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Can One Predict Resolution of Neonatal Hyperthyrotropinemia?
Luisa Aguiar1, Jane Garb2, Edward Reiter1
1Department of Pediatrics, Baystate Health, Springfield, MA.
Insights
Male infants and those with higher maternal age, cesarean delivery, and retinopathy of prematurity are more likely to experience transient neonatal hyperthyrotropinemia, indicating potential links to perinatal stress.
Area of Science:
- Neonatal Endocrinology
- Pediatric Endocrinology
- Thyroid Disorders
Background:
- Neonatal hyperthyrotropinemia, characterized by elevated thyroid-stimulating hormone (TSH) levels, can be transient or permanent.
- Predicting the persistence of elevated TSH is crucial for appropriate management and follow-up of affected infants.
Purpose of the Study:
- To identify predictors distinguishing transient from permanent neonatal hyperthyrotropinemia.
- To investigate the hypothesis that greater perinatal stress is associated with transient TSH elevations.
Main Methods:
- Retrospective study of infants diagnosed with hyperthyrotropinemia between 2002 and 2014.
- Classification into three groups: never treated, transient congenital hypothyroidism, and permanent congenital hypothyroidism.
- Univariate and multiple logistic regression analyses were performed, with and without exclusion of infants with maternal thyroid disease.
Main Results:
- Of 76 infants, 46% had transient hyperthyrotropinemia. Male infants were nearly 5 times more likely to have transient elevations.
- Transient congenital hypothyroidism was associated with greater maternal age, higher rates of cesarean delivery, and retinopathy of prematurity.
Conclusions:
- Neonatal thyrotropin elevations are transient in a majority of cases.
- Maternal and perinatal risk factors may be associated with the development and persistence of neonatal hyperthyrotropinemia.
Objective:
To identify predictors of transience vs permanence of neonatal hyperthyrotropinemia. We hypothesized that infants with greater severity of perinatal stress are more likely to have transient thyrotropin elevations.
Study Design:
We retrospectively studied infants diagnosed with hyperthyrotropinemia between 2002 and 2014, following them for up to 12 years after diagnosis. Patients were divided into 3 groups: transient hyperthyrotropinemia (treatment was never prescribed), transient congenital hypothyroidism (treatment started but discontinued), and permanent congenital hypothyroidism (withdrawal unsuccessful or not attempted). We performed univariate and multiple logistic regression analyses, including and excluding infants with maternal thyroid disease.
Results:
We included 76 infants, gestational age mean (±SD) 34.2 (±5.7) weeks, evaluated for hyperthyrotropinemia. Thirty-five (46%) were never treated, and 41 (54%) received levothyroxine. Of the treated patients, 16 successfully discontinued levothyroxine, and for 25 withdrawal either failed or was not attempted. We found that male patients were almost 5 times more likely than female patients to have transient neonatal hyperthyrotropinemia (OR 4.85; 95% CI 1.53-15.37). We documented greater maternal age (31.5 ± 5.48 years vs 26 ± 6.76 years, mean ± SD, P = .02), greater rate of cesarean delivery (86.7% vs 54.2%; P = .036), and retinopathy of prematurity (37.5% vs 8%; P = .02) in the group with transient congenital hypothyroidism vs the group with permanent congenital hypothyroidism.
Conclusion:
The results show transience of neonatal thyrotropin elevations in a majority of patients and suggest a possible association of hyperthyrotropinemia with maternal and perinatal risk factors.
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