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Comparison between transient and permanent congenital hypothyroidism on a thyroid function test after re-evaluation.

Song Han Lee1, Hyun Gyung Lee1, Eun Mi Yang1

  • 1Department of Pediatrics, Chonnam National University Medical School & Children's Hospital, Gwangju, Korea.

Annals of Pediatric Endocrinology & Metabolism
|January 4, 2024
PubMed
Summary

Transient congenital hypothyroidism (TCH) requires re-evaluation after levothyroxine discontinuation. Thyroid function tests, particularly thyroid-stimulating hormone (TSH), help predict permanent congenital hypothyroidism (PCH) in children.

Keywords:
Congenital hypothyroidismFree thyroxinePermanentRe-evaluationThyroid stimulating hormoneTransient

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Area of Science:

  • Pediatric Endocrinology
  • Neonatal Screening
  • Thyroid Function Tests

Background:

  • Congenital hypothyroidism (CH) is diagnosed via neonatal screening and treated neonatally.
  • Transient CH (TCH) is a subset of CH requiring re-evaluation to discontinue treatment.
  • Identifying optimal strategies for levothyroxine discontinuation in TCH is crucial.

Purpose of the Study:

  • To determine the best method for discontinuing levothyroxine in patients with CH.
  • To analyze trends in thyroid function tests (TFTs) following levothyroxine discontinuation.
  • To differentiate between transient and permanent CH (PCH).

Main Methods:

  • Retrospective review of 388 patients diagnosed with CH.
  • Classification of patients into permanent CH (PCH) and TCH groups (83 patients total).
  • Comparison of clinical parameters and TFT trends to predict TCH.

Main Results:

  • Higher thyroid-stimulating hormone (TSH) levels observed in the PCH group post-discontinuation and over 1-3 years (P<0.01).
  • Higher free thyroxine (fT4) levels observed in the TCH group post-discontinuation and over 1-3 years (P<0.01).
  • An average TSH >9.05 μIU/mL over 3 years accurately predicted PCH with 100% sensitivity and specificity.

Conclusions:

  • Levothyroxine can be discontinued when TSH is between 10–20 μIU/mL, with subsequent results around 10 μIU/mL or decreasing.
  • Thyroid function test trends, especially TSH, are key indicators for managing TCH re-evaluation.
  • A 3-year average TSH cutoff >9.05 μIU/mL reliably identifies PCH.