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Screening and management of thyroid dysfunction in preterm infants
1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
Insights
Preterm infants often experience thyroid dysfunction due to immature development and illness. Recent guidelines suggest rescreening all preterm neonates for congenital hypothyroidism, with treatment for persistent issues.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Pediatrics
Background:
- Preterm infants exhibit higher rates of thyroid dysfunction compared to term infants, linked to developmental immaturity of the hypothalamic-pituitary-thyroid axis.
- Thyroid dysfunction in preterm neonates is influenced by postnatal illness, medications, and iodine levels, with increasing incidence due to improved survival rates.
- Hypothyroxinemia is common in extreme preterm neonates, and delayed thyrotropin elevation occurs frequently between 2-6 weeks of age.
Purpose of the Study:
- To summarize current understanding and management of thyroid dysfunction in preterm infants.
- To highlight the increasing incidence and specific patterns of thyroid dysfunction in this population.
- To address the controversy and recommendations regarding routine rescreening for congenital hypothyroidism in preterm neonates.
Main Methods:
- Review of current literature and guidelines on neonatal thyroid screening and dysfunction.
- Analysis of incidence rates and clinical presentations of thyroid dysfunction in preterm infants.
- Evaluation of diagnostic criteria and treatment recommendations for hypothyroxinemia and thyrotropin elevation.
Main Results:
- Thyroid dysfunction is prevalent in preterm infants, with specific patterns like early hypothyroxinemia and later thyrotropin elevation.
- Recent guidelines advocate for rescreening all preterm neonates for congenital hypothyroidism.
- Thyroid hormone replacement is indicated for persistent thyrotropin elevation, but not for isolated hypothyroxinemia without elevated thyrotropin.
Conclusions:
- Most thyroid dysfunctions in preterm infants are transient, necessitating careful follow-up after treatment cessation.
- Management strategies focus on identifying persistent hypothyroidism while avoiding unnecessary levothyroxine supplementation.
- Rescreening preterm neonates is crucial for timely diagnosis and management of congenital hypothyroidism.
Abstract:
Preterm infants can suffer various thyroid dysfunctions associated with developmental immaturity of the hypothalamic-pituitary-thyroid axis, postnatal illness, medications, or iodine supply. The incidence of thyroid dysfunction among preterm infants is higher than that among term infants and has been increasing with improvement in the survival of preterm infants. Hypothyroxinemia is frequently observed during the first week of life in extreme preterm neonates, and the incidence of delayed thyrotropin elevation is high at the age of 2-6 weeks. Although the necessity of routine rescreening remains controversial, recent guidelines on screening for congenital hypothyroidism have recommended rescreening of all preterm neonates. Thyroid hormone replacement is recommended for persistent thyrotropin elevation with or without hypothyroxinemia. Hypothyroxinemia without thyrotropin elevation does not require treatment, and some potential risks of levothyroxine supplementation have been reported. Although most thyroid dysfunctions are transient, careful follow-up after discontinuation of levothyroxine is considered so as to avoid missing persistent hypothyroidism.
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