sağlıklı term (≥37 gebelik haftası) ve sağ-lıklı preterm (<37 gebelik haftası) yenidoğanların postnatal üçüncü günlerinde alınan tiroid stimulan hormon (TSH) ve serbest tiroksin düzeyleri geriye dönük değerlendirildi. Ça-lışmaya annelerinde tiroid hastalığı olan bebekler, sepsis, solunum güçlüğü, asfiksi vb. hastalık nedeniyle yenidoğan yoğun bakım ünitesinde izlenen bebekler ve <31 haftalık preterm bebekler alınmadı. Bulgular:Toplam 371 yenidoğan incelendi. Bebeklerin 190'ı (%51) erkek ve 181'i (%49) kız idi. TSH değerleri bakımından gruplar arasında fark saptanmadı (p>0.05). Term olguların ortalama serbest tiroksin değeri preterm olgulardan anlamlı derece yüksekti (p<0.05). Gruplar arasında ortalama serbest tiroksin değerleri bakımından anlamlı farklılık gözlendi.Sonuç: Sağlıklı pretermlerde sağlıklı term bebeklere göre hipotiroksinemi saptanmıştır.

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Postnatal thyroid hormone replacement in very preterm infants

Cited by 22 publications

References 60 publications

Update of Newborn Screening and Therapy for Congenital Hypothyroidism

Update of Newborn Screening and Therapy for Congenital Hypothyroidism

Gestation-Specific Thyroxine and Thyroid Stimulating Hormone Levels in the United States and Worldwide

Comparison of thyroid functions in healthy term and preterm neonates

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