Psychomotor development in congenital hypothyroidism

Komianou, Filadelfia; Makaronis, G.; Lambadaridis, J.; Sarafidou, E.; Vrachni, F.; Mengreli, Chryssanthi; Pantelakis, S

doi:10.1007/bf00442694

Cited by 13 publications

(3 citation statements)

References 12 publications

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“…Several studies (1-3) report CHT infants displaying minor neurologic dysfunctions and subnormal IQ at later age despite early diagnosis and treatment. Other studies report normal findings (4)(5)(6).…”

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confidence: 86%

“…The importance of adequate induction is also supported by developmental studies in older CHT children. Normal IQ scores and normal school performances were obtained in those studies in which the patients received a high initial dosage of I-T4 (8 to 10 or 10 pg/kg/d) (4)(5)(6)29). In those studies in which a lower induction regimen was given comparable to that of our study (1-3), however, subnormal IQ scores and developmental delays were found, especially for the TD patients.…”

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confidence: 99%

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Influence of Treatment on the Maturation of the Somesthetic Pathway in Infants with Primary Congenital Hypothyroidism during the First Year of Life

Bongers-Schokking

Colon²,

Mulder

et al. 1993

Pediatr Res

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ABSTRACT. To assess the influence of treatment on the development of the somesthetic pathway in infants with congenital hypothyroidism receiving early treatment, median nerve somatosensory evoked potentials were measured during the 1st y of life.Twenty-nine infants were studied with six to seven somatosensory evoked potential tests per infant. The cervical latency (N13) divided by arm length and the first (N19) and second (N32) cephalic latencies as well as N13-N32 latency were measured. At diagnosis, all components showed a small but significant delay, which was not related to thyroxine (T4) levels before treatment. During treatment, T4 ranged from 50 to 290 nmol/L. At 12 mo, the cervical latency divided by arm length had normalized, whereas N19 and N13-N32 were more abnormal than at diagnosis. For N19, these abnormalities were related to a slow initial rise of T4 (1100 nmol/L after 1 wk of treatment) and the initial N19 values. Abnormal N13-N32 values were associated with high T4 values during treatment (>200 nmol/L) and the type of congenital hypothyroidism (partial or total deficiency in T4 production). Induction of therapy with I-triiodothyronine rather than I-thyroxine and the occurrence of low T4 values ( e l 0 0 nmol/L) after the 4th wk of therapy had no such effect. Our data suggest that, for normal CNS development, euthyroidism should be reached as soon as possible by adequate induction therapy. Thereafter, T4 supplementation should be strictly dosed, keeping the serum T4 values within narrow limits around the mean normal for age, because overtreatment, like initial undertreatment, may lead to CNS abnormalities at the end of the first year. (Pediatr Res 34: 73-78,1993) Abbreviations CHT, congenital hypothyroidism I-T4, levo-thyroxine 1-T3, levo-triiodothyronine I-T4/f, fast initial serum T4 rise on I-T4 induction I-T4/s, slow initial serum T4 rise on I-T4 induction PD, partial deficiency in T4 production TD, total deficiency in T4 production PMA, postmenstrual age SEP, somatosensory evoked potentials N13/AL, latency to first negative peak in cervical lead divided by arm length N19, latency to first negativity in cephalic lead N32, latency to second negativity in cephalic lead N60, latency to third negativity in cephalic lead P22, latency to first positivity after N19 T4>200, group with serum T4 >200 nmol/L on all occasions T 4~2 0 0 , group with serum T4 ~2 0 0 nmol/L on all occasions bl, slope for period T4 ~2 0 0 nmol/L b2, slope for period T4 >200 nmol/L The major objective of the national screening programs for CHT is the prevention of neurologic damage. On the whole, the results of the screening seem gratifying, but there are still unsatisfying aspects. Several studies (1-3) report CHT infants displaying minor neurologic dysfunctions and subnormal IQ at later age despite early diagnosis and treatment. Other studies report normal findings (4-6).Generally, the neurologic deficits are ascribed to perinatal thyroid hormone deficiency, because they were found to be related to very low initial T4 val...

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confidence: 86%

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confidence: 99%

Influence of Treatment on the Maturation of the Somesthetic Pathway in Infants with Primary Congenital Hypothyroidism during the First Year of Life

Bongers-Schokking

Colon²,

Mulder

et al. 1993

Pediatr Res

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“…The most important determinants for outcome are severity of hypothyroidism, defined by initial thyroxine level at the time of screening (Murphy et al 1990, Fuggle et al 1991, Derksen-Lubsen and Verkerk 1996, and age at the start of treatment (Ilicki andLarsson 1988, Rovet andEhrlich 2000). Although several studies assumed that early treatment might prevent irreversible impairment of brain development (Virtanen et al 1980, Ilicki and Larsson 1988, Komianou et al 1988, New England Congenital Hypothyroidism Collaborative 1990, there is ample evidence that neurological dysfunctions, motor disorders, and below normal IQ can persist but to a lesser degree (MacFaul et al 1978, Glorieux et al 1985, Rovet et al 1987. Early treatment by thyroxine replacement showed that vestibular function was similar to that in a control group (Meza et al 1996); delaying the onset of treatment was associated with poor outcome and led to abnormal vestibular function (Sato et al 1987).…”

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confidence: 99%

Effect of age at thyroid stimulating hormone normalization on postural control in children with congenital hypothyroidism

Gauchard¹,

Deviterne²,

Leheup³

et al. 2004

Dev Med Child Neurol

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Neonatal screening programmes allow early treatment to limit the consequences of congenital hypothyroidism on maturation of the central nervous system, and on psychomotor and educational outcome. Consequences of age at thyroid stimulating hormone (TSH) normalization on postural control were evaluated in 17 children with congenital hypothyroidism (14 females, three males; median age 12 years 1 month, range 7 to 14 years) and in 11 control individuals (eight females, three males: median age 10 years 6 months, range 8 to 14 years). Children with congenital hypothyroidism were split into two groups according to time of TSH normalization: before (group 1) or after (group 2) 3 months of age. Posturography (static and dynamic tests), educational (school performance), and psychomotor (WISC and revised Bruininks Oseretsky tests) evaluations were carried out. Group 2 results showed significant abnormalities in postural, educational, and psychomotor aptitudes in comparison with group 1 and control children (stability, Bruininks-Oseretsky, school performance: p < or = 0.05 or p < or = 0.01). Early TSH normalization is necessary to allow for normal development of the neurosensorial afferent pathways (vestibular, proprioceptive) and of central integration (cerebellum, vestibular nuclei).

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