Cognitive outcome of 458 children over 25 years of neonatal screening for congenital hypothyroidism

Pelaez, Julita Maria; RAMOS, Juliana Cristina Romero Rojas; Domingos, Mouseline T.; Lima, Marcella Rabassi de; Kraemer, Gabriela de Carvalho; Cardoso-Demartini, Adriane; Pereira, Rosana Marques; Lacerda, Luiz de; Nesi-França, Suzana

doi:10.1016/j.jped.2023.03.003

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…Some reports suggest differences in the neurodevelopment of children with borderline b-TSH were not clinically relevant to recommend changes in the cut-off [ 39 , 40 , 41 ], while others show that these children had an increased risk of poor school performance, developmental changes, reduced memory span, and a higher chance to develop special needs [ 42 , 43 ]. This assessment is complex since cognitive deficits can be associated to multiple factors, including socioeconomic and environmental factors [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Lowering TSH Cut-Off on Neonatal Screening for Congenital Hypothyroidism in Minas Gerais, Brazil

Teixeira Palla Braga,

Vilela Antunes,

Colosimo

et al. 2024

IJNS

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A higher incidence of primary congenital hypothyroidism (CH) has been related to increased sensitivity in neonatal screening tests. The benefit of treatment in mild cases remains a topic of debate. We evaluated the impact of reducing the blood-spot TSH cut-off (b-TSH) from 10 (Group 2) to 6 mIU/L (Group 1) in a public neonatal screening program. During the study period, 40% of 123 newborns with CH (n = 162,729; incidence = 1:1323) had b-TSH between 6 and 10 mIU/L. Group 1 patients had fewer clinical signs (p = 0.02), lower serum TSH (p < 0.01), and higher free T4 (p < 0.01) compared to those in Group 2 at diagnosis. Reducing the b-TSH cut-off from 10 to 6 mIU/L increased screening sensitivity, allowing a third of diagnoses, mainly mild cases, not being missed. However, when evaluating the performances of b-TSH cut-offs (6, 7, 8, 9, and 10 mIU/L), the lower values were associated with low positive predictive values (PPVs) and unacceptable increased recall rates (0.57%) for a public health care program. A proposed strategy is to adopt a higher b-TSH cut-off in the first sample and a lower one in the subsequent samples from the same child, which yields a greater number of diagnoses with an acceptable PPV.

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Section: Discussionmentioning

confidence: 99%

Impact of Lowering TSH Cut-Off on Neonatal Screening for Congenital Hypothyroidism in Minas Gerais, Brazil

Teixeira Palla Braga,

Vilela Antunes,

Colosimo

et al. 2024

IJNS

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Cerebral Cortical Thickness Morphometry and Neurocognitive Correlations in Adolescents With Congenital Hypothyroidism

RAMOS

Pelaez²,

Ono

et al. 2023

The Journal of Clinical Endocrinology &Amp; Metabolism

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Background Subtle cognitive impairments have been described in children with congenital hypothyroidism (CH) detected by neonatal screening (NS), even with early and adequate treatment. Patients with CH may present brain cortical thickness (CT) abnormalities, which may be associated with neurocognitive impairments. Aims To evaluate the CT in adolescents with CH detected by the NS Program (Paraná, Brazil), and to correlate possible abnormalities with cognitive level and variables of neurocognitive prognosis. Methods Review of medical records followed by psychometric evaluation of adolescents with CH. Brain magnetic resonance imaging with analysis of 33 brain areas of each hemisphere was performed in 41 patients (29 females) and in a control group of 20 healthy adolescents. CT values were correlated with Full-scale Intelligence Quotient (FSIQ) scores, age at start of treatment, pretreatment thyroxine levels and maternal schooling. Results No significant difference in CT between patients and controls. However, there was a trend toward thinning in the right lateral orbitofrontal cortex among patients and in the right postcentral gyrus cortex among controls. CT correlated significantly with FSIQ scores and with age at start of treatment in one area, and with hypothyroidism severity in five brain areas. Maternal schooling level did not correlate with CT but was significantly correlated with FSIQ. Cognitive level was within average in 44.7% of patients (13.2% had intellectual deficiency). Conclusions There was a trend toward morphometric alterations in the cerebral cortex of adolescents with CH compared with healthy controls. The correlations between CT and variables of neurocognitive prognosis emphasize the influence of hypothyroidism on cortical development. Socioeconomic status exerts a limiting factor on cognitive outcome.

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Neurodevelopmental Status in 3 - 5 Years-Old Children with a History of Congenital and Acquired Hypothyroidism

Amirikandbon,

Moienafshar,

Shariatpanahi

et al. 2024

J Compr Ped

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Background: Misdiagnosis and delayed treatment of hypothyroidism can lead to irreversible complications in children. Objectives: This study aimed to compare the neurodevelopmental status of children with congenital and acquired hypothyroidism. Methods: A retrospective cohort study was conducted in Tehran, Iran (2021 - 2022), involving children aged 3 - 5 years diagnosed with hypothyroidism. Participants were divided into two groups based on medical records: Congenital and acquired hypothyroidism. Neurodevelopmental status was assessed using the Ages and Stages Questionnaire (ASQ). Final scores above -1 SD and below -2 SD were considered as normal and abnormal neurodevelopmental status, respectively. The frequency of abnormal neurodevelopmental status was compared between the groups. Results: The frequency of delayed neurodevelopmental status was higher in the congenital hypothyroidism group than in the acquired group; however, the difference was not statistically significant. In the congenital group, the age of diagnosis was significantly associated with delays in communication (P = 0.03), gross motor (P = 0.03), fine motor (P = 0.04), and problem-solving (P = 0.02) domains. Significant associations were also observed between low levels of free T4 and delays in communication (P = 0.04), gross motor (P = 0.04), and problem-solving (P = 0.02) skills. Maternal hypothyroidism during pregnancy was significantly associated with abnormal personal-social behavior (P = 0.02). Conclusions: Although the frequency of neurodevelopmental abnormalities was higher in the congenital hypothyroidism group compared to the acquired group, the difference was not significant. The comparable risks for neurodevelopmental abnormalities in both congenital and acquired hypothyroidism groups suggest the need for increased attention and interventions to prevent adverse outcomes. Further studies with larger sample sizes are required to confirm these findings.

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Cognitive outcome of 458 children over 25 years of neonatal screening for congenital hypothyroidism

Cited by 3 publications

References 23 publications

Impact of Lowering TSH Cut-Off on Neonatal Screening for Congenital Hypothyroidism in Minas Gerais, Brazil

Impact of Lowering TSH Cut-Off on Neonatal Screening for Congenital Hypothyroidism in Minas Gerais, Brazil

Cerebral Cortical Thickness Morphometry and Neurocognitive Correlations in Adolescents With Congenital Hypothyroidism

Neurodevelopmental Status in 3 - 5 Years-Old Children with a History of Congenital and Acquired Hypothyroidism

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