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Published on: July 18, 2014
Clinical course of infants with congenital heart disease who developed thyroid dysfunction within 100 days
Hye Jin Lee1, Hyeoh Won Yu2, Gi Beom Kim2
1Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
Insights
Thyroid dysfunction is common in infants with congenital heart disease (CHD), affecting two-thirds of those screened. Transient dysfunction was more frequent, highlighting the need for revised thyroid function test (TFT) screening criteria in these vulnerable infants.
Area of Science:
- Pediatric Endocrinology
- Neonatal Cardiology
- Thyroidology
Background:
- Congenital heart disease (CHD) presents unique challenges for neonatal care.
- Thyroid dysfunction can complicate the clinical course of infants with CHD.
- Neonatal screening tests (NSTs) may not detect all thyroid abnormalities in CHD infants.
Purpose of the Study:
- To investigate the incidence and clinical course of thyroid dysfunction in infants with CHD within 100 days of birth.
- To identify potential risk factors associated with thyroid dysfunction in this population.
- To evaluate the effectiveness of current screening protocols.
Main Methods:
- Retrospective review of 54 infants with CHD who underwent thyroid function tests (TFTs).
- Data collection included birth history, CHD diagnosis, genetic abnormalities, medications, surgeries, and exposure to iodine contrast media (ICM).
- Analysis of neonatal screening tests (NSTs) and TFT results.
Main Results:
- Thyroid dysfunction was observed in 36 out of 54 (66.7%) infants, with 53.7% transient and 13.0% permanent.
- Infants with transient dysfunction had lower birth weight and higher exposure to thyroid-disrupting medications/ICM, though not statistically significant.
- Eight patients exposed to ICM showed thyroid dysfunction, with five recovering from transient forms.
Conclusions:
- Thyroid dysfunction is prevalent in CHD infants, often occurring despite normal NSTs.
- Risk factors like ICM exposure and medication require further investigation.
- Larger studies are needed to refine TFT screening guidelines for CHD infants.
Purpose:
We investigated the clinical course of infants with congenital heart disease (CHD) who experienced thyroid dysfunction within 100 days of birth.
Methods:
We performed retrospective medical reviews of 54 CHD patients (24 male patients) who underwent a thyroid function test (TFT) between January 2007 and July 2016. Data were collected on birth history, diagnosis of CHD, underlying chromosomal or genetic abnormalities, medication history, surgery, ventilator care, and exposure to iodine contrast media (ICM). Results of neonatal screening tests (NSTs) and TFTs were reviewed.
Results:
A total of 36 patients (29 transient, 7 permanent) showed thyroid dysfunction. Among the seven patients with permanent hypothyroidism, three had an underlying syndrome, three showed abnormal NST results, and one was admitted to the intensive care unit for macroglossia and feeding cyanosis. We found that infants with transient thyroid dysfunction had a lower birth weight and were more commonly exposed to thyroid disrupting medication and/or ICM. However, these risk factors were not significant. A total of 8 patients with a history of ICM exposure showed thyroid dysfunction. Excluding 3 patients with elevated thyroid stimulating hormone before ICM exposure, 5 patients recovered from transient thyroid dysfunction.
Conclusions:
We observed thyroid dysfunction in two-thirds of CHD infants (53.7% transient, 13.0% permanent) who had risk factors and received TFT screening within 100 days, despite normal NSTs. Further studies with larger sample sizes are required to revise the criteria for TFT screening in CHD infants.
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