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

Kanike, Neelakanta; Davis, Ajuah; Shekhawat, Prem

doi:10.21037/tp.2017.09.07

Cited by 50 publications

(50 citation statements)

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“…Although the history of maternal thyroid disease is generally considered a risk factor for CH ( 35 – 37 ), few studies have actually examined its effect on neonatal TSH. Some authors ( 15 , 16 , 25 ) did not observe a relationship between history of maternal thyroid dysfunction and/or thyroid nodules, and neonatal TSH, either in univariate models or after adjusting for gestational age.…”

Section: Discussionmentioning

confidence: 99%

A Detailed Analysis of the Factors Influencing Neonatal TSH: Results From a 6-Year Congenital Hypothyroidism Screening Program

et al. 2020

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Background: Neonatal thyrotropin (TSH) on dried blood spot (DBS), the most common screening strategy for primary congenital hypothyroidism (CH), is influenced by numerous factors that may hinder a true CH diagnosis. A second test can thus be performed to clarify the initial findings, although its application varies among screening programs. Objectives: The aim of this study was to evaluate the effect of maternal and neonatal factors on neonatal TSH levels and offer practical screening recommendations. Methods: We retrospectively analyzed screening data of 62,132 neonates born in Abruzzo, an Italian region considered mildly iodine deficient, between 2011 and 2016. We then performed a multiple linear regression to model the relationship between TSH (the dependent variable) and 13 independent variables extracted from blood collection cards. Results: Most neonates (53,551 of 62,132, 86%) had normal TSH and no clinical indications for a second screening. A minority (1,423, 2.3%) had elevated TSH in the initial DBS, which was confirmed in 97 cases (7%) on a second screen. The remaining neonates (6,594, 10.6%) had a normal initial TSH but underwent a second test in accordance with screening protocols, and were found to have delayed TSH elevation in 23 cases (0.4%). Those 120 newborns (97 + 23), considered highly suspicious for primary CH, were referred to a pediatrician for confirmatory testing and excluded from subsequent analysis of factors influencing TSH levels. Sex (β regression coefficient, β = 1.11 female to male, 95% CI 1.09, 1.12) and age at collection (β = 0.78 day 5 to days 2-3, 95% CI 0.74, 0.83) affected neonatal TSH, suggesting the utility of specific nomograms. In addition, prematurity (β = 0.85 term to preterm, 95% CI 0.80, 0.91), dopamine use (β = 0.71, 95% CI 0.62, 0.81), and birth weight (β = 1.40 normal vs. very low, 95% CI 1.05, 1.89) strongly influenced neonatal TSH. Conclusions: Neonatal TSH is influenced by several factors supporting the delineation of local sex-and age-adjusted TSH cutoffs, and the universal adoption of a second TSH test in neonates at risk of missed primary CH diagnosis.

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Section: Discussionmentioning

confidence: 99%

A Detailed Analysis of the Factors Influencing Neonatal TSH: Results From a 6-Year Congenital Hypothyroidism Screening Program

et al. 2020

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“…During the study, 224 [118 female (52.7%); female to male = 1.11) subjects with confirmed permanent primary CH were enrolled. Seasonal distributions were as permanent CH subject [7]. According to most CH screening plans [8], a heal prick whole blood thyrotropin (TSH) measurement and, if needed, a confirmatory serum test for thyroxine (T4) and TSH are tests required for the diagnosis and the appropriate management of all neonates [1].…”

Section: Resultsmentioning

confidence: 99%

Thyroid scintigraphy in three-year-old children with congenital hypothyroidism in correlation with neonatal TSH

