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Updated: Jul 19, 2025
Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
Published on: February 9, 2024
Dynamic Screening of Thyroid Function for the Timely Diagnosis of Congenital Hypothyroidism in Very Preterm Infants:
Ranran Shi1,2, Jie Jiang3, Baohong Wang4
1Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Insights
Weekly screening for congenital hypothyroidism (CH) in very preterm infants (VPIs) is crucial. This dynamic approach improves timely diagnosis and treatment, especially for those with delayed thyrotropin elevation, reducing risks associated with missed diagnoses.
Area of Science:
- Neonatology
- Endocrinology
- Pediatric Screening
Background:
- Congenital hypothyroidism (CH) is prevalent in very preterm infants (VPIs).
- Optimal screening strategies for CH in VPIs remain under investigation.
- Lower gestational age is associated with increased CH incidence.
Purpose of the Study:
- To evaluate thyroid function characteristics in VPIs through weekly screening.
- To enable timely diagnosis and treatment of CH in VPIs.
- To assess the impact of gestational age on CH and delayed thyrotropin elevation (dTSH).
Main Methods:
- Prospective cohort study of VPIs (GA <32 weeks) from 2019-2022.
- Serial serum thyroid hormone measurements weekly within the first month.
- Screening continued until 36 weeks corrected age or discharge.
Main Results:
- CH incidence was 7.6% in 5992 VPIs, increasing with lower gestational age.
- Delayed thyrotropin elevation (dTSH) occurred in 57.7% of CH cases, rising with lower GA.
- Weekly screening identified 42.3% of CH cases initially; cumulative rates reached 98.9% by the fourth week.
Conclusions:
- CH and dTSH incidence rise with decreasing gestational age in VPIs.
- Dynamic weekly thyroid function screening is vital for early CH diagnosis and treatment in VPIs.
- This screening protocol can mitigate complications from missed or delayed CH diagnosis.
Abstract:
Preterm infants presented a high prevalence of congenital hypothyroidism (CH), while the optimal screening pattern is still under debate. This study aimed at evaluating the characteristics of thyroid function by conducting weekly screening during the first month of life in very preterm infants (VPIs) to achieve timely diagnosis and treatment of CH. A prospective cohort study was carried out on VPIs born with gestational age (GA) <32 weeks (w) and admitted to the participating institutes from January 1, 2019 to December 31, 2022. Serial serum thyroid hormone levels were measured weekly within the first month after birth, and at 36 w of corrected age, or before discharge. Datasets for serial thyroid hormone levels and general information were obtained. A total of 5992 VPIs were enrolled in this study, of which 456 (7.6%) [95% confidence interval (CI), 6.9-8.3%] were diagnosed with CH. The incidence of CH increased with lower GA, moving from 4.8% [CI, 3.4-6.1%] at GA 31 w to 16.9% [CI, 8.3-25.4%] at GA <26 w. Among the CH subjects, 57.7% [CI, 53.1-62.2%] were identified after the first screening and classified as delayed thyrotropin elevation (dTSH). With the decrease of GA, the proportion of dTSH also increased, moving from 38.1% [CI, 27.5-48.7%] at GA 31 w to 82.6% [CI, 65.8-99.4%] at GA <26 w. Through conducting weekly screening of thyroid function, it was remarkable that only 42.3% [CI, 37.8-46.9%] of CH subjects were diagnosed during the first screening. The cumulative rate of CH identified by rescreening performed at the second, third, and fourth week was 76.1% [CI, 72.2-80.0%], 90.6% [CI, 87.9-93.3%], and 98.9% [CI, 97.9-99.9%], respectively. The incidence of CH and dTSH both increase with lower GA in VPIs. Dynamic screening of thyroid function by weeks within the first month of life is crucial for the timely diagnosis and treatment of CH in VPIs, and it might effectively reduce the implications of missed diagnosis and delayed treatment. ChiCTR1900025234 and ChiCTR2000037918 (Registration number).
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