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Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
Published on: February 9, 2024
Correlation Between Thyroid Hormone Concentrations and Ultrasound Thyroid Volume in Preterm Infants Born Before 33
Aleksandra Mikołajczak1, Katarzyna Kufel2, Renata Bokiniec2
1Neonatal and Intensive Care Department, Institute of Mother and Child, Warsaw, Poland.
Insights
Preterm infants require lower free thyroxine (FT4) levels based on gestational age (GA). Ultrasound thyroid imaging can aid in assessing thyroid disorders in premature infants.
Area of Science:
- Neonatology
- Endocrinology
- Pediatric Imaging
Background:
- Thyroid disorders are common in premature infants, but treatment guidelines are limited by a lack of gestational age-specific reference ranges.
- Establishing these ranges is crucial for appropriate clinical management of thyroid dysfunction in this vulnerable population.
Purpose of the Study:
- To evaluate gestational age-specific thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels in preterm infants.
- To investigate the correlation between TSH, FT4 serum levels, and ultrasound-measured thyroid volume in preterm infants.
Main Methods:
- An observational, prospective study involving 98 preterm infants born before 33 weeks gestational age (GA).
- Infants were categorized into 24-28 weeks GA and 29-32 weeks GA groups.
- TSH and FT4 levels were measured at 2 weeks postnatal age (PNA) and 32 weeks postmenstrual age (PMA), with comparisons made between groups and time points.
Main Results:
- A significant difference in FT4 concentration was observed between GA groups, with lower FT4 in the 24-28 weeks GA group compared to the 29-32 weeks GA group at both PNA 2 weeks and PMA 32 weeks.
- A positive correlation was found between FT4 and GA, indicating a gradual increase in FT4 with advancing GA in preterm infants.
- A significant correlation was noted between thyroid volume and FT4 levels (rho=0.25, p=0.019) and between thyroid volume and weight (rho=0.37, p<0.001) across all studied infants.
Conclusions:
- Preterm infants exhibit lower FT4 requirements that are dependent on their gestational age.
- Ultrasound thyroid imaging shows potential as a valuable tool for evaluating thyroid disorders in preterm infants, complementing biochemical assessments.
Objective:
Thyroid disorders are commonly concomitant with premature birth; however, indications to start therapy remain unclear due to a lack of gestational age (GA)-specific reference ranges. We aimed to evaluate the age-specific thyroid-stimulating hormone (TSH), free thyroxine (FT4) levels and the correlation between TSH and FT4 serum levels and ultrasound thyroid volume in preterm infants.
Materials And Methods:
This was an observational, prospective, single-center study of 98 preterm infants born before 33 weeks GA. The infants were divided into the 24-28 weeks and 29-32 weeks GA groups. TSH and FT4 serum levels were measured at two time points: at postnatal age (PNA) 2 weeks and at postmenstrual age (PMA) 32 weeks; the results were compared between groups at two consecutive time points.
Results:
There was a statistically significant between-group difference in FT4 concentration. There was a positive correlation between FT4 and GA at both screening times. FT4 in the 24-28 weeks GA group was significantly lower than in the 29-32 weeks GA group. The mean (standard deviation [SD]) FT4 at PNA 2 weeks was 11.72 ± 2.16 pmol/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p<0.001). The mean (SD) FT4 at PMA 32 weeks was 11.96 ± 1.98 pmo/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p=0.001). Our results reflect a slow and gradual upward trend of FT4 in the 24-28 weeks GA. It is of interest that the correlation between thyroid volume and FT4 was statistically significant (rho=0.25, p=0.019) for all studied preterm infants. The correlation between thyroid volume and weight was statistically significant for the entire study group (rho=0.37, p<0.001). We did not find statistically significant differences in TSH and FT4 values between consecutive time points at 24-28 weeks GA. The thyroid volume was not significantly different between both groups. The total thyroid volume was 0.26 vs. 0.27 ml for the 24-28 and 29-32 weeks GA groups, respectively.
Conclusion:
The results of this study indicate that preterm infants require lower FT4 values depending on GA. Moreover, ultrasound thyroid imaging may facilitate the evaluation of questionable thyroid disorders.
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