Improved prognosis in congenital hypothyroidism treated before three months. Behavior concerns of parents of treated cretins

Klein, Alan H.; Meltzer, Stephanie; Kenny, Frederic M.; Oliver, Thomas K.

doi:10.1203/00006450-197108000-00117

Cited by 12 publications

(5 citation statements)

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“…The mental prognosis was best in those children treated before 3 months of age. Similar results were found in a study of 31 children by Klein et al (1972). A Belgian study (Wolter et al, 1979) showed that the IQ is in the normal range when treatment is started before 3 months of age, even with a prenatal bone age.…”

Section: Congenital Hypothyroidism and Mental Developmentsupporting

confidence: 85%

Congenital Hypothyroidism and Neurological Development

Hulse

1983

Child Psychology Psychiatry

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Section: Congenital Hypothyroidism and Mental Developmentsupporting

confidence: 85%

Congenital Hypothyroidism and Neurological Development

Hulse

1983

Child Psychology Psychiatry

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“…In the human infant Klein e t al. (26) have recently shown that very early treatment of hypothyroidism will minimize the degree of mental retardation.…”

Section: Discussionmentioning

confidence: 99%

Growth and Development of the Thyroidectomized Ovine Fetus

et al. 1974

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ExtractThyroidectomies were performed through a flank incision and uterotomy on five fetuses of 1-4-year-old Columbia and Columbia Suffolk date-bred ewes of 90-1 1 0 days gestation. The fetuses were killed 19-43 days post-thyroidectomy. Body and organ weights, limb roentgenograms, DNA, RNA, and protein concentrations of selected tissues, cerebral and cerebellar lipid concentrations, and cerebellar cerebroside fatty acid composition were measured and compared with similar measurements in control animals. In the thyroidectomized fetuses mean carcass and lung weights were significantly reduced and wool development was consistently delayed. Extremity x-rays showed a delay in the time of appearance and a decrease in the size of epiphyseal centers. The mean DNA concentration was low in muscle tissue; mean protein concentrations were reduced in cerebellum, heart, lung, thymus, and muscle tissues, while mean total lipid concentration was low in cerebral tissue; the percentage of 18-carbon fatty acids was significantly increased in cerebellar cerebrosides. These results indicate that thyroid hormone deficiency, present during the last trimester of gestation in the ovine fetus, impairs carcass and lung growth, delays bone and skin maturation, inhibits growth in cell size in heart, lung, thymus, and cerebral tissues, and delays myelination in the central nervous system (CNS). SpeculationThe present results, considered with results of other investigations of the effects of thyroid hormone deficiency in fetal and newborn mammals, indicate that hypothyroidism impairs somatic growth, delays bone growth and maturation, delays cell growth and replication in the CNS, and inhibits CNS myelination. The critical period for these effects varies in different species. In the rat this period is postnatal, whereas in the sheep it extends into the third trimester of pregnancy. During pregnancy, carcass growth, bone maturation, and lung maturation are most affected in the sheep; CNS changes are minimal. In man fetal hypothyroidism may produce some delay in bone maturation but somatic growth retardation and signs and symptoms of hypothyroidism are not usually present a t birth. Moreover, as in the sheep, any delay in CNS maturation probably is minimal in utero, since very early postnatal treatment minimizes mental retardation. Thus early diagnosis and treatment of hypothyroidism is necessary and consideration of the possibility of newborn screening would seem appropriate.19, 23). Therefore, it is possible that thyroid hormones are not necessary for normal fetal somatic growth. The effect of intrauterine hypothyroidism on CNS growth and maturation also is not entirely clear. Thus we have conducted studies of body and organ growth and thyroid hormone kinetics in the fetal sheep after thyroidectomy. The kinetic studies, described elsewhere (141, indicated that fetal serum levels of both thyroxine (T4) and triiodothyronine ( T 3 ) are unmeasurable soon after fetal thyroidectomy and that the athyrotic fetus receives minimal quantities of materna...

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“…Since thyroid hormones are known to play an essential role in the development and growth of the brain, an early start of treatment with thyroxine is essential to prevent the neurological, mental and physical deficiences [4]. Follow up at seven years of age of affected children who were diagnosed through screening programs showed an intelligence quotient which is not different from normal control children [5,6].…”

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confidence: 99%

Neonatal Screening for Congenital Hypothyroidism: Incidence, Imaging, Feasability, and Difficulties of a Nationwide Program

et al. 1992

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A pilot project was carried out in Riyadh to study the incidence and pattern of congenital hypothyroidism (CH) among newborns delivered at the Ministry of Health (MOH) hospitals. Cord blood was assayed for thyroid stimulating hormone (TSH). For affected infants, Tc-99m pertechnetate thyroid scintigraphy and perchlorate discharge test (PDT) using I 123 were performed to determine the cause of congenital hypothyroidism. Fifteen affected newborns were diagnosed among 40,000 newborns screened giving an incidence of 1:2666. Tc-99m thyroid scan revealed athyreosis in five infants; the thyroid gland was ectopic in eight and eutopic in two infants. In eight infants thyroid tissue was visualized, PDT was performed and the test was positive in seven cases (two eutopic and five ectopic). We concluded that the incidence of CH was higher compared with other parts of the world. Thyroid scintigraphy has a primary role in the evaluation of infants with congenital hypothyroidism and should be part of the protocol for the screening program. As early initiation of thyroxine therapy will prevent neurological and physicial handicaps of the disease, the decision was made to have a nationwide screening program established in Saudi Arabia. The orgnaization and difficulties of the screening program are being discussed.

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Improved prognosis in congenital hypothyroidism treated before three months. Behavior concerns of parents of treated cretins

Cited by 12 publications

References 0 publications

Congenital Hypothyroidism and Neurological Development

Congenital Hypothyroidism and Neurological Development

Growth and Development of the Thyroidectomized Ovine Fetus

Neonatal Screening for Congenital Hypothyroidism: Incidence, Imaging, Feasability, and Difficulties of a Nationwide Program

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