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Evolution of congenital hypothyroidism in a cohort of preterm born children
Maria Scavone1, Laura Giancotti1, Elisa Anastasio1
1Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Insights
Congenital hypothyroidism (CH) in preterm infants is unpredictable. Gestational age, birth weight, and thyroid stimulating hormone levels can help predict if CH will be transient or permanent.
Area of Science:
- Neonatology
- Endocrinology
- Pediatric Endocrinology
Background:
- Congenital hypothyroidism (CH) is more prevalent in preterm infants, particularly those who are critically ill.
- The progression of CH to transient or permanent forms in neonates is often unpredictable.
- Thyroidal alterations are common in preterm infants, necessitating careful monitoring.
Purpose of the Study:
- To investigate predictive factors for the evolution of congenital hypothyroidism in preterm infants.
- To differentiate between permanent and transient CH in preterm neonates.
- To identify clinical and biochemical markers for early detection of transient CH forms.
Main Methods:
- Retrospective analysis of 28 preterm infants with positive CH screening.
- Classification of infants into groups: permanent CH with thyroid dysgenesis, permanent CH with eutopic gland, and transient CH with eutopic gland.
- Comparison of clinical and biochemical characteristics, including thyroid stimulating hormone (TSH) levels and levothyroxine (L-T4) dosage, between groups.
Main Results:
- 21.4% of infants had thyroid dysgenesis; 78.6% had eutopic glands.
- Infants with thyroid dysgenesis showed higher baseline TSH and L-T4 doses.
- Among infants with eutopic glands, 36% had permanent CH and 64% had transient CH.
- Gestational age, birth weight, TSH levels, and age at treatment initiation differed significantly between groups.
Conclusions:
- Gestational age, birth weight, and newborn screening TSH levels are key indicators for CH evolution.
- Baseline TSH, levothyroxine dosage, and age at treatment initiation may predict transient CH.
- These factors can aid in the early identification of transient congenital hypothyroidism in preterm infants.
Background:
Congenital hypothyroidism (CH) is reported to be more common in preterm infants than in term infants, especially in sick preterm infants. Though a frequent possibility of transitory thyroidal alterations in this category of neonates, the evolution of CH to transient or permanent forms is unpredictable.
Methods:
We retrospectively analyzed medical records of 28 preterm infants (<37 weeks gestation) who had exhibited a positive screening for CH at birth during the period 2000-2015 followed in our Center. Children were divided into three groups: permanent CH (PCH) with thyroid dysgenesis, PCH with eutopic normal-sized thyroid gland, and transient CH (TCH) with eutopic normal-sized thyroid gland. In all groups we described clinical and biochemical characteristics. Secondly, we analyzed the differences between patients with thyroid dysgenesis and patients with eutopic normal-sized gland and we compared PCH and TCH groups with normal-sized thyroid gland in order to identify clinical or biochemical data for early detection of transient forms.
Results:
Of all patients, 21.4% showed thyroid dysgenesis while 78.6% presented eutopic normal-sized gland. Infants with thyroid dysgenesis had higher median (IQR) baseline s-TSH and levothyroxine (L-T4) dose per weight at 12 months (12 m-dose) than patients with eutopic normal-sized gland. At re-evaluation of the patients with eutopic normal-sized gland, 36% showed PCH and 64% had TCH. The age of the patients at the beginning of L-T4 treatment, gestational age (GA), birth weight, blood thyroid stimulating hormone levels (b-TSH) at first newborn screening (NBS), baseline serum thyroid stimulating hormone (s-TSH), and L-T4 12 m-dose were statistically different between the two groups.
Conclusions:
Our results demonstrate that factors as GA, birth weight, b-TSH levels at first NBS, baseline s-TSH, L-T4 12 m-dose and age at the start of the treatment may be considered useful predictive elements for the evolution of CH.
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