Hyperthyrotropinemia is common in preterm infants who are born small for gestational age

Background To determine the incidence of congenital hypothyroidism (CH) with a delayed increase in thyroid-stimulating hormone (TSH) levels in preterm infants and to describe the associated factors. Methods A prospective newborn screening (NBS) was conducted in 122 very low birth weight (VLBW) premature neonates born between June 2016 and September 2017. A dried blood spot thyroid stimulating hormone (TSH) level ≥15 mIU/L at 7 and 15 days of life, ≥10 in serum at the second screen or ≥5 at the third screen was defined as positive for CH. A concomitant increase in the TSH level and normal free thyroxine (T4) level was classified as hyperthyrotropinemia (HT). Results Before the first month of life, no cases of CH were identified. However, the second and third NBS identified 10 and six subjects with HT, respectively, but no cases of CH. The overall cumulative incidence of HT was 1:8. Small for gestational age (SGA) was a variable that was significantly associated with HT, even after the exclusion of patients with Down syndrome. Conclusions A high incidence of HT, but not CH, was found after the first month of life in preterm infants. Being SGA was strongly associated with having higher TSH. The need for repeating TSH screening after the first month of life in this population remains to be established.