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Congenital hypothyroidism with delayed thyroid-stimulating hormone elevation in premature infants born at less than

D C Kaluarachchi1, T T Colaizy1, L M Pesce2

  • 1Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|December 2, 2016
PubMed

Insights

Congenital hypothyroidism with delayed thyroid-stimulating hormone elevation is common in premature infants but often missed by newborn screening. Testing thyroid function at 30 days of life is recommended for these high-risk infants.

Area of Science:

  • Neonatology
  • Pediatric Endocrinology
  • Thyroid Disorders

Background:

  • Congenital hypothyroidism (CH) with delayed thyroid-stimulating hormone (TSH) elevation is a frequent endocrine issue in premature infants.
  • Standard newborn screening (NBS) protocols may fail to detect CH with delayed TSH elevation, potentially delaying diagnosis and treatment.

Purpose of the Study:

  • To determine the prevalence of CH with delayed TSH elevation in premature infants.
  • To identify risk factors associated with CH with delayed TSH elevation in this vulnerable population.

Main Methods:

  • Retrospective analysis of serum thyroid function screening (TFS) data from premature infants (<30 weeks gestation) admitted to a neonatal intensive care unit.
  • Serum TSH and free thyroxine levels were assessed on day of life 30.
  • Follow-up testing and pediatric endocrinology consultations were performed as per institutional guidelines.

Main Results:

  • Out of 286 infants, 26 (9.1%) were diagnosed with thyroid dysfunction, with 20 (6.9%) having CH with delayed TSH elevation.
  • NBS identified only three cases, highlighting its limitations for detecting this condition.
  • CH with delayed TSH elevation was significantly associated with multiple gestation, lower birth weight, higher gestational age, and lower 5-minute APGAR scores.

Conclusions:

  • Thyroid dysfunction, particularly CH with delayed TSH elevation, is prevalent in premature infants born before 30 weeks gestation.
  • NBS is insufficient for identifying the majority of these cases.
  • Measuring serum TSH and free T4 on day of life 30 is recommended for premature infants (<30 weeks gestation) to ensure timely diagnosis of CH with delayed TSH elevation.
Abstract

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