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Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
Published on: February 9, 2024
Challenges in management of abnormal thyroid function tests in unwell infants: A tertiary centre real-world
Annabelle Hobbs1, Michelle Jack2, Paul Benitez-Aguirre1,3
1The Children's Hospital Westmead, Sydney, New South Wales, Australia.
Insights
Clinicians face challenges managing abnormal thyroid function tests in hospitalized infants, particularly premature and unwell ones. Further research is needed to identify predictors of permanent congenital hypothyroidism in this population.
Area of Science:
- Neonatal endocrinology
- Pediatric thyroid disorders
- Infant health
Background:
- Abnormal thyroid function tests (TFTs) are common in hospitalized infants.
- Management decisions for these infants are complex, especially in premature and medically compromised neonates.
Purpose of the Study:
- To review management decisions and outcomes for hospitalized infants with abnormal TFTs.
- To identify factors influencing treatment decisions with thyroxine in this population.
Main Methods:
- Retrospective descriptive study of infants referred to an endocrinology service.
- Data collected from electronic medical records including neonatal factors, TFTs, investigations, and treatment.
- Study period: July 2019 to June 2021 at a tertiary Australian center.
Main Results:
- 124 infants were referred; 43% were premature with significant comorbidities.
- Levothyroxine treatment was initiated in 66% of infants, often with a presumptive diagnosis of transient congenital hypothyroidism.
- 70% of treated infants remained on thyroid replacement at the study's end.
Conclusions:
- Managing abnormal TFTs in premature and unwell infants presents a clinical challenge.
- Predictors of permanent congenital hypothyroidism in this complex group require further investigation.
- Prospective studies are needed to guide management decisions.
Aim:
Abnormal thyroid function tests (TFTs) are found in a wide range of settings in hospitalised infants. This retrospective descriptive study reviewed management decisions and outcomes of these infants, identifying factors influencing clinicians' decision to treat with thyroxine.
Methods:
Data were collected for all infants referred to the on-call endocrinology service at a tertiary Australian centre for thyroid dysfunction between 1 July 2019 and 30 June 2021. Electronic medical records were reviewed for birth and neonatal factors, TFTs, relevant investigations, treatment and disposition.
Results:
Of 124 infants referred to the service over a 2-year period, 43% (52 out of 120) were premature, with a high rate of comorbidities, including jaundice, hypoglycaemia, respiratory distress and cardiac anomalies. About 57% (69 out of 121) of referrals to the service were from neonatal intensive care units. Investigations to evaluate hypothyroidism included nuclear thyroid scans in 40% (46 out of 114) and ultrasound in 37% (41 out of 112). Levothyroxine treatment was initiated in 66% (77 out of 117) of infants, with 63% (73 out of 117) assigned a presumptive diagnosis of transient congenital hypothyroidism. At the end of the study period, 70% (54 out of 77) remained on thyroid replacement.
Conclusion:
Our study demonstrates the challenge clinicians face when deciding whether to treat premature and medically unwell infants with abnormal TFTs. Further prospective studies are required to determine predictors of permanent CH in this complex population.
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