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Treatment for congenital hypothyroidism: thyroxine alone or thyroxine plus triiodothyronine?
Alessandra Cassio1, Emanuele Cacciari, Alessandro Cicognani
1Department of Pediatrics, University of Bologna, Bologna, Italy.
Insights
Combined therapy with thyroxine (T4) and triiodothyronine (T3) showed no significant advantages over T4 alone for congenital hypothyroid (CH) infants. Early treatment with T4 alone maintained optimal free T4 levels without adverse effects.
Area of Science:
- Pediatric Endocrinology
- Neonatal Screening
- Thyroid Hormone Replacement Therapy
Background:
- Congenital hypothyroid (CH) infants require timely thyroid hormone replacement.
- The optimal hormone regimen, T4 alone versus T4 plus T3, is debated.
- Early diagnosis through neonatal screening is crucial for preventing developmental issues.
Purpose of the Study:
- To compare the efficacy of thyroxine (T4) plus triiodothyronine (T3) versus T4 alone in infants with congenital hypothyroidism.
- To evaluate thyroid hormone levels, cardiac function, and neurodevelopmental outcomes.
Main Methods:
- 14 screened CH infants were randomized into two groups: T4 alone or T4 plus T3.
- Thyroid hormone levels (TSH, free T4) and electrocardiograms were monitored over 12 months.
- Psychological assessments were conducted at 6 and 12 months.
Main Results:
- T4 alone normalized TSH levels faster than T4 plus T3 in the initial 15 days.
- Free T4 levels were higher in the T4 alone group, remaining in the upper normal range.
- No cardiac abnormalities were observed; psychometric scores were similar between groups but lower than controls.
Conclusions:
- Combined T4 plus T3 therapy offers no clear advantage over T4 alone in early-treated CH infants.
- T4 alone appears sufficient for maintaining adequate thyroid hormone status.
- Longer-term, extensive follow-up studies are necessary to confirm these findings.
Objective:
To compare the effects of therapy with thyroxine (T4) plus triiodothyronine (T3) versus T4 alone from the first days of life in screened congenital hypothyroid (CH) infants.
Methods:
We examined 14 CH infants diagnosed by neonatal screening and a group of control infants. CH patients were divided randomly into 2 groups, 1 treated with T4 alone (group 1) and the other treated with T4 plus T3 (liothyronine; group 2). In all patients electrocardiography and thyroid hormone evaluations were performed before and 15 and 30 days and 3, 6, and 12 months after the beginning of therapy. Psychological tests were also performed at 6 and 12 months of age in CH patients and in other matched controls.
Results:
After 15 days of treatment, serum thyrotropin (TSH) levels become normal in 5 of 7 cases of group 1 (median TSH level 10.7 micro U/ml) and in 1 of 7 cases of group 2 (median TSH level 72.5 micro U/ml). At the same period, serum-free thyroid hormone levels were within the normal range in both groups, but free T4 values were significantly higher in group 1 than in group 2 and in controls. At the subsequent examinations, free T4 values were within the upper normal limit in group 1, whereas they remained within the normal range in group 2. No clinical or electrocardiographic signs of heart disease were found in any of the patients. The psychometric quotient in CH infants was significantly lower than in controls, but similar in patients of group 1 and group 2.
Conclusions:
The combined treatment with T4 plus T3 seems not to show significant advantages, at least in our experimental conditions, compared with the traditional treatment with T4 alone in early treated CH infants. A further longer and more extensive follow-up is mandatory.