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Shah AN, Li W, Zheng D, Lalani S, Kaluarachchi DC, Findley TO. A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants. J Perinatol 2024:10.1038/s41372-024-01985-5. [PMID: 38734804 DOI: 10.1038/s41372-024-01985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES To assess utility and accuracy of a gestational age-based screening targeting premature infants to detect congenital hypothyroidism. STUDY DESIGN A prospective cohort study was conducted in infants <35 weeks' gestational age with clinical outcomes at 2-3 years of age. Patients received newborn screenings at 24 hours and 10-14 days of life. Free T4 (FT4) and thyroid-stimulating hormone (TSH) levels were measured at one month of life and repeated based on algorithm by corrected gestational age. RESULTS Among infants <35 weeks gestation (n = 938), the incidence of hypothyroidism requiring treatment was 1:58. TSH levels at one month of age was predictive of treatment (AUC 0.96, 95% CI 0.88-1). The optimal TSH threshold of 8 mIU/L (8 µU/ml) increased the specificity to 0.97 and sensitivity to 0.88. Following initiation of treatment for hypothyroidism during NICU hospitalization, 43.8% (n = 7) were diagnosed with permanent congenital hypothyroidism. CONCLUSIONS Our study supports a gestational age-based screening algorithm for early detection of hypothyroidism in premature infants.
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Affiliation(s)
- Avni N Shah
- Division of Pediatric Endocrinology, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Denise Zheng
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Psychiatry, Case Western Reserve University - University Hospitals, Cleveland, OH, USA
| | - Sana Lalani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Tina O Findley
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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Aygün E, Semerci SY, Çakıl Sağlık A, Yurdakul Ertürk E. Neurodevelopmental Outcome of Infants with Transient Hypothyroxinemia of Prematurity in a Newborn Intensive Care Unit. J Clin Res Pediatr Endocrinol 2024; 16:60-68. [PMID: 37750208 PMCID: PMC10938524 DOI: 10.4274/jcrpe.galenos.2023.2023-6-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/25/2023] [Indexed: 09/27/2023] Open
Abstract
Objective The aim of this study was to evaluate neurological development of infants with transient premature hypothyroxinemia (THOP). Methods This prospective study included newborns who were born between 28-36 weeks of gestation (GW) and were admitted to the neonatal intensive care unit. Newborns exposed to maternal thyroid disease, or with severe intracranial problems, and congenital anomalies were excluded. Infants with THOP were the study group and those without THOP formed the control group. The study group was subdivided into those receiving levothyroxine replacement (5 μg/kg/day) and those who were untreated. Neonatal demographics, and morbidities, including respiratory distress syndrome, bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) were evaluated. The Ages and Stages Questionnaire (ASQ) and ASQ:Social-Emotional (ASQ:SE) developmental screening tests were administered to the entire study population at the corrected age of two years. Results Seventy infants were included in this study, 40 of whom had THOP. The mean GW was 34.4±3.8 weeks in the study group and 37.2±2.3 weeks in controls (p=0.69). Mean overall birth weight was 1640±428 g. Levothyroxine replacement was started in 12/40 infants (30%). The groups were similar in terms of demographic characteristics. Rates of BPD and ROP were higher in the treated group (p=0.01). ASQ and ASQ:SE results did not differ between groups (p=0.75), nor did these scores differ between infants with THOP who did or did not receive levothyroxine (p=0.14). Conclusion Although levothyroxine replacement therapy was associated with increased rates of BPD and ROP, this treatment did not appear to improve long-term neurological outcomes in this small group of infants with THOP. Prospective controlled studies with much larger sample sizes are needed to clarify the role of levothyroxine replacement in THOP.
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Affiliation(s)
- Erhan Aygün
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Neonatology, İstanbul, Turkey
| | - Seda Yılmaz Semerci
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Neonatology, İstanbul, Turkey
| | - Adviye Çakıl Sağlık
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Neonatology, İstanbul, Turkey
| | - Emine Yurdakul Ertürk
- Ordu University Training and Research Hospital, Department of Pediatrics, Ordu, Turkey
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Nolan B, Uy C, Stablein L, Bany-Mohammed F. Screening for Delayed Thyroid Stimulation Hormone Rise and Atypical Congenital Hypothyroidism in Infants Born Very Preterm and Infants with Very Low Birth Weight. J Pediatr 2024; 269:113974. [PMID: 38401790 DOI: 10.1016/j.jpeds.2024.113974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/24/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To determine among infants born very preterm (VPT) or with very low birth weight (VLBW) the incidence of alterations in thyroid function and associated comorbidities; the incidence of atypical congenital hypothyroidism (CH) requiring thyroxine therapy; and reference ranges for rescreening at 1 month of age. STUDY DESIGN A retrospective review of infants born VPT or with VLBW and admitted to UC Irvine Medical Center between January 1, 2012, and December 31, 2020. Repeat thyroid screening was obtained at 1 month of life (+10 days). Infants with thyroid-stimulating hormone (TSH) >5 μIU/mL or free thyroxine <0.8 ng/dL underwent follow-up testing and endocrinology consultation. Initial newborn screening (NBS) and repeat thyroid screening data were collected via chart review. Demographic data and short-term outcomes were abstracted from the California Perinatal Quality Care Collaborative database. RESULTS In total, 430 patients were included; 64 of 429 patients (14.9%) had TSH >5 μIU/mL and 20 of 421 patients (4.8%) had free thyroxine <0.8 ng/dL. Logistic regression analysis identified small for gestational age (P = .044), patent ductus arteriosus (P = .013), and late-onset sepsis (P = .026) as risk factors associated with delayed TSH rise. Atypical CH requiring treatment through neonatal intensive care unit discharge was diagnosed in 6 patients (incidence of 1.4%); none were identified by NBS. The 90th percentile TSH for infants with extremely low birth weight (<1000 g) was 7.2 μIU/mL, and the 95th percentile for those with birth weight of 1000-1500 g was 6.1 μIU/mL; using these cutoff values identified all infants diagnosed with atypical CH with 100% sensitivity and 90%-95% specificity. CONCLUSIONS Abnormal thyroid function is common in infants born preterm. Those infants, including some with atypical CH, are missed by NBS. We recommend repeat thyroid screening with TSH at 1 month of age in infants born VPT or infants with VLBW to identify CH that may require therapy.
