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Head circumference and linear growth during the first 3 years in treated congenital hypothyroidism in relation to
Sze May Ng1, Sze Choong Wong, Mohammed Didi
1Endocrinology Department, Royal Liverpool Children's Hospital Alder Hey, Liverpool, UK. ngszemay@yahoo.com
Insights
Congenital hypothyroidism (CH) affects head growth. Children with athyreosis had larger head circumference, influenced by initial thyroxine levels, impacting early development.
Area of Science:
- Pediatric Endocrinology
- Neonatal Health
- Growth and Development
Background:
- Congenital hypothyroidism (CH) is a condition requiring timely diagnosis and treatment.
- Understanding factors influencing growth in CH is crucial for long-term outcomes.
- Head circumference and linear growth are key indicators of development in infants.
Purpose of the Study:
- To assess head circumference and linear growth in children with CH during the first three years of life.
- To investigate the relationship between growth parameters, CH etiology, and initial thyroid function severity.
- To identify factors influencing head growth in infants with CH.
Main Methods:
- Studied 125 CH patients from diagnosis to 3 years of age.
- Categorized patients by CH etiology: athyreosis, ectopia, and dyshormonogenesis.
- Analyzed head circumference (OFC) SD, length SD, TSH, T4, and used regression analysis.
Main Results:
- Athyreosis group showed significantly larger head circumferences from 1-3 years compared to other groups.
- Initial plasma thyroxine (T4) levels at diagnosis were lower in athyreosis.
- Initial T4 was the only independent risk factor for head circumference SD at 3 years.
Conclusions:
- Athyreosis in CH is associated with larger head circumference in early childhood, independent of linear growth.
- Initial thyroxine levels at diagnosis are a critical independent factor for head growth in the first three years of life.
- Early biochemical severity impacts head development in congenital hypothyroidism.
Aims:
To determine the head circumference and linear growth in children with congenital hypothyroidism (CH) during the first 3 years of life in relation to the aetiology of CH and initial biochemical severity of thyroid function.
Methods:
We examined the head circumference and linear growth of 125 patients with CH from diagnosis up to 3 years of age. All infants had radionuclide scans prior to treatment. Patients were categorized into athyreosis, ectopia and dyshormonogenesis. Occipito-frontal circumference (OFC) SD, length SD, initial plasma TSH, initial plasma thyroxine (T4) and age of suppression of plasma TSH were compared between the groups. Multiple linear regression analysis was used to determine factors affecting OFC SD at 3 years of age.
Results:
There were 125 children in the study: athyreosis (n = 34), ectopia (n = 73) and dyshormonogenesis (n = 18). No difference was found in gestation, birth weight, age of starting L-T4 and initial dose of L-T4 in mcg/kg/day between groups. Confirmatory plasma total T4 at diagnosis was significantly lower for athyreosis when compared with ectopia and dyshormonogenesis. Median values for confirmatory TSH were significantly lower in dyshormonogenesis compared with the other two groups. At diagnosis, OFC were similar in all three groups. Children with athyreosis showed significantly larger OFCs compared with ectopia and dyshormonogenesis from 1 to 3 years. Length SD was within 1 SD of normal population standards at diagnosis and did not differ between the three groups throughout the 3 years. Spearman's correlation for OFC SD at 3 years of age showed a significant negative correlation with initial confirmatory plasma T4 (r = -0.35, P = 0.01). Multivariate analysis for OFC SD at 3 years of age showed confirmatory T4 as the only independent risk factor.
Conclusion:
Children with athyreosis showed significantly larger OFC from 1 to 3 years of age compared with ectopia and dyshormonogenesis, independent of linear growth. Our data shows that initial confirmatory T4 at diagnosis is an independent factor influencing head growth in the first 3 years of life.
