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Growth development in children with congenital hypothyroidism: the effect of screening and treatment variables-a
Zahra Heidari1, Awat Feizi2,3, Mahin Hashemipour4,5,6
1Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Early treatment and appropriate levothyroxine dosage are crucial for optimal growth in infants with congenital hypothyroidism. Timely intervention significantly impacts height, weight, and head circumference development.
Area of Science:
- Pediatrics
- Endocrinology
- Neonatal Health
Background:
- Congenital hypothyroidism (CH) is a condition requiring prompt diagnosis and treatment to prevent developmental issues.
- Neonatal screening programs are vital for early detection of CH.
- Longitudinal growth monitoring is essential for assessing treatment efficacy in CH patients.
Purpose of the Study:
- To investigate the impact of screening and early treatment factors on the growth status of neonates with congenital hypothyroidism.
- To identify key diagnostic and therapeutic variables influencing anthropometric development in CH patients.
- To determine the relationship between treatment initiation, dosage, and normalization of thyroid hormones with growth outcomes.
Main Methods:
- A longitudinal study followed 760 neonates diagnosed with CH via screening from 2002-2009 in Isfahan, Iran, up to 5 years.
- Anthropometric measurements (height, weight, head circumference) were recorded periodically.
- Quantile regression for longitudinal data analyzed the effects of serum hormone levels, age at treatment onset, initial dosage, and hormone normalization age on growth.
Main Results:
- Longitudinal growth in height and weight correlated significantly with age at treatment onset and initial therapeutic dosage (p < 0.01).
- Head circumference growth was associated with the initial therapeutic dosage (p < 0.05) and thyroid-stimulating hormone at diagnosis (p < 0.05).
- Age of thyroxine normalization significantly impacted weight, height, and head circumference across different quantiles (p < 0.05 to p < 0.001).
Conclusions:
- The initial therapeutic dosage, age at treatment onset, and age of thyroxine normalization are critical factors for anthropometric development in CH patients.
- Earlier treatment initiation and appropriate levothyroxine dosage may lead to more optimal growth outcomes.
- These findings underscore the importance of timely and effective management of congenital hypothyroidism for healthy development.
Abstract:
Investigating the screening and early treatment factors potentially affects the growth status of the patients with congenital hypothyroidism. In a longitudinal study, 760 (45 % girl) neonates born in 2002-2009 with congenital hypothyroidism diagnosed by neonatal screening in Isfahan-Iran were followed up to 5 years from the time of diagnosis (i.e., 3-4 records for the first year of age and 2-3 records after that). During follow-up, height, weight, and head circumferences of the patients were measured. Diagnostic and therapeutic factors included serum thyroxine and thyroid stimulating hormone concentration at diagnosis and after treatment initiation, the age at onset of treatment, the first therapeutic dosage, and age at first normalization of thyroxine and thyroid stimulating hormone. Quantile regression for longitudinal data was used for determining the effects of main factors on growth development. Longitudinal growth in height and weight was significantly correlated with the age at onset of treatment and the first therapeutic dosage (p < 0.01), while head circumference only with first therapeutic dosage (p < 0.05). Growth in weight and head circumference was affected by thyroid stimulating hormone at the time of diagnosis (p < 0.05). Also the age of thyroxine normalization had heterogeneous significant impact over the proposed quantiles on weight (p < 0.05), height (p < 0.01), and head circumference (p < 0.001). Among studied factors, the first therapeutic dosage, age at onset of treatment and age of thyroxine normalization seem to be more important for anthropometric development, suggesting that more optimal outcome might be achievable through earlier treatment and appropriate levothyroxine dosage.
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