Aminzadeh

2019

Endokrynologia Polska

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Introduction:A large number of congenital hypothyroidism (CH) cases in Iran are transient. This study was designed to investigate the aetiology of permanent CH (PCH) by thyroid scintigraphy (TS) and its relationship with the first diagnostic thyrotropin (TSH). Material and methods: During 12 years (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) of CH screening in southwest Iran, all infants referred with the diagnosis of CH were followed until their third birthday, when they were re-evaluated for serum T4, TSH after discontinuing the treatment for 3-4 weeks. If the last test indicated a PCH state (TSH >10 mU/L with any levels of T4), TS was performed, and, based on the results, the patients were categorised as agenesis, dysgenesis (sublingual, thyroglossal cyst), and normal/diffuse goitre (indicating dyshormonogenesis). Results: After excluding all transient CH subjects, 224 permanent CH cases were enrolled (52.7% female). Seasonal distributions were as follows: spring: 25.7%, summer: 27.9%, autumn: 20.3%, and winter: 26.1%. No significant differences were found between females and males and the different modes of delivery (55.4% were delivered by caesarean section) regarding T4, TSH (p > 0.05). Of a total of 213 performed scans, 20.7% had agenesis, 36.2% had dysgenesis, and 43.2% were normal or goitrous. Those with agenesis/dysgenetic thyroid had a lower T4 and a higher TSH than those with normal scans. However, the differences were not significant. Compared to those who had TSH < 40 mU/L, patients with TSH ≥ 40mU/L had 46% (95% CI; 1.06-2.02) more risk of agenesis or dysgenesis in TS. Conclusions: More than 40% of PCH are caused by dyshormonogenesis in Iran. Having a TSH ≥ 40 mU/L after the first week of life significantly raises the probability of thyroid agenesis/dysgenesis as the cause. (Endokrynol Pol 2019; 70 (1): 43-48) StreszczenieWstęp. W populacji irańskiej wrodzona niedoczynność tarczycy (CH) ma w wielu przypadkach charakter przemijający. Przedstawione badanie przeprowadzono w celu oceny etiologii trwałej CH (PCH) na podstawie scyntygrafii tarczycy oraz zależności między wynikami tego badania a stężeniem tyreotropiny (TSH) w pierwszym badaniu diagnostycznym. Materiał i metody. W okresie 12 lat (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), w którym prowadzono przesiewowe badania pod kątem CH w południowo-wschodnim Iranie, wszystkie dzieci skierowane do ośrodka autorów obserwowano do ukończenia 3. roku życia, kiedy przeprowadzano ponowną ocenę stężenia w surowicy T4 i TSH po zaprzestaniu leczenia na 3-4 tygodnie. Jeśli ostatnie badanie sugerowało PCH (TSH >10 mj./l, niezależnie od stężenia T4), wykonywano scyntygrafię tarczycy i w zależności od wyniku przydzielano chorych do jednej z następujących kategorii: agenezja, dysgenezja (tarczyca podjęzykowa, torbiel przewodu tarczowo-językowego), tarczyca prawidłowa/wole guzkowe (wskazujące na dyshormonogenzę). Wyniki. Po wykluczeniu z badania wszystkich dzieci z przemijającą CH do analizy włączo...

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“…The first two weeks of life are critical [12]. It is estimated that children whose levothyroxine supplementation was included between 12 and 30 days of age have an IQ ratio approximately 15.7 higher compared to children whose treatment was included after 30 days of age [13]. However, according to data, subclinical hypothyroidism, which is a consequence of the amiodarone therapy, rarely leads to abnormal development of the nervous system.…”

Section: Discussionmentioning

confidence: 99%

Amiodarone-induced thyroid dysfunction in the developmental period: prenatally, in childhood, and adolescence — case reports and a review of the literature

Furtak

Wędrychowicz

Kalicka-Kasperczyk

et al. 2019

Endokrynologia Polska

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Introduction:Amiodarone is an important antiarrhythmic drug used in paediatric practice, mainly in children with complex congenital cardiac diseases and/or severe arrhythmias. One of the side effects of amiodarone therapy is thyroid dysfunction, which is observed in about 20% of patients. The thyroid dysfunction may present with various forms: from subclinical changes in hormone levels to amiodaroneinduced thyrotoxicosis (AIT) and amiodarone-induced hypothyroidism (AIH). Material and methods:We reported six patients in the age range from two weeks to 14 years, with complex congenital cardiac diseases and severe arrhythmias, who developed amiodarone-induced thyroid dysfunctions: thyrotoxicosis or hypothyroidism or both together. The clinical signs and symptoms of all thyroid dysfunctions were atypical, most patients presented with an aggravation of heart insufficiency. Our patients with thyrotoxicosis were treated with combined therapy including thionamides and corticosteroids due to the presentation of mixed-identified type of AIT. Results: Currently, five patients (one patient's status is unknown) are in biochemical and clinical euthyreosis; however, in one of them it was impossible to discharge amiodarone treatment. Three of them are still treated with levothyroxine, and two do not need thyroid treatment. Conclusions: Amiodarone-induced thyroid dysfunction is usually atypical; therefore, monitoring of thyroid status before, during, and after amiodarone is demanded. AIH could significantly influence the development of the child, while AIT could significantly deteriorate the clinical status of children with complex cardiac diseases. Early and proper diagnose of AIT and AIH allows the introduction of immediate and appropriate treatment considering the cardiac condition of the young patient. (Endokrynol Pol 2019; 70 (5): 392-400)

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

Cited by 50 publications

References 61 publications

A Detailed Analysis of the Factors Influencing Neonatal TSH: Results From a 6-Year Congenital Hypothyroidism Screening Program

A Detailed Analysis of the Factors Influencing Neonatal TSH: Results From a 6-Year Congenital Hypothyroidism Screening Program

Thyroid scintigraphy in three-year-old children with congenital hypothyroidism in correlation with neonatal TSH

Amiodarone-induced thyroid dysfunction in the developmental period: prenatally, in childhood, and adolescence — case reports and a review of the literature

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