Neonatal hyperthyrotropinemia: population characteristics, diagnosis, management and outcome after cessation of therapy

Zung, Amnon; Tenenbaum‐Rakover, Yardena; Barkan, Shiri; Hanukoglu, Aaron; Hershkovitz, Eli; Pinhas‐Hamiel, Orit; Bistritzer, Tzvy; Zadik, Zvi

doi:10.1111/j.1365-2265.2009.03634.x

Cited by 38 publications

(34 citation statements)

References 39 publications

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“…In a multicenter retrospective study, we observed a high prevalence of prematurity (21%), small size for gestational age (SGA) (7%), or both (14%) among neonates identified with HT (1). This observation corroborates a previous report by Kohler et al (2) who also found a high prevalence of prematurity in a cohort of newborns with transient congenital hypothyroidism (CH) (38%) and transient congenital HT (18%).…”

Section: Introductionsupporting

confidence: 80%

Neonatal hyperthyrotropinemia is associated with low birth weight: a twin study

Zung

Yehieli

Almashanu

2013

European Journal of Endocrinology

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Objective: Contradictory reports ascribe neonatal hyperthyrotropinemia (HT) to prematurity or small weight for gestational age. We aimed to evaluate the association between neonatal HT and birth weight (BW), recovery rate of the disorder, and possible association with perinatal stress. Design: Based on a neonatal screening database, a retrospective twin study was designed where withinpair differences in thyroid function were evaluated while controlling for differences in gestational age and thyroid-affecting environmental confounders. Methods: Two thousand five hundred and ninety-five twin pairs that were screened both for TSH and thyroxine (T 4 ) over 3 years were included. TSH and T 4 levels were evaluated along with BW, birth order, gender, and 17-hydroxyprogesterone (17OHP) that was considered as a surrogate marker for stress. Results: Of all the twin pairs, 7.2% had neonatal HT. Among 156 pairs, HT was more prevalent in the smaller twins (64%; P!0.001), especially in the discordant pairs (76%; PZ0.001). Seventy-five percent of the twins demonstrated a recovery within the first few weeks of life. 17OHP levels were similarly distributed between twins with and without HT. In a cohort of 1534 twin pairs with normal thyroid function, mean TSH levels were significantly higher in the smaller than in the larger twin in the whole group (4.1G3.2 vs 3.8G2.9 mIU/l; P!0.001) and especially among discordant twins (4.7G3.4 vs 3.8G3.0 mIU/l; P!0.001). Conclusions: Elevated TSH levels are associated with low BW, both in infants with HT and in normal neonates. A rapid recovery rate is expected in most cases.

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Section: Introductionsupporting

confidence: 80%

Neonatal hyperthyrotropinemia is associated with low birth weight: a twin study

Zung

Yehieli

Almashanu

2013

European Journal of Endocrinology

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“…Although the evolution over time of the cases with eutopic gland is difficult to be predicted preliminarily, in the last few years a lot of studies [6,7,8,9,10,11,12] have been conducted with the purpose of determining how best to discriminate between cases with either T or permanent (P) CH before the age of 3 years, which is currently adopted for reevaluation.…”

Section: Introductionmentioning

confidence: 99%

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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“…This result indicates that these two distinct thyroid dysfunctions including CH and persistent HT have a different clinical course. Previous reports also suggests the possibility that HTT might be caused by clinical conditions associated with the preterm birth rather than the abnormality of the thyroid gland itself and therefore infants with persistent HTT showed a higher incidence of transient hypothyroidism after re-evaluation [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factor of Permanent Hypothyroidism in Preterm Infants

Chung¹

2017

J Neonatal Biol

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Background: To investigate the incidence and risk factors of permanent hypothyroidism in premature infants diagnosed with congenital hypothyroidism. Methods:A retrospective review of medical records of preterm infants was performed between March 2010 and December 2013. We included infants who were treated with thyroxine after being diagnosed with congenital hypothyroidism and persistent hyperthyrotropinemia. Exclusion criteria included an infants who were lost to follow up or earlier discontinuation of thyroxine medication and had proven permanent hypothyroidism. We performed trial offtherapy at 36 months of age.Results: A total of 49 infants were eligible for trial off-therapy at age 3 years. Permanent and transient hypothyroidism was diagnosed in 12 and 37 infants, respectively. Persistent hypothyroidism was more frequent in the infants with high TSH and low FT4 levels at initial screening and high incidence in abnormalities in thyroid imaging work-ups and positive anti-thyroid antibodies. Moreover, the average thyroxine dosage during follow-up was significantly higher in infants with persistent hypothyroidism (p<0.05). Conclusion:Thyroid dysfunction is common in preterm infants, and nearly 80% of infants showed transient hypothyroidism. Therefore, if there is no other risk factor for permanent hypothyroidism, it is possible to consider an earlier trail off-therapy for preterm infants.

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Neonatal hyperthyrotropinemia: population characteristics, diagnosis, management and outcome after cessation of therapy

Abstract: We recommend obtaining thyroid imaging to distinguish between the two forms of HT. Adherence to recommended doses of thyroxine and probably early cessation of therapy in transient HT can prevent iatrogenic hyperthyroidism in these patients.

Cited by 38 publications

References 39 publications

Neonatal hyperthyrotropinemia is associated with low birth weight: a twin study

Neonatal hyperthyrotropinemia is associated with low birth weight: a twin study

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

Incidence and Risk Factor of Permanent Hypothyroidism in Preterm Infants

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