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[Alpha fetoprotein in congenital hypothyroidism before and during treatment]
J E Toublanc1, J Ingrand, M Megarbane
1Département de pédiatrie, hôpital Saint-Vincent-de-Paul, Paris.
Insights
Alphafetoprotein (AFP) levels are higher in infants with congenital hypothyroidism (CH), correlating with TSH. Early AFP normalization during treatment may predict better infant neurodevelopmental outcomes.
Area of Science:
- Endocrinology
- Neonatal screening
- Biomarker research
Context:
- Congenital hypothyroidism (CH) screening offers a chance to study maturation using alphafetoprotein (AFP).
- Maternal and infant AFP levels were measured in controls and infants with permanent or transient CH.
- AFP was compared with FT4, TSH, and bilirubin levels.
Purpose:
- To investigate the role of alphafetoprotein (AFP) in congenital hypothyroidism (CH).
- To compare AFP levels in infants with CH versus controls.
- To assess the correlation of AFP with thyroid hormones and bilirubin, and its response to treatment.
Summary:
- Blood AFP was elevated in CH infants, differing significantly based on jaundice presence, but not in transient hypothyroidism (FT) cases compared to controls.
- Initial infant AFP correlated with maternal AFP. Post-treatment with l-T4, AFP normalized gradually, showing correlation with TSH but not FT4.
- Preliminary one-year follow-up suggests better IQ scores in infants with early AFP normalization.
Impact:
- Elevated AFP in CH infants may serve as an indicator of disease severity or related complications.
- The correlation between AFP and TSH during treatment suggests AFP's potential as a marker for hypothyroidism management.
- Early normalization kinetics of AFP under therapy might offer prognostic value for neurodevelopmental outcomes in infants with CH.
Background:
Screening for congenital hypothyroidism (CH) is an opportunity to investigate maturation by measuring alphafetoprotein (AFP).
Patients And Methods:
Blood AFP was measured in 73 full-term infants (controls), 22 infants with permanent CH and 19 with a transient form (FT) of hypothyroidism. It was also measured in mothers of the two groups with hypothyroidism. AFP was measured by RIA and its value was compared to those of FT4, TSH and bilirubin.
Results:
Blood AFP was higher in patients with CH with significant differences between patients who had jaundice or not, but AFP was not significantly different in FT patients and controls. Initial values of AFP in both CH and FT population was correlated to the levels of AFP in their mothers. Under treatment with 7.5 micrograms/kg/day of l-T4, AFP levels remained increased at T15, then gradually normalized at T30-T60. The log of AFP was correlated to TSH levels between T15 and T60 but was not correlated to FT4 levels. Preliminary results at one year of age show that IQ seems better in infants with early normalization of AFP.
Conclusions:
Prolonged follow-up is necessary to assess the possibility that initial kinetics of AFP under therapy have a prognostic value for estimating the quality of outcome.