Levothyroxine requirement in congenital hypothyroidism: a 12-year longitudinal study

Delvecchio, Maurizio; Salerno, Mariacarolina; Vigone, Maria Cristina; Wasniewska, Malgorzata; Popolo, Pietro Pio; Lapolla, Rosa; Mussa, Alessandro; Tronconi, G; D’Acunzo, Ida; Mase, Raffaella Di; Falcone, Rosa; Corrias, Andrea; Luca, Filippo De; Weber, Giovanna; Faienza, Maria Felicia

doi:10.1007/s12020-015-0574-1

Cited by 16 publications

(7 citation statements)

References 29 publications

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“…Finally, the results of the present study confirm that the daily L-T4 requirements to maintain biochemical euthyroidism are higher in the patients with P CH and eutopic gland than in those with dysgenetic gland, as also reported just recently by Delvecchio et al [19]. …”

Section: Discussionsupporting

confidence: 92%

Early Discrimination between Transient and Permanent Congenital Hypothyroidism in Children with Eutopic Gland

et al. 2015

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Aim: To analyze the factors that might allow an early discrimination between permanent (P) and transient (T) congenital hypothyroidism (CH). Methods: Clinical, biochemical and imaging data of 64 children with eutopic gland, who were positively screened and treated for CH during the period 1998-2011, were retrospectively analyzed. Results: During a 3-year treatment period, the mean doses of L-thyroxine (L-T4) per kilogram of body weight at various times were significantly lower in the 46 children with T CH than in the remaining 18 with P CH. No patients with T CH had required any increment of the doses of L-T4 per kilogram of body weight to maintain normal thyroid-stimulating hormone levels over time, whereas 16/18 children with P CH during the same period had needed some dose increments (p < 0.0001). Conclusions: (a) L-T4 requirements >4.9 µg/kg/day at 12 months or >4.27 µg/kg/day at 24 months are highly suggestive of P CH, irrespective of gland ultrasonography; (b) L-T4 requirements <1.7 µg/kg/day at 12 months or <1.45 µg/kg/day at 24 months are highly suggestive of T CH, at least in the cases with eutopic gland, and (c) the analysis of L-T4 requirements during the first years of treatment might allow an early discrimination between T and P CH in the cases with eutopic gland.

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Section: Discussionsupporting

confidence: 92%

Early Discrimination between Transient and Permanent Congenital Hypothyroidism in Children with Eutopic Gland

et al. 2015

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“…The mean starting dose of L-T4 falls within the recommended range [6,7,12]. The significant difference of L-T4 dose between CH newborns with dysgenesis and those with an eutopic thyroid at 3 months, 18 months, 2, 2.5 and 3 years, confirms that a different dose of L-T4 is required according to CH etiology [23][24][25].…”

Section: Discussionmentioning

confidence: 63%

Congenital hypothyroidism after newborn screening program reorganization in the Apulia region

Simonetti

Damato²,

Esposito

et al. 2022

Ital J Pediatr

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Background Congenital hypothyroidism (CH) is the most frequent congenital endocrine disorder. The purpose of the present study was to evaluate the incidence and etiological classification of CH in Apulia in a three-year period according to the reorganization of the regional screening program in a single central laboratory, as well as to analyze the growth characteristics and the associated risk factors of the CH newborns diagnosed during the study period. Methods Data derived from the reorganization of the newborn screening program for CH in a single central laboratory that collects dried blood spot (DBS) from 27 Maternity Hospitals are analyzed over a three-year period. Birth weight and length, daily dose of L-T4 at specific key points (3, 6, 12 and 18 months, 2, 2.5 and 3 years) were also obtained from medical records of the CH newborns during the study period and calculated as standard deviation score (SDS). Results The screening program diagnosed 90 newborns with confirmed CH (incidence 1:990; recall rate: 3.6%). In detail, 75.6% newborns had an eutopic thyroid, and 24.4% had thyroid dysgenesis; 33 out of the 90 newborns (36.6%) had one or more risk factors. Among these, the multiple pregnancies are the most important because they tripled the risk of CH. At diagnosis, TSH levels were different between patients with dysgenesis and those with an eutopic thyroid (p = 0.005). Treatment was started at a mean of 18.5 ± 12.8 days of life. The mean starting dose of levothyroxine (L-T4) was 11.38 ± 2.46 μg/kg/day. Conclusions The results of these study show an increase of CH cases in newborns with an eutopic thyroid compared to the traditional classification. The centralization of the screening program allows a closer cooperation between laboratory and clinical centers and facilitates the implementation of appropriate diagnostic evaluations and timely initiation of treatment, with positive effects on the management of the condition.

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“…The latest data support the concept that patients with dysgenesis showed a higher daily L-T4 requirement than patients with in situ gland, especially in the first years of life. 31 With regard to patients with eutopic normal-sized thyroid gland, to date there are no data concerning factors that could predict evolution of CH in preterm infants. In the study by Vigone et al, neither screening nor confirmatory s-TSH levels predicted future thyroid function after the age of two years.…”

Section: Characteristicsmentioning

confidence: 99%

Evolution of congenital hypothyroidism in a cohort of preterm born children

Scavone

Giancotti

Anastasio

et al. 2020

Pediatrics & Neonatology

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Background: Congenital hypothyroidism (CH) is reported to be more common in preterm infants than in term infants, especially in sick preterm infants. Though a frequent possibility of transitory thyroidal alterations in this category of neonates, the evolution of CH to transient or permanent forms is unpredictable. Methods: We retrospectively analyzed medical records of 28 preterm infants (<37 weeks gestation) who had exhibited a positive screening for CH at birth during the period 2000 e2015 followed in our Center. Children were divided into three groups: permanent CH (PCH) with thyroid dysgenesis, PCH with eutopic normal-sized thyroid gland, and transient CH (TCH) with eutopic normal-sized thyroid gland. In all groups we described clinical and biochemical characteristics. Secondly, we analyzed the differences between patients with thyroid dysgenesis and patients with eutopic normal-sized gland and we compared PCH and TCH groups with normal-sized thyroid gland in order to identify clinical or biochemical data for early detection of transient forms.Results: Of all patients, 21.4% showed thyroid dysgenesis while 78.6% presented eutopic normal-sized gland. Infants with thyroid dysgenesis had higher median (IQR) baseline s-TSH and levothyroxine (L-T4) dose per weight at 12 months (12 m-dose) than patients with eutopic normal-sized gland. At re-evaluation of the patients with eutopic normal-sized gland, 36% showed PCH and 64% had TCH. The age of the patients at the beginning of L-T4 treatment, gestational age (GA), birth weight, blood thyroid stimulating hormone levels (b-TSH) at first newborn screening (NBS), baseline serum thyroid stimulating hormone (s-TSH), and L-T4 12 m-dose were statistically different between the two groups. Conclusions: Our results demonstrate that factors as GA, birth weight, b-TSH levels at first NBS, baseline s-TSH, L-T4 12 m-dose and age at the start of the treatment may be considered useful predictive elements for the evolution of CH.

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Levothyroxine requirement in congenital hypothyroidism: a 12-year longitudinal study

Cited by 16 publications

References 29 publications

Early Discrimination between Transient and Permanent Congenital Hypothyroidism in Children with Eutopic Gland

Early Discrimination between Transient and Permanent Congenital Hypothyroidism in Children with Eutopic Gland

Congenital hypothyroidism after newborn screening program reorganization in the Apulia region

Evolution of congenital hypothyroidism in a cohort of preterm born children

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