Three-year follow-up of children with abnormal newborn screening results for congenital hypothyroidism

Kang, Min Jae; Chung, Hye Rim; Oh, Yeon Joung; Shim, Young‐Soo; Yang, Seung; Hwang, Il Tae

doi:10.1016/j.pedneo.2017.01.002

Cited by 35 publications

(30 citation statements)

References 24 publications

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“…However, the optimal cut-off in this study was 30.5 IU/L. Kang and coworkers reported a similar TSH cut-off point of 31 IU/L for distinguishing TCH and PCH ( 17 ). Other studies suggested initial TSH cut-off values of 28.4 IU/L and 34 IU/L ( 14 , 18 ).…”

Section: Discussionmentioning

confidence: 52%

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Diagnostic re-evaluation of congenital hypothyroidism in Macedonia: predictors for transient or permanent hypothyroidism

Zdraveska¹,

Zdravkovska

Anastasovska³

et al. 2018

Endocrine Connections

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BackgroundDiagnostic re-evaluation is important for all patients with congenital hypothyroidism (CH) for determining the etiology and identifying transient CH cases. Our study is a first thyroxine therapy withdrawal study conducted in Macedonian CH patients for a diagnostic re-evaluation. We aimed to evaluate the etiology of CH, the prevalence of transient CH and identify predictive factors for distinguishing between permanent (PCH) and transient CH (TCH).Materials and methodsPatients with CH aged >3 years underwent a trial of treatment withdrawal for 4 weeks period. Thyroid function testing (TFT), ultrasound and Technetium-99m pertechnetate thyroid scan were performed thereafter. TCH was defined when TFT remained within normal limits for at least 6-month follow-up. PCH was diagnosed when TFT was abnormal and classified according the imaging findings.Results42 (55%) patients had PCH and 34 (45.0%) patients had TCH. Thyroid agenesia was the most prevalent form in the PCH group. Patients with TCH had lower initial thyroid-stimulating hormone (TSH) values (P < 0.0001); higher serum thyroxine levels (P = 0.0023) and lower mean doses of levothyroxine during treatment period (P < 0.0001) than patients with PCH. Initial TSH level <30.5 IU/mL and levothyroxine dose at 3 years of age <2.6 mg/kg/day were a significant predictive factors for TCH; sensitivity 92% and 100%, specificity 75.6% and 76%, respectively.ConclusionTCH presents a significant portion of patients with CH. Initial TSH value and levothyroxine dose during treatment period has a predictive role in differentiating TCH from PCH. Earlier re-evaluation, between 2 and 3 years age might be considered in some patients requiring low doses of levothyroxine.

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Section: Discussionmentioning

confidence: 52%

“…Patients with TCH exhibited significantly lower TSH and higher T 4 levels at the time of diagnosis compared to those with PCH. Some previous studies in the literature reported that the initial T 4 did not differentiate between TCH and PCH cases ( 13 , 17 , 22 ).…”

Section: Discussionmentioning

confidence: 85%

Diagnostic re-evaluation of congenital hypothyroidism in Macedonia: predictors for transient or permanent hypothyroidism

Zdraveska¹,

Zdravkovska

Anastasovska³

et al. 2018

Endocrine Connections

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“…In Korea, a total of 13 laboratories perform the NBS TSH, and the cutoff levels of TSH vary from 10.0 to 22.5 mIU/mL according to each laboratory protocol (8). Another recent study from Korea showed that nearly 80% of preterm infants with CH treated for 3 years with thyroxine were later diagnosed with transient hypothyroidism (9 (11).…”

Section: Epidemiologymentioning

confidence: 99%

Transient hypothyroidism in the newborn: to treat or not to treat

Kanike¹,

Davis²,

Shekhawat³

2017

Transl. Pediatr

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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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Three-year follow-up of children with abnormal newborn screening results for congenital hypothyroidism

Cited by 35 publications

References 24 publications

Diagnostic re-evaluation of congenital hypothyroidism in Macedonia: predictors for transient or permanent hypothyroidism

Diagnostic re-evaluation of congenital hypothyroidism in Macedonia: predictors for transient or permanent hypothyroidism

Transient hypothyroidism in the newborn: to treat or not to treat

Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study

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