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Updated: Apr 1, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
"Unveiling thyroid dysfunction in preterm neonates": A prospective observational study
Binsi Charulatha1, Meghna Nema1, Aswathy Rahul1
1Department of Neonatology, Government Medical College, Thiruvananthapuram, India.
Insights
Thyroid dysfunction requiring treatment occurred in 4% of preterm infants. Early screening and repeat testing up to 3-4 weeks postnatal age are crucial for accurate diagnosis and appropriate management in neonates.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Pediatrics
Background:
- Thyroid dysfunction is prevalent in preterm neonates due to immature hypothalamic-pituitary-thyroid axis, increased metabolic demands, and drug exposure.
- Transient thyroid dysfunctions may resolve spontaneously, necessitating careful monitoring rather than immediate treatment.
- Current guidelines advocate for repeated screening in preterm infants to accurately assess thyroid status.
Purpose of the Study:
- To determine the incidence of thyroid dysfunction requiring thyroxine replacement therapy in preterm neonates (≤32 weeks) up to 40 weeks of corrected gestational age.
- To identify independent predictors associated with thyroid dysfunction requiring treatment in this vulnerable population.
Main Methods:
- A prospective observational study involving 421 preterm neonates (≤32 weeks) admitted to a NICU in South India.
- Serial screening of serum free thyroxine (FT4) and thyroid stimulating hormone (TSH) at 72 hours, 2 weeks, and 3-4 weeks postnatal age.
- Management decisions based on abnormal screening results.
Main Results:
- Among 376 neonates completing all screenings, 4% (95% CI 2.2-6.5%) required thyroxine replacement therapy.
- Persistent hypothyroxinemia (2.65%) was the most common diagnosis, followed by congenital hypothyroidism with delayed TSH elevation (1.06%) and primary congenital hypothyroidism (0.26%).
- Extremely low birth weight (ELBW) and necrotizing enterocolitis (NEC) ≥ stage 2 were significant independent predictors for thyroid dysfunction requiring treatment.
Conclusions:
- The incidence of treatable thyroid dysfunction in preterm neonates is higher than in the general population.
- Repeated screening, particularly up to 3-4 weeks postnatal age, is essential to avoid overtreatment and detect late-onset thyroid dysfunction.
- Identifying high-risk factors like ELBW and NEC can aid in targeted monitoring of preterm infants for thyroid abnormalities.
Abstract:
BackgroundThyroid dysfunction is common in preterm neonates due to immaturity of hypothalamic pituitary thyroid axis, increased demand and drug exposure. The dysfunctions seen in early days may get corrected later and may not require treatment. Guidelines recommend repeated screening for preterm. This study was planned to estímate the incidence of thyroid dysfunction requiring thyroxine replacement therapy within 40 weeks of corrected gestational age in preterm neonates ≤32 weeks.MethodologyThis prospective observational study included 421 preterm neonates born ≤32 weeks and admitted in the NICU of a Government Medical College in South India. Serial screening of serum free thyroxine and thyroid stimulating hormone (FT4 and TSH) was done at 72 h of life, followed by 2 weeks and then at 3-4 weeks postnatal age. Management was done for abnormal results.ResultsAmong 376 babies who completed all three screenings, the incidence of thyroid dysfunction requiring thyroxine replacement therapy was 4% (95% CI 2.2-6.5%, (n = 15)). Majority (2.65%, n = 10) had persistent hypothyroxinemia suggestive of possible central hypothyroidism followed by congenital hypothyroidism with delayed TSH elevation (1.06%, n = 4) and congenital primary hypothyroidism (0.26% n = 1). Extremely low birth weight (ELBW) and necrotizing enterocolitis ≥ stage 2 (NEC) were the independent predictors significantly associated with thyroid dysfunction requiring thyroxine replacement therapy.ConclusionThe occurrence of thyroid dysfunction necessitating treatment in preterms was higher than general population. Repeating the abnormal tests and rescreening preterm neonates at least till 3-4 weeks postnatal age is required for avoiding unnecessary treatment and to pick up late presentation.
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