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Neuropsychologic development in early treated congenital hypothyroidism: analysis of literature data
G Derksen-Lubsen1, P H Verkerk
1Juliana Childrens Hospital, The Hague, The Netherlands.
Insights
Congenital hypothyroidism (CH) detected early still leads to lower IQ scores and poorer motor skills in children. The severity of CH, not treatment timing, is the primary risk factor for cognitive deficits.
Area of Science:
- Pediatric Endocrinology
- Neurodevelopmental Disorders
- Genetics and Genomics
Background:
- Congenital hypothyroidism (CH) is a condition requiring early detection and treatment.
- Neuropsychological development in CH patients, even with early intervention, requires further investigation.
Purpose of the Study:
- To evaluate the neuropsychological development in children with congenital hypothyroidism (CH) screened and treated early.
- To identify risk factors influencing neurodevelopmental outcomes in CH patients.
Main Methods:
- Meta-analysis of seven studies involving 675 CH patients and 570 controls.
- Inclusion criteria: patients and controls aged 5 years or older with well-defined control groups.
- Focus on intellectual development (IQ) and motor skills.
Main Results:
- CH patients exhibited a trend towards lower intelligence quotient (IQ) and poorer motor skills compared to controls.
- Meta-analysis revealed a significant mean IQ deficit of 6.3 points in CH patients.
- Severity of CH at diagnosis (initial thyroxine levels, skeletal maturation) was the most significant risk factor for outcome.
Conclusions:
- Early detection and treatment of CH do not fully prevent an IQ deficit.
- The severity of CH is the most critical individual risk factor for cognitive development.
- Further research is needed to clarify the impact of various biomedical risk factors due to variability in study methodologies.
Abstract:
The aim of this study was to determine the neuropsychologic development in patients with congenital (primary) hypothyroidism (CH) detected by screening and treated from early age. Seven studies were evaluated, including 675 CH patients and 570 controls. Criteria for inclusion of the studies were: 1) age of patients and controls > or = 5 y; 2) control group well defined in the original article. A meta-analysis of the data on the intellectual development was performed. All analyzed studies show a trend toward lower intelligence quotient (IQ) and--as far as investigated--poorer motor skills in CH patients compared with controls. Pooling of data showed a significant deficit of the mean IQ of 6.3 (95% confidence interval: 4.7-7.8). The most important independent risk factor for the eventual outcome appears to be the severity of CH (defined by initial thyroxine at the moment of diagnosis and by skeletal maturation); treatment variables do not seem to have an important effect the cognitive development. We conclude that CH, despite early detection and treatment, results in an IQ deficit; the severity of CH seems to be the most important individual risk factor. Our second conclusion is that, although biomedical risk factors are well investigated, the individual weight of these factors is yet largely unknown. This may be due to the variability of definitions and test tools, especially for the investigation of motor skills, that have been used.