No Association between Elevated Thyroid-Stimulating Hormone at Birth and Parent-Reported Problem Behavior at Preschool Age

Abstract

ObjectivesMild level of iodine deficiency during pregnancy may reduce maternal thyroid hormone production and supply to the fetus hence affecting brain neurodevelopment. The aim of the present study was to investigate the association between elevated neonatal thyroid-stimulating hormone (TSH) level (>5 mU/L), used as a marker of maternal mild iodine deficiency during late pregnancy, and behavioral development of preschool children.MethodsThis retrospective cohort study included 310 Belgian mothers and their children aged 4–5 years old with TSH levels in the range of 0.45–15 mU/L at birth. The TSH level was measured in dried blood spots on filter paper collected by heel stick 3–5 days after birth. Low birth weight, prematurely born children, or children with congenital hypothyroidism were excluded. The degree of behavioral problems was evaluated using the Child Behavior Check List (CBCL) for age 1½–5 years questionnaire. Relevant socioeconomic, maternal, and child factors were also collected.ResultsTSH concentrations and CBCL scores were not associated both in univariate analysis and when adjusting for confounding factors in multivariate analysis.DiscussionElevated TSH concentrations measured at birth was not associated with behavioral development scores.

Are lower TSH cutoffs in neonatal screening for congenital hypothyroidism warranted?

“…The Belgian study conducted by Trumpff et al . found no association between TSH concentration (0.1–15 U/L) and cognitive, psychomotor and behavioral development at preschool age when adjusting for confounding factors using multivariate analysis (28, 29, 56). Cognitive and psychomotor assessment was performed by psychologists using age-appropriate clinical diagnostic tools, respectively, the Wechsler Preschool and Primary Scale of Intelligence (third edition) and Charlop-Atwell Scale of Motor Coordination (28, 30).…”

“…Cognitive and psychomotor assessment was performed by psychologists using age-appropriate clinical diagnostic tools, respectively, the Wechsler Preschool and Primary Scale of Intelligence (third edition) and Charlop-Atwell Scale of Motor Coordination (28, 30). Psychosocial development was assessed using the Child Behavior Check List for age 1½–5 years standardized and validated questionnaire completed by the mothers, a widely used measure for evaluating maladaptive behavioral and emotional problems (56). Of note, the sample size had the statistical power to detect an IQ score difference as small as 4.3 points.…”

Maternal Thyroid Function During Pregnancy or Neonatal Thyroid Function and Attention Deficit Hyperactivity Disorder

“…Three of the five studies of neonatal thyroid hormones and ADHD symptoms were cohort studies (Table 6): Trumpff et al (2016) studied a Belgian cohort ( N total =310), 63 and there were two studies of Canadian cohorts with less than 100 participants each (Ishaik et al 2000; Simic et al 2009). 15,64 Two of the five studies had matched case–control designs: 65,66 ADHD cases (identified through neurodevelopmental diagnostic clinics in Washington, D.C) were matched on the day of newborn screening and birth hospital.…”

Congenital hypothyroidism: insights into pathogenesis and treatment

“…Several recent studies have attempted to address this question. A series of studies in Belgian children that assessed the relationship between newborn screening TSH concentrations and various neurodevelopmental outcomes found no relationship between mild TSH elevation (up to 15 mIU/L) and cognitive or psychomotor development or parent-reported behavior scores at 4–6 years of age [ 54 – 56 ]. However, the power of these studies to detect differences in outcomes was limited by the small number of patients with elevated TSH concentrations, particularly in the 10–15 mIU/L range.…”