Impaired Neuromotor Outcome in School-Age Children With Congenital Hypothyroidism Receiving Early High-Dose Substitution Treatment

Abstract

Congenital hypothyroidism (CH) can lead to intellectual deficits despite early high-dose treatment. Our study aimed to determine whether motor impairments can occur despite early highdose treatment. Sixty-three children with CH and early (median age of onset of treatment 9 d), high-dose treatment (median starting dose of levothyroxine 14.7 g/kg/d) were tested with the Zurich Neuromotor Assessment (ZNA) at a median age of 13.8 y (range 7.0 -14.2 y). Median z-scores in the children with CH were Ϫ0.95 in the pure and Ϫ0.56 in the adaptive fine motor component, significantly lower than in the ZNA test norms (p Ͻ 0.001 and p ϭ 0.01, respectively). The 26 children with athyreosis were more affected than the 33 children with dysgenesis, particularly in the pure motor (Ϫ1.55 versus Ϫ0.76, p ϭ 0.03), adaptive fine motor (Ϫ1.31 versus 0.13, p Ͻ 0.01), and static balance task (Ϫ0.47 versus 0.67, p ϭ 0.01). Boys performed worse than girls. Older age at onset of treatment was related to poorer adaptive fine motor performance. Movement quality (assessed by associated movements) was not affected. We conclude that severe CH can cause neuromotor deficits persisting into adolescence. These deficits cannot completely be reversed by postnatal treatment, but earlier age at treatment may reduce the degree of impairment. (Pediatr Res 70: 614-618, 2011)

European Society for Paediatric Endocrinology Consensus Guidelines on Screening, Diagnosis, and Management of Congenital Hypothyroidism

“…Subtle and specific memory deficits and reduced hippocampal volumes may be observed ( 117 ). There is also a risk of fine motor impairment ( 118 ). However, most early-treated patients are well integrated into society with no impairment in educational level ( 46 ).…”

Habilidade motora fina e linguagem expressiva em crianças com hipotireoidismo congênito

“…In children with congenital hypothyroidism examined between 7 and 14 years of age, a significantly poorer performance was found in gross and fine motor functions, and the researchers concluded that problems with fine motor skills may be associated with visuomotor and visuospatial changes, besides problems with memory and attention (7) .…”

“…Given that the major alterations in children with CH are focused on several areas, but particularly in motor (7) and language skills (11)(12)(13) , the objectives of this study were to screen the global development of children with and without congenital hypothyroidism and to investigate the relationship between fine motor skills and expressive language skills in these two groups.…”

Congenital Hypothyroidism

“…Contrary to this other studies have shown behavior problems like increased anxiety, social withdrawal and poor concentration with higher doses in children at age of 8 years. Thus demonstrating potential dangers of overtreatment with levothyroxine in CH children [52].…”