Follow-up of newborns with low thyroxine and nonelevated thyroid-stimulating hormone–screening concentrations: Results of the 20-year experience in the Northwest Regional Newborn Screening Program

Hunter, Maya K.; Mandel, Scott; Sesser, David E.; Miyahira, Richard S.; Rien, Leanne; Skeels, Michael R.; LaFranchi, Stephen

doi:10.1016/s0022-3476(98)70487-1

Cited by 73 publications

(52 citation statements)

References 13 publications

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“…The patients like this case may suffer from irreversible damage to the developing brain, if they are left untreated from early infancy or if there is a delay in initiation of replacement therapy. Hunter et al also described the patients with "delayed TSH rise" in a large-scale survey [2]. From the aforementioned experience and this report, we believe that infants who repeatedly show mild hyperthyrotropinemia with normal FT4 levels should not be regarded as "transient elevation in serum TSH of the neonates" and left untreated without close observation.…”

Section: Discussionmentioning

confidence: 59%

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Persistence of Mild Hyperthyrotropinemia after Discontinuation of Three-Year Course of Low-Dose L-Thyroxine Therapy in Infants with Borderline Hypothyroidism

et al. 2003

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Abstract. Treatment plan for neonates with borderline hypothyroidism (persistent hyperthyrotropinemia with normothyroxinemia) has not been established. In this study, changes in thyroid function after discontinuation of low-dose L-thyroxine (L-T4) supplement in infants with the condition were evaluated. Fourteen infants with hyperthyrotropinemia at neonatal screening had repeated hyperthyrotropinemia (>8 mU/L) with normothyroxinemia. TSH response was exaggerated at TRH testing. The subjects were treated with low-dose L-T4 (3 to 9 mg/kg/day) for 2.2 to 6 years, and euthyroid status was maintained. After discontinuation of therapy, mild hyperthyrotropinemia persisted up to 24 months, while serum FT4 remained within the lower half of the normal range. TSH response to TRH stimulation, which tended to be exaggerated 1 month after discontinuation, became lower 6 to 12 months later. RAIU and thyroid scintigraphy were normal in all subjects. No patient developed hypothyroxinemia, although mild elevation of TSH lasted rather long after discontinuation of low-dose L-T4 therapy. Administration of L-T4 was not resumed provided the subjects were followed at regular interval. Further long-term investigation is needed to define whether re-administration is necessary or not.

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Section: Discussionmentioning

confidence: 59%

“…Hunter et al also described the occurrence of delayed TSH rise [2]. Hence, it is our current practice to treat those with borderline hypothyroidism with low dose L-T4 regimen for 3 years and finalize the diagnosis thereafter.…”

mentioning

confidence: 99%

Persistence of Mild Hyperthyrotropinemia after Discontinuation of Three-Year Course of Low-Dose L-Thyroxine Therapy in Infants with Borderline Hypothyroidism

et al. 2003

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“…The additional incidence of CH based on a second screening at 2 weeks of age is approximately 1 in 30 000. 38,40 Infants with CH detected at the later screening time tend to be of LBW or VLBW, with mild or delayed TSH elevations. 41 Whether these cases represent transient or permanent cases is unknown.…”

