Sustained attention in school-age children with congenital hypothyroidism: influence of episodes of overtreatment in the first three years of life

Arnao, M.D. Rodríguez; Sánchez, Ana Rodríguez; Íñiguez, E. Dulín; González, María Auxiliadora

doi:10.1016/j.nrleng.2017.08.005

Cited by 6 publications

(8 citation statements)

References 33 publications

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“…In addition, early episodes of both under- and overtreatment may be associated with permanent behavioral problems in a limited number of preadolescent children with CH ( 109 ). Overtreatment during the first months of life (with the exception of fT4 above the normal range with not supressed TSH and/or without signs or symptoms of hyperthyroidism), a critical period for brain development, may be associated with attention deficit at the school age ( 109 , 171 , 172 ), and lower IQ scores ( 108 , 173 , 174 ). Finally, other factors such as socioeducational status ( 71 ) and poor adherence to the treatment ( 71 , 167 , 174 ) may also negatively affect cognitive outcome and educational attainement.…”

Section: Outcomes Of Neonatal Screening and Early Treatmentmentioning

confidence: 99%

Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology

Trotsenburg

Stoupa

Léger

et al. 2021

Thyroid

287

254

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Background: An ENDO-European Reference Network (ERN) initiative was launched that was endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology with 22 participants from the ENDO-ERN and the two societies. The aim was to update the practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). A systematic literature search was conducted to identify key articles on neonatal screening, diagnosis, and management of primary and central CH. The evidence-based guidelines were graded with the Grading of Recommendations, Assessment, Development and Evaluation system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. Summary: The recommendations include the various neonatal screening approaches for CH as well as the etiology (also genetics), diagnostics, treatment, and prognosis of both primary and central CH. When CH is diagnosed, the expert panel recommends the immediate start of correctly dosed levothyroxine treatment and frequent follow-up including laboratory testing to keep thyroid hormone levels in their target ranges, timely assessment of the need to continue treatment, attention for neurodevelopment and neurosensory functions, and, if necessary, consulting other health professionals, and education of the child and family about CH. Harmonization of diagnostics, treatment, and follow-up will optimize patient outcomes. Lastly, all individuals with CH are entitled to a well-planned transition of care from pediatrics to adult medicine. Conclusions: This consensus guidelines update should be used to further optimize detection, diagnosis, treatment, and follow-up of children with all forms of CH in the light of the most recent evidence. It should be helpful in convincing health authorities of the benefits of neonatal screening for CH. Further epidemiological and experimental studies are needed to understand the increased incidence of this condition.

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Section: Outcomes Of Neonatal Screening and Early Treatmentmentioning

confidence: 99%

Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology

Trotsenburg

Stoupa

Léger

et al. 2021

Thyroid

287

254

View full text Add to dashboard Cite

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“…Therefore, many clinical guidelines recommend using a high initial dosage of levothyroxine (10–15 μg/kg·d), regardless of the cause and severity of CH, to ensure a serum FT4 (or T4) concentration in the upper half of the pediatric reference range and a serum TSH level in the normal range for age, is achieved as soon as possible [ 5 – 7 ]. However, a few studies have shown that using a lower thyroxine dosage than recommended could also achieve the same goal while reducing the risk of thyroxine overdose [ 5 , 8 ]. Excessive serum FT4 levels may lead to craniosynostosis (premature fusion of one or more cranial sutures), developmental-behavioral impairment, and attention deficit hyperactivity [ 8 – 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, a few studies have shown that using a lower thyroxine dosage than recommended could also achieve the same goal while reducing the risk of thyroxine overdose [ 5 , 8 ]. Excessive serum FT4 levels may lead to craniosynostosis (premature fusion of one or more cranial sutures), developmental-behavioral impairment, and attention deficit hyperactivity [ 8 – 10 ]. Moreover, levothyroxine might also have a negative effect on intelligence quotients during puberty [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Levothyroxine treatment for congenital hypothyroidism based on thyroid function: a 10-year clinical retrospective study

