Neuropsychological Follow-up in Early-Treated Congenital Hypothyroidism: A Problem-Oriented Approach

Abstract

Screening programs for congenital hypothyroidism (CH) dramatically improved the neuropsychological prognosis in affected children. However, mild impairments in cognitive performances, poorer motor skills, defective language abilities, and learning problems have been reported in some studies of early-treated CH children. The occurrence of these defects makes neuropsychological follow-up mandatory. The aim of the present study was to identify those neuropsychological functions that are more frequently affected in early-treated CH children and that might require prompt rehabilitation treatment to prevent permanent defects. The study group involved 24 CH children. Levothyroxine (LT4) treatment (initial dose 8-10 microg/kg per day) was started at mean age of 28 days (range 15-45) and was then adjusted with the goal to keep thyrotropin (TSH) and free thyroid hormone levels in the normal range. Cognitive evaluation was performed at 3, 5, and 7 years of age and did not significantly differ from that of controls. Mean neurological scores were lower in children 5 years of age than in controls. Children with severe neonatal hypothyroidism (serum thyroxine [T4] < 2 microg/dL) had significantly lower neurological scores compared to less affected CH children and normal controls. The most affected functions were balance, extremity coordination, fine motricity, quality of movements, associated movements, and head movements. Language disorders were observed in half of CH children at 3 and 5 years of age, but moderately severe defects were restricted to those with severe neonatal hypothyroidism. In conclusion, a problem-oriented, simplified neuropsychological follow-up of early-treated children with CH should not systematically include the frequent repetition of time-consuming and expensive psychometric tests because individual IQ scores are in the normal range of tests in almost all CH children and can be differentiated from those of normal controls only on a population-statistic basis. Selected tests of motor proficiency are indicated at 3 and 5 years of age to detect those defects in motor skills that appear to be more specifically affected in CH children. Language performances are at particular risk in CH children, and should be always checked at 3 and 5 years of age. Children with even mild language disorders or delayed language achievements should be regularly reevaluated at 6-month intervals and, if no spontaneous improvement is observed, they should receive specific rehabilitation treatment. No further motor and language evaluation is warranted in CH children with normal tests at age 5 years.

Alterações fonoaudiológicas em crianças com hipotireoidismo congênito: revisão crítica da literatura

“…The results showed from the three Speechlanguage Pathology fields investigated, language was the one with higher number of published papers [16][17][18][19][20][21][22][23][24][25][26] . This allows the arguing about this topic in CH children to be more clear and consistent, but do not exclude the importance of other communication aspects.…”

“…Subtitles: SG= study group; CG = control group Figure 2 -Contents of localized papers about speech-language disturbances related to congenital hypothyroidism significant delay in language development [17][18][19][20][22][23][24]26 .…”

“…Besides, does not seem to have a relation between the paper publication period and obtained results, once the most recent ones had variability about the findings of CH children language development [22][23][24][25][26] .…”

Psychological and behavioural aspects in children and adolescents with congenital hypothyroidism diagnosed by neonatal screening: comparison between parents' and children's perceptions

“…Among the remaining 104 patients who came to our paediatric centre for clinical and hormonal follow-up during 2005-2006, 84 were enrolled in the study. The inclusion criteria at the moment of the testing and filling in the questionnaires were as follows: written consent to the study by the parents and/or the patients, good compliance and adequacy of the levothyroxine (L-T 4 ) treatment assayed by regular evaluations of TSH and FT 4 and intelligence quotient (IQ) in the normal range (low average 80-89; average 90-109; high average 110-119; 4 patients with IQ !80 and 7 with IQ O119 were excluded).…”

“…However, previous studies have indicated that children who receive early treatment for CH have a normal intelligence quotient combined with attention problems (2,3), motor deficits and defects in visuospatial skills, language and memory (4,5). Several studies have correlated these problems with the severity of CH and others with the timing in starting treatment (6)(7)(8)(9)(10)(11).…”