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Value of thyroid volume as a complementary indicator for initial levothyroxine dosing in congenital hypothyroidism: a
Yuling Zhang1,2, Qingbiao Liu3, Huichang Luo4
1The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang Guangdong, China.
Objective:
This study aimed to generate hypotheses on the effectiveness and safety of pre-treatment thyroid volume as an adjunctive parameter for guiding initial levothyroxine (L-T4) dosing in children with congenital hypothyroidism (CH).
Methods:
This retrospective study included children diagnosed with CH at Huizhou First Maternal and Child Health Hospital (2021-2023). Based on first follow-up ultrasound thyroid volume, patients were divided into reduced (A, n = 6), normal (B, n = 48), and enlarged (C, n = 19) groups. Initial L-T4 doses were 11-13 μg/kg/d (A), 6-9 (B), and 9-11 (C). Outcomes included time to thyroid function normalization, L-T4 dose requirements, physical growth, and Gesell Developmental Quotient (DQ) up to 24 months of age.
Results:
At screening and before treatment, both Group A and Group C had significantly higher TSH levels and lower FT4 levels than Group B (all P < 0.001). In Group C, thyroid volume showed a significant positive correlation with pre-treatment TSH (r = 0.705, P < 0.001) and a non-significant negative correlation with FT4 (r = -0.440, P = 0.060). The median time to TSH normalization was 28 days (IQR 28-29.75) in Group A, 14 days (IQR 14-14) in Group B, and 14 days (IQR 14-28) in Group C; FT4 normalization was achieved at 14 days in all groups. Although there were significant differences in L-T4 dose requirements among the three groups (Group A > Group C > Group B), no significant differences in body weight, length/height, or DQ were observed between any CH group and the healthy control group within 24 months of age (P > 0.05).
Conclusion:
These findings suggest that children with CH and abnormal thyroid volume may require higher initial L-T4 doses and a longer time to TSH normalization. Based on these observations, we propose the following hypothesis: thyroid volume, as an adjunct to thyroid function tests in guiding initial dosing regimens, holds certain research value in clinical practice. Future prospective, multicenter, and large-sample studies are required to validate this hypothesis.