Section: The Specimenmentioning

confidence: 99%

Update of Newborn Screening and Therapy for Congenital Hypothyroidism

Rose¹,

Brown²

2006

Pediatrics

587

301

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Unrecognized congenital hypothyroidism leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. The primary thyroid-stimulating hormone screening has become standard in many parts of the world. However, newborn thyroid screening is not yet universal in some countries. Initial dosage of 10 to 15 g/kg levothyroxine is recommended. The goals of thyroid hormone therapy should be to maintain frequent evaluations of total thyroxine or free thyroxine in the upper half of the reference range during the first 3 years of life and to normalize the serum thyroid-stimulating hormone concentration to ensure optimal thyroid hormone dosage and compliance.Improvements in screening and therapy have led to improved developmental outcomes in adults with congenital hypothyroidism who are now in their 20s and 30s. Thyroid hormone regimens used today are more aggressive in targeting early correction of thyroid-stimulating hormone than were those used 20 or even 10 years ago. Thus, newborn infants with congenital hypothyroidism today may have an even better intellectual and neurologic prognosis. Efforts are ongoing to establish the optimal therapy that leads to maximum potential for normal development for infants with congenital hypothyroidism.Remaining controversy centers on infants whose abnormality in neonatal thyroid function is transient or mild and on optimal care of very low birth weight or preterm infants. Of note, thyroid-stimulating hormone is not elevated in central hypothyroidism. An algorithm is proposed for diagnosis and management.Physicians must not relinquish their clinical judgment and experience in the face of normal newborn thyroid test results. Hypothyroidism can be acquired after the newborn screening. When clinical symptoms and signs suggest hypothyroidism, regardless of newborn screening results, serum free thyroxine and thyroidstimulating hormone determinations should be performed. INTRODUCTIONCongenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation. In most cases, the disorder is permanent and results from an All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.Key Words congenital hypothyroidism, thyroid hormone, thyroid-stimulating hormone, newborn screening Abbreviations CH-congenital hypothyroidism TH-thyroid hormone T 4 -thyroxine T 3 -triiodothyronine TSH-R-thyrotropin receptor TRBAb-thyrotropin receptor-blocking antibody FT 4 -free thyroxine TSH-thyroid-stimulating hormone TBG-thyroid-binding globulin LBW-low birth weight VLBW-very low birth weight L-T 4 -levothyroxine TRH-thyrotropin-releasing hormone PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

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“…27 Second, infants with non-elevated TSH and low thyroxine that might be missed by TSH testing alone can be prevented by clinical suspicion and re-screening using both TSH and T4. 16,28 …”

Section: Hypothyroidismmentioning

confidence: 99%

A Neonatal Screening in Lebanon: Results of Five Years’ Experience

et al. 2003

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Background: Neonatal screening programs for common disorders like phenylketonuria, congenital hypothyroidism, and glucose-6-phosphate dehydrogenase (G6PD) deficiency are not fully established at the national level in Lebanon. Screening for the above disorders was carried out for newborns delivered at the American University of Beirut Medical Center over a period of five years. Subjects and Methods: Blood specimens collected 2-3 days after birth were applied to neonatal screening blood collection cards. A total of 9117 newborns were screened using phenylalanine, thyroid-stimulating hormone, and G6PD activity measurements on blood spots. Results: One case of phenylketonuria and another of hyperphenylalaninemia were detected. We also detected 5 cases of permanent type congenital hypothyroidism, giving an incidence of 5:9117 (1:1823). The age range at initiation of hormonal replacement therapy was 9-46 days. The overall incidence of G6PD was 106:9117 (1:86 or 1.16%), of which 84 had complete deficiency (1:109 or 0.92%), and 22 with intermediate activity. Conclusion:The incidence of these disorders found in this Lebanese sub-population warrants consideration of a comprehensive nationwide neonatal screening program.

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Follow-up of newborns with low thyroxine and nonelevated thyroid-stimulating hormone–screening concentrations: Results of the 20-year experience in the Northwest Regional Newborn Screening Program

Cited by 73 publications

References 13 publications

Persistence of Mild Hyperthyrotropinemia after Discontinuation of Three-Year Course of Low-Dose L-Thyroxine Therapy in Infants with Borderline Hypothyroidism

Persistence of Mild Hyperthyrotropinemia after Discontinuation of Three-Year Course of Low-Dose L-Thyroxine Therapy in Infants with Borderline Hypothyroidism

Update of Newborn Screening and Therapy for Congenital Hypothyroidism

A Neonatal Screening in Lebanon: Results of Five Years’ Experience

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