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[Transient congenital hypothyroidism: physiopathology and clinica]
L Montanelli1, A Pinchera, F Santini
1Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, Università degli Studi, Pisa.
Insights
Iodine deficiency in pregnant women and newborns can cause transient neonatal hypothyroidism, impacting development. Iodine prophylaxis is crucial for preventing these disorders, especially where intake is inadequate.
Area of Science:
- Endocrinology
- Neonatal Health
- Public Health
Context:
- Fetus and newborns exhibit heightened sensitivity to iodine deficiency compared to adults.
- Iodine-deficient regions frequently report transient neonatal hypothyroidism, often linked to neonatal goiter and elevated thyroglobulin.
- Borderline elevated neonatal thyroid-stimulating hormone (TSH) levels are common in iodine-deficient areas, increasing screening recall rates.
Purpose:
- To highlight the heightened vulnerability of fetuses and newborns to iodine deficiency.
- To underscore the neurological and developmental consequences of iodine deficiency, ranging from minor deficits to endemic cretinism.
- To emphasize the effectiveness of iodine prophylaxis in preventing iodine deficiency disorders.
Summary:
- Transient neonatal hypothyroidism, associated with goiter and elevated thyroglobulin, is prevalent in iodine-deficient areas.
- Mild to moderate iodine deficiency can lead to subtle neurodevelopmental deficits in children due to maternal and neonatal effects.
- Endemic cretinism represents the severe, irreversible neurological damage from fetal and neonatal iodine deprivation.
Impact:
- Iodine prophylaxis is a highly effective intervention for preventing iodine deficiency disorders, including transient neonatal hypothyroidism.
- Inadequate iodine prophylaxis in Italy contributes to ongoing iodine deficiency, increasing the incidence of transient neonatal hypothyroidism and hyperthyrotropinemia.
- Addressing iodine deficiency is critical for optimal fetal and neonatal neurodevelopment and long-term cognitive health.
Abstract:
The fetus and the newborn are more sensitive than adults to a reduced environmental iodine supply, and in iodine-deficient areas, transient neonatal hypothyroidism is frequently observed. This transient thyroid failure may be associated with neonatal goiter and elevated serum thyroglobulin levels at birth. Borderline elevated neonatal serum TSH concentrations frequently occur in newborns in iodine deficient areas, and result in a higher recalling rate at the screening for congenital hypothyroidism. Minor defects in mental performances and neurological development are observed in children living in areas of mild to moderate iodine deficiency, and result from the concomitant effects of iodine deficiency in the mother during pregnancy and transient neonatal hypothyroidism. Endemic cretinism is the severe and irreversible neurological consequence of iodine deficiency during fetal and neonatal life. Iodine prophylaxis is highly effective in preventing the development of iodine deficiency disorders including transient neonatal hypothyroidism. Since iodine prophylaxis in Italy is inadequate, variable degrees of iodine deficiency are still present all-over the country, and are responsible of a higher incidence of transient neonatal hypothyroidism or hyperthyrotropinemia.