Long-Term Course of Hypothyroidism Detected through Neonatal TSH Screening in a Population-Based Cohort of Very Preterm Infants Born at Less than 32 Weeks of Gestation

Odenwald, Birgit; Fischer, Aline G.; Röschinger, Wulf; Liebl, Bernhard; Schmidt, Heinrich; Nennstiel, Uta

doi:10.3390/ijns7040065

Cited by 4 publications

(5 citation statements)

References 53 publications

(84 reference statements)

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“…Although the number of reports of transient hypothyroxinemia in premature infants and considerations regarding the principles and indications for initiating LT4 treatment is increasing, universal rules have not yet been established. Some recommendations propose that the assessment should be limited to TSH and FT4 in children born before the 32 nd week of gestation and with a birth body weight (BBW) lower than 1500 g, also in critically ill children or children from twin pregnancies ( 3 , 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

The prevalence of hypothyroxinemia in premature newborns

et al. 2022

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Congenital hypothyroidism diagnosed by TSH assessment in bloodspot screening may be overlooked in preterm newborns due to immaturity of the hypothalamus-pituitary-thyroid axis in them. The purpose of the study was to determine the prevalence and causes of hypothyroxinemia in preterm newborns, determined by TSH and FT4 serum concentration measurement, performed on the 3-5th day of life. We assessed TSH, FT4 and FT3 serum concentration on the 3-5th day of life in preterm children born at our centre within three consecutive years. We assessed the incidence of hypothyroxinemia, and its cause: primary hypothyroidism, secondary hypothyroidism or low FT4 syndrome - with normal TSH concentration, its dependence - among others - on gestational age (GA), birth body weight (BBW) and being SGA. A total of 525 preterm children were examined. FT4 concentration was decreased in 14.9% of preterm newborns. The most frequent cause of hypothyroxinemia was low FT4 syndrome (79.5%). More than 92% cases of hypothyroxinemia occurred in children born before the 32nd week and/or with BBW below 1500 g. Thus, every fourth child in these groups had a reduced FT4 concentration. Neonates with hypothyroxinemia were significantly lighter than those with normal FT4. In older and heavier neonates with hypothyroxinemia, serious congenital defects were observed. Neither IVH nor SGA nor twin pregnancies predispose children to hypothyroxinemia. Among newborns with untreated hypothyroxinemia in whom TSH and FT4 assessment was repeated within 2-5 weeks, a decreased FT4 concentration was confirmed in 56.1% of cases. As hypothyroxinemia affects 25% of newborns born before the 32nd week of gestation and those in whom BBW is less than 1500g, it seems that in this group of children the newborn screening should be extended to measure serum TSH and FT4 concentration between the 3-5th day of life. In older and heavier neonates, additional serum TSH and FT4 assessment should be limited to children with severe congenital abnormalities but not to all SGA or twins. Despite the fact that the most common form of preterm hypothyroxinemia is low FT4 syndrome, it should be emphasized that FT4 remains lowered on subsequent testing in more them 50% of cases.

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Section: Discussionmentioning

confidence: 99%

The prevalence of hypothyroxinemia in premature newborns

et al. 2022

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“…Immature hypothalamo-pituitary-thyroid axis and thyroid dysfunction are frequently encountered in newborn babies and especially in premature babies (11). Although the relationship between CH and its morbidities in premature babies has been evaluated, the effect of CH on morbidity is still unknown [6][7][8][9][10] . It is known that newborn babies with SGA are at risk for endocrine problems in their advanced ages 26 .…”

Section: Discussionmentioning

confidence: 99%

“…The appropriate levothyroxine dose was determined by measuring serum fT4 and TSH levels at regular intervals (once a week). Based on our routine protocol, all patients admitted to the NICU were diagnosed and treated according to this guideline [10][11][12]21 . The patients who were followed by two Neonatologist (DY, CT) were included in this study.…”

Section: Examination Of Thyroid Function Testsmentioning

confidence: 99%

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Preterm yenidoğanlarda gebelik yaşına göre küçük olmak ile tiroid fonksiyon testleri arasındaki ilişki

Yildiz

Çakır

Tugcu

et al. 2022

Cukurova Medical Journal

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Purpose: The aim of this study was to evaluate the relationship between thyroid hormone levels and clinical outcomes in preterm, small for gestational age (SGA) infants. Materials and Methods: The premature newborns (gestational age of ≤30 weeks) were divided into two groups as SGA and non-SGA. Thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels, the frequency of congenital hypothyroidism (CH), demographic and clinical characteristics, morbidity and mortality rate were compared between the groups. Results: A total of 430 premature newborns, 72 in the SGA group and 358 in the non-SGA group were included. The frequency of CH, morbidity, demographic and clinical characteristics were similar between two groups. The mortality rate was higher in SGA (36.1%) than in non-SGA group (13.6%). Serum fT4 level was lower in SGA group (1.04±0.30 ng/dl) compared to the non-SGA group (1.24±0.33 ng/dl). The serum TSH level was higher in SGA group (9.91 ± 5.6 uIU/L) than in non-SGA group (6.6 ± 5.2 uIU/L). Conclusion: The frequency of thyroid dysfunction was higher in preterm SGA infants compared to non-SGA, which was due to transiently high TSH and low fT4 concentrations. Therefore, thyroid function tests should be monitored periodically in preterm and SGA infants.

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“…Studies evaluating large CH cohorts demonstrate enrichment of preterm cases ( 4 , 16 , 34 ). However, the data are conflicted in defining whether prematurity is associated with permanent ( 17 ) or transient dysfunction ( 35 , 36 ) or both ( 37 ), and the extent to which preterm birth can be used as a reliable predictor of TCH is not clear. Barry et al ( 15 ) confirmed a significant association but others have generally failed to implicate gestational age in this role ( 22 , 24 , 38 ).…”

Section: Preterm Infant and Thyroid Dysfunctionmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: The pathophysiology of transient congenital hypothyroidism

Peters

Schoenmakers

2022

European Journal of Endocrinology

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Transient congenital hypothyroidism (TCH) refers to congenital hypothyroidism which spontaneously resolves in the first few months or years of life. Currently, there is a paucity of reliable markers predicting TCH at diagnosis, and the diagnosis is established following withdrawal of levothyroxine therapy around 3 years of age. The incidence of TCH is increasing, and it is a major contributor to the overall increase in incidence of CH in recent studies. Both genetic factors, in particular mutations affecting DUOX2 and DUOXA2, and environmental factors, e.g iodine deficiency and excess, anti- TSHR antibodies and exposure to anti-thyroid or iodine-rich medications may cause TCH. Resolution of TCH in childhood may reflect both normal thyroid physiology (decreased thyroid hormone biosynthesis requirements after the neonatal period) and clearance or cessation of environmental precipitants. The relative contributions and interactions of genetic and environmental factors to TCH, and the extent to which TCH may be prevented, require evaluation in future population-based studies.

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Long-Term Course of Hypothyroidism Detected through Neonatal TSH Screening in a Population-Based Cohort of Very Preterm Infants Born at Less than 32 Weeks of Gestation

Cited by 4 publications

References 53 publications

The prevalence of hypothyroxinemia in premature newborns

The prevalence of hypothyroxinemia in premature newborns

Preterm yenidoğanlarda gebelik yaşına göre küçük olmak ile tiroid fonksiyon testleri arasındaki ilişki

MECHANISMS IN ENDOCRINOLOGY: The pathophysiology of transient congenital hypothyroidism

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