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Effect of age at thyroid stimulating hormone normalization on postural control in children with congenital
Gérome C Gauchard1, Dominique Deviterne, Bruno Leheup
1Balance Control and Motor Performance Laboratory, UFR STAPS, Université Henri Poincaré--Nancy 1, Villers-lès-Nancy, France.
Insights
Early treatment of congenital hypothyroidism is crucial. Delays in normalizing thyroid-stimulating hormone (TSH) beyond three months negatively impact children's postural control, educational, and psychomotor development.
Area of Science:
- Pediatrics
- Endocrinology
- Neuroscience
Background:
- Congenital hypothyroidism (CH) can affect central nervous system maturation.
- Neonatal screening enables early treatment to mitigate developmental consequences.
Purpose of the Study:
- To evaluate the impact of age at thyroid-stimulating hormone (TSH) normalization on neurodevelopmental outcomes in children with CH.
- To compare postural control, educational, and psychomotor performance between CH children with early versus late TSH normalization and controls.
Main Methods:
- A cohort of 17 children with CH and 11 controls underwent posturography (static and dynamic).
- Educational (school performance) and psychomotor (WISC, Bruininks-Oseretsky) assessments were conducted.
- CH patients were categorized into two groups based on TSH normalization before or after 3 months of age.
Main Results:
- Children with TSH normalization after 3 months (Group 2) exhibited significant deficits in stability, psychomotor function (Bruininks-Oseretsky), and school performance compared to Group 1 and controls.
- Statistical significance was observed at p < 0.05 or p < 0.01 for these impaired domains.
Conclusions:
- Early normalization of TSH (before 3 months) is essential for normal neurodevelopmental outcomes in children with CH.
- Delayed TSH normalization adversely affects the development of neurosensorial pathways and central integration, impacting motor control and cognitive function.
Abstract:
Neonatal screening programmes allow early treatment to limit the consequences of congenital hypothyroidism on maturation of the central nervous system, and on psychomotor and educational outcome. Consequences of age at thyroid stimulating hormone (TSH) normalization on postural control were evaluated in 17 children with congenital hypothyroidism (14 females, three males; median age 12 years 1 month, range 7 to 14 years) and in 11 control individuals (eight females, three males: median age 10 years 6 months, range 8 to 14 years). Children with congenital hypothyroidism were split into two groups according to time of TSH normalization: before (group 1) or after (group 2) 3 months of age. Posturography (static and dynamic tests), educational (school performance), and psychomotor (WISC and revised Bruininks Oseretsky tests) evaluations were carried out. Group 2 results showed significant abnormalities in postural, educational, and psychomotor aptitudes in comparison with group 1 and control children (stability, Bruininks-Oseretsky, school performance: p < or = 0.05 or p < or = 0.01). Early TSH normalization is necessary to allow for normal development of the neurosensorial afferent pathways (vestibular, proprioceptive) and of central integration (cerebellum, vestibular nuclei).
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