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Cognitive function and neurophysiological evaluation in early-treated hypothyroid children
G Weber1, S Mora, L M Prina Cerai
1Department of Pediatrics Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, Via Olgettina 60, I-20132 Milan, Italy.
Insights
Congenital hypothyroidism (CH) can impact cognitive function and brain development. Despite early treatment, some CH children show neurophysiological damage, highlighting the importance of treatment timing and severity for long-term outcomes.
Area of Science:
- Pediatric Endocrinology
- Neurodevelopmental Pediatrics
- Clinical Neurophysiology
Background:
- Congenital hypothyroidism (CH) is a condition present from birth that can affect cognitive and neurophysiological development.
- Early detection through neonatal screening and prompt treatment are crucial for mitigating the effects of CH.
- The long-term impact of CH severity and treatment timing on neurodevelopment requires further investigation.
Purpose of the Study:
- To assess cognitive function and neurophysiological development in children with congenital hypothyroidism.
- To investigate the influence of treatment timing and severity of fetal hypothyroidism on neurodevelopmental outcomes.
- To identify potential central nervous system damage in CH patients despite early intervention.
Main Methods:
- A cross-sectional study was conducted involving 25 children with CH (ages 6.00-10.83) and 34 healthy controls (ages 4-11).
- Cognitive function was evaluated using neuropsychological tests (WISC-R).
- Neurophysiological development was assessed using auditory P300 and long-latency somatosensory evoked potential (LLSEP) tests.
Main Results:
- CH patients and controls showed comparable scores on WISC-R and auditory P300 tests.
- Significantly longer LLSEP latencies were observed in CH patients compared to controls (p < 0.03).
- CH patients treated later (>30 days after birth) had lower neuropsychological scores. More severe fetal hypothyroidism correlated with lower neuropsychological scores.
Conclusions:
- The severity of fetal hypothyroidism and the timing of thyroid hormone replacement therapy significantly influence the cognitive outcomes of CH children.
- Neurophysiological assessments reveal that central nervous system damage can occur in some CH patients even with early treatment.
- Long-latency somatosensory evoked potentials may serve as a sensitive indicator of neurophysiological alterations in CH.
Abstract:
In this study, we assessed cognitive function and neurophysiological development in congenitally hypothyroid (CH) children. We performed a cross-sectional study at the outpatient Pediatric Clinic and Department of Neurophysiology at San Raffaele Hospital, Milan. The study enrolled 25 CH patients (6.00-10.83 years of age) detected by neonatal screening, and 34 healthy control children (4-11 years of age). Patients and controls had comparable scores at neuropsychological tests (WISC-R), and at auditory P300 tests. In contrast, we found significantly longer LLSEP latencies in CH patients (p < 0.03). CH patients treated 30 days after birth showed lower scores at neuropsychological tests, but not at neurophysiological tests, compared to patients who started the replacement therapy earlier. Patients with more severe fetal hypothyroidism (T4 levels at diagnosis < or = 2 micrograms/dl) had lower neuropsychological scores, and similar neurophysiological results, compared with patients with moderate fetal hypothyroidism. The severity of fetal hypothyroidism and early treatment influence the mental outcome of CH patients. Neurophysiological results show that central nervous system damage occurs in some patients despite early treatment.