Yang

et al. 2022

BMC Endocr Disord

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Objective To explore the appropriate dosage of levothyroxine treatment for congenital hypothyroidism patients with different thyroid stimulating hormone (TSH) levels. Methods A total of 116 patients, who were regularly followed-up in our endocrine clinic from January 2010 to December 2020, were divided into four groups based on their thyroid function (group A: TSH ≥ 100 mIU/L, group B: TSH ≥ 20, and < 100, group C: TSH > 4.6 mIU/L and < 20 mIU/L with free thyroxine (FT4) < 6.6 pmol/L, and group D: TSH > 4.6 mIU/L and < 20 mIU/L with FT4 > 6.6 pmol/L). The initial dosage of levothyroxine was individualized for each patient based on their TSH level and then adjusted according to their thyroid function at every follow-up time point. The levothyroxine dosage at each time point was compared between the groups, and thyroid function and physical and neurological development after treatment were also compared. Results After individualized dosage adjustment, all patients achieved normal thyroid function. Although there were statistical differences in neurological development between the four groups (p < 0.05), development was within the normal range for all groups. Conclusion An individualized levothyroxine dosage can provide the same therapeutic effect compared to the recommended dosage. This strategy may also reduce the risk of a drug overdose.

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“…High initial doses of Na-LT 4 (10-15 μg/kg/day) are recommended for rapid normalization of thyroid hormones and TSH for all infants, irrespective of severity and cause of CH. There are studies that have shown lower doses may also have similar success with less risk of overtreatment ( 6 , 9 , 15 , 16 ). Supraphysiological levels of fT 4 may result in premature craniosynostosis, behavioral problems, and attention impairment, and furthermore, may have a negative effect on IQ at adolescence, as one Dutch study has shown ( 15 , 16 , 17 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

“…There are studies that have shown lower doses may also have similar success with less risk of overtreatment ( 6 , 9 , 15 , 16 ). Supraphysiological levels of fT 4 may result in premature craniosynostosis, behavioral problems, and attention impairment, and furthermore, may have a negative effect on IQ at adolescence, as one Dutch study has shown ( 15 , 16 , 17 , 18 ). Although the importance of early detection and effective treatment of CH is beyond dispute, there are some controversies in standard high dose Na-LT 4 ( 19 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Basal Serum Thyroxine Level should Guide Initial Thyroxine Replacement Dose in Neonates with Congenital Hypothyroidism

Günbey¹,

Özön²,

Gönç³

et al. 2021

Jcrpe

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Objective: Initial high-dose sodium levothyroxine (Na-LT 4 ) (10-15 μg/kg/day) replacement for primary congenital hypothyroidism (CH) is recommended in guidelines. However, high-dose Na-LT 4 risks iatrogenic hyperthyroidism. The aim of this study was to investigate the normalizing effect of varying initial doses of Na-LT 4 on serum thyroid hormone levels. Methods: Fifty-two patients were analyzed retrospectively. The patients were classified into mild (27/51.9%), moderate (11/21.1%) and severe (14/26.9%) CH, based on initial free thyroxine (fT 4 ) levels. Time taken to achieve target hormone levels was compared within groups. Results: Initial mean Na-LT 4 doses for mild, moderate and severe disease were 6.9±3.3, 9.4±2.2 and 10.2±2 μg/kg/day. Serum fT 4 levels reached the upper half of normal range (>1.32 ng/dL) in a median of 16, 13 and 16 days in patients with mild, moderate and severe CH with the mean time from initial treatment to first control visit of 14.8±6 days (range 1-36). There was no significant difference in terms of time to achieve target fT 4 hormone levels according to disease severity (p=0.478). Seven (25.9%), eight (72.7%) and eight (57.1%) patients experienced hyperthyroxinemia (serum fT 4 >1.94 ng/dL) in the mild, moderate, and severe CH groups at the first visit, respectively (p=0.016). Conclusion: Not all patients diagnosed with CH require high-dose Na-LT 4 . Initial dose of Na-LT 4 may be selected on the basis of pretreatment thyroid hormone levels. Some patients with moderate and severe CH, experienced iatrogenic hyperthyroxinemia even though the dose was close to the lower limit of the recommended range in guidelines. We suggest that lower initial doses may be appropriate with closer follow-up within the first week.

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Sustained attention in school-age children with congenital hypothyroidism: influence of episodes of overtreatment in the first three years of life

Cited by 6 publications

References 33 publications

Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology

Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology

Levothyroxine treatment for congenital hypothyroidism based on thyroid function: a 10-year clinical retrospective study

Basal Serum Thyroxine Level should Guide Initial Thyroxine Replacement Dose in Neonates with Congenital Hypothyroidism

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