Transient versus Permanent Congenital Hypothyroidism after the Age of 3 Years in Infants Detected on the First versus Second Newborn Screening Test in Oregon, USA

Ford, George; Denniston, Sara; Sesser, David E.; Skeels, Michael R.; LaFranchi, Stephen

doi:10.1159/000448658

Cited by 46 publications

(25 citation statements)

References 17 publications

(24 reference statements)

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“…Oregon NBS program follows a primary T4, reflex TSH method for which the first blood sample is collected in first week of life and a second sample is collected at approximately 2-4 weeks of life in all babies. In the infants diagnosed on the first test, 83% were permanent and 17% were transient, while in the infants diagnosed on the second test, 23% were permanent and 77% were transient (6).…”

Section: Epidemiologymentioning

confidence: 86%

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

Kanike¹,

Davis²,

Shekhawat³

2017

Transl. Pediatr

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Section: Epidemiologymentioning

confidence: 86%

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

Kanike¹,

Davis²,

Shekhawat³

2017

Transl. Pediatr

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“…Sepsis could also have caused the euthyroid sick syndrome when the level of thyrotropin decreased into normal range. 20 Ford et al 21 22,23 However, in our case, TPN, sepsis, and prematurity could have explained the high levels of bilirubin, which probably delayed the diagnosis of hypothyroidism.…”

Section: Discussionmentioning

confidence: 60%

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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“…This was attributed to the fact that the majority of patients were from rural areas and probably have some difficulties in accessing their results of screening as well as in admission to our tertiary pediatric endocrine centre. While in some studies, a female predominance has been reported, some others, showed a male predominance ( 8 , 9 , 10 , 11 , 12 , 13 , 14 ). In the present study, there was a slight female predominance.…”

Section: Discussionmentioning

confidence: 92%

Validity of Six Month L-Thyroxine Dose for Differentiation of Transient or Permanent Congenital Hypothyroidism

Asena¹,

Demiral²,

Ünal³

et al. 2020

Jcrpe

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Objective: The tendency to reduce thyroid stimulating hormone (TSH) referral cut-off values in congenital hypothyroidism (CH) neonatal screening programs has resulted in an increase in the incidence of CH, but also the referral of infants with mild transient elevation of TSH. Therefore, there is a need to develop markers for differentiation of transient elevated TSH and permanent CH as early as safely possible to avoid unnecessary treatment. The aim was to evaluate sixth-month L-thyroxine (LT4) dose as a predictive marker for differentiation of transient elevated TSH and permanent CH. Methods: Data of patients who had been followed after referral from the neonatal screening programme between the year 2010 and 2019 in a tertiary pediatric endocrine centre were examined retrospectively. Results: There were 226 cases referred, of whom 186 (82.3%) had eutopic thyroid gland, and 40 (17.7%) had dysgenetic gland. In patients with a dysgentic gland there was a non-significant tendency to have lower diagnostic free thyroxine concentration but significantly higher TSH compared with those with eutopic gland (p=0.44 and p=0.023, respectively). Patients with thyroid dysgenesis required higher initial and six month LT4 doses compared with those with eutopic glands (p=0.001). Receiver operator curve analysis showed the optimum cut-off value for LT4 at six months for transient vs. permanent CH was 2 μg/kg/day (sensitivity 77% and specificity 55%), regardless of etiology. Similarly, in patients with eutopic glands the optimum cut-off value for LT4 dose at six months for permanent vs. transient patients was 2 μg/kg/day (sensitivity 72% and specificity 54%). Conclusion: Results suggest that LT4 requirement at six months of therapy may be a good marker for predicting transient TSH elevation in patients with eutopic thyroid gland, thus facilitating the decision to halt LT4 therapy.

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Transient versus Permanent Congenital Hypothyroidism after the Age of 3 Years in Infants Detected on the First versus Second Newborn Screening Test in Oregon, USA

Cited by 46 publications

References 17 publications

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

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

Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study

Validity of Six Month L-Thyroxine Dose for Differentiation of Transient or Permanent Congenital Hypothyroidism

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