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Persistent hyperthyrotropinaemia since the neonatal period in clinically euthyroid children
L A Tyfield1, S S Abusrewil, S R Jones
1Neonatal Screening Laboratory, Southmead Hospital, Bristol, UK.
Insights
Mild hyperthyrotropinemia in children, identified through neonatal screening, indicates compensated hypothyroidism. These children show normal growth and development without thyroid hormone replacement therapy.
Area of Science:
- Pediatric Endocrinology
- Neonatal Screening
- Thyroid Function Testing
Background:
- Persistent mild elevation of thyroid stimulating hormone (TSH) since the neonatal period can occur.
- Normal thyroid hormone levels (thyroxine and triiodothyronine) are crucial for development.
- Distinguishing true thyroid dysfunction from transient or artifactual elevations is essential.
Purpose of the Study:
- To describe the long-term outcomes of children with persistent mild hyperthyrotropinemia.
- To investigate the clinical significance of this condition in the absence of overt hypothyroidism.
- To assess the potential for compensated hypothyroidism in affected individuals.
Main Methods:
- Longitudinal follow-up of three children identified with persistent mild hyperthyrotropinemia.
- Regular monitoring of thyroid stimulating hormone and thyroid hormone levels.
- Assessment of growth parameters and neurodevelopmental milestones.
Main Results:
- Three children aged 5-6 years maintained elevated TSH levels since birth with normal free thyroxine and triiodothyronine.
- No evidence of artifactual elevation or antibody interference was found.
- All children exhibited normal growth and psychomotor development without thyroid hormone treatment.
Conclusions:
- Persistent mild hyperthyrotropinemia in the neonatal period may represent a compensated hypothyroid state.
- These children may not require thyroid hormone replacement therapy if growth and development remain normal.
- Neonatal screening for congenital hypothyroidism is crucial for early identification and appropriate management, preventing potential later-onset juvenile hypothyroidism.
Abstract:
We describe three children, now aged between 5 and 6 years, with a persistent mild hyperthyrotropinaemia since the neonatal period and normal levels of thyroid hormones. The increased thyroid stimulating hormone concentration is not artefactual and is not caused by antibody interferences. Their growth and development is normal and none has received thyroid hormone replacement. We believe that they have compensated hypothyroidism, and that before the advent of screening for congenital hypothyroidism these children would have presented in mid-childhood with juvenile hypothyroidism.