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Sixty children with congenital hypothyroidism detected by neonatal thyroid: mental development at 1, 4, and 7 years:
Insights
Early treatment of congenital hypothyroidism (C.H.) with thyroxine replacement therapy leads to favorable mental development outcomes. Most children achieved normal developmental quotients/intelligence quotients, especially when other risk factors were absent.
Area of Science:
- Pediatrics
- Endocrinology
- Developmental Psychology
Background:
- Congenital hypothyroidism (C.H.) can impact neurodevelopment if not treated promptly.
- Early detection and intervention are crucial for managing C.H. and mitigating potential developmental deficits.
Purpose of the Study:
- To prospectively evaluate the mental development of children diagnosed with congenital hypothyroidism.
- To assess the long-term neurodevelopmental outcomes in relation to treatment initiation and associated risk factors.
Main Methods:
- A cohort of 60 infants with C.H. received 1-thyroxine treatment starting at approximately 10 days of age.
- Developmental testing (Brunet-Lezine, Snijders-Oomen, Wechsler) was conducted at 1, 4, and 7 years.
- Thyroid hormone levels (T4, TSH) were monitored regularly to ensure treatment compliance.
Main Results:
- Most children demonstrated global DQ/IQ scores within the normal range (3rd-97th percentile) compared to controls.
- Mean scores were lower than controls, particularly at 1 year, but improved over time.
- Children without associated findings or risk factors showed DQ/IQ scores identical to the control group.
Conclusions:
- Early and consistent thyroid hormone replacement therapy is associated with favorable mental development in children with C.H.
- The presence of associated findings or risk factors may influence developmental outcomes.
- Strict monitoring of treatment compliance is essential for achieving optimal results.
Abstract:
A prospective study of mental development has been carried out in 60 unselected children with congenital hypothyroidism (C.H.) detected between 1976 and February 1985. Treatment with 1-thyroxin was initiated at the age of 10.4 +/- 2.5 days and supervised by T4 and TSH monitoring in 3-6 monthly intervals. Although clinical signs were mild or missing, skeletal maturation was prenatal in more than half. Developmental testing was carried out at 1, 4 and 7 years by the Brunet-Lezine (n = 60), the non-verbal Snijders-Oomen (n = 40), and the german version of the Wechsler intelligence test (n = 20), respectively. The global DQ/IQ in all but a few children at each age group are within the 3rd and 97th percentile of the DQ/IQ distribution in a control group tested during the same period of time. The mean values of all global and subscores, however, are lower than that one in the control group, differences being highly significant at 1 year. In 21 of our 60 children, associated findings and/or risk factors were present. The DQ/IQ in children without risk factors are identical to that of the control group. There are no significant DQ/IQ differences neither between athyroidism and ectopic thyroid glands, nor between prenatal bone age and normal skeletal maturation at diagnosis. We assume that the favourable results in our children with C.H. may be ascribed to the early onset of thyroid hormone replacement and the strictly controlled compliance.