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Affiliation(s)
- Bret Nolan
- Division of Neonatology, Department of Pediatrics, University of California Irvine, Orange, CA
| | - Cherry Uy
- Division of Neonatology, Department of Pediatrics, University of California Irvine, Orange, CA
| | - Lisa Stablein
- UC Irvine Medical Center High-Risk Infant Follow-up Program, Department of Pediatrics, University of California Irvine, Orange, CA
| | - Fayez Bany-Mohammed
- Division of Neonatology, Department of Pediatrics, University of California Irvine, Orange, CA.
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Costeira MJ, Costa P, Roque S, Carvalho I, Vilarinho L, Palha JA. History of Neonatal Screening of Congenital Hypothyroidism in Portugal. Int J Neonatal Screen 2024; 10:16. [PMID: 38390980 PMCID: PMC10885029 DOI: 10.3390/ijns10010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Congenital hypothyroidism (CH) leads to growth and development delays and is preventable with early treatment. Neonatal screening for CH was initiated in Portugal in 1981. This study examines the history of CH screening in the country. Data were obtained from annual reports and from the national database of neonatal screening laboratory. The CH screening strategy primarily relies on the thyroid-stimulating hormone (TSH), followed by total thyroxine measurement as the second tier for confirmation. The TSH cutoff started at 90 mIU/L, decreasing to the actual 10 mIU/L. The coverage of the screening program has increased rapidly; although voluntary, it reached about 90% in 6 years and became universal in 10 years. Guideline and cutoff updates led to the identification of over 200 additional cases, resulting in specific retesting protocols for preterm and very-low-birth-weight babies. The actual decision tree considers CH when TSH levels are above 40 mIU/L. Data from the CH screening also provide an indication of the iodine status of the population, which is presently indicative of iodine insufficiency. The Portuguese neonatal screening for CH is a history of success. It has rapidly and continuously adapted to changes in knowledge and has become a universal voluntary practice within a few years.
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Affiliation(s)
- Maria José Costeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.J.C.); (P.C.)
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
- Department of Neonatology, Unidade Local de Saúde do Alto Ave Rua dos Cutileiros, 4835-044 Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.J.C.); (P.C.)
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
| | - Susana Roque
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.J.C.); (P.C.)
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
| | - Ivone Carvalho
- Neonatal Screening, Metabolism & Genetics—National Institute of Health Dr. Ricardo Jorge, 4000-053 Porto, Portugal; (I.C.); (L.V.)
| | - Laura Vilarinho
- Neonatal Screening, Metabolism & Genetics—National Institute of Health Dr. Ricardo Jorge, 4000-053 Porto, Portugal; (I.C.); (L.V.)
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.J.C.); (P.C.)
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
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Li X, Zhang Z, Cai W, Zhou X, Zhang Y, Wu C, Xu X, Wu H. Association Between Serum Ferritin Levels in Early Pregnancy and Thyroid Function and Pregnancy Outcomes in Chinese Population. Int J Womens Health 2023; 15:1951-1957. [PMID: 38106565 PMCID: PMC10723073 DOI: 10.2147/ijwh.s436651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
Background The relationship of iron deficiency and thyroid hormone has been researched a lot among pregnant or other healthy population. However, invisible iron deficiency, namely shortage of serum ferritin (sFer) level, has been barely investigated among Chinese pregnant women. This study aimed to explore the effects of sFer status on thyroid function and pregnancy outcomes in a population-based upper first-class hospital. Methods A total of 781 singleton pregnant women of gestation in Shanghai General Hospital took part in this retrospective cohort study. The participants were divided into four groups by quartiles of serum ferritin levels (Q1-4). Binary logistic regressions were used to examine the strength of association between the different traits and the serum ferritin (sFer) quartiles separately, where Q1 (lowest ferritin quartile) was taken as the base reference. One-way ANOVA was adopted to compare the averages of the different variables across sFer quartiles. Categorical measures were compared by Fisher exact test or chi-square test. Results As the sFer concentration rises, incidence of premature birth (15.8%vs 12.3% vs 9.20% vs 6.20% p = 0.016) as well as threatened miscarriage (14.8% vs 7.2% vs 8.70% vs 6.70% p = 0.021) presented a downward trend. Compared with the other sFer group, subjects of the low sFer group were older, more often to be found to have lower serum γT3 and FT4 levels in early pregnancy but not in middle pregnancy. Conclusion sFer concentration in the first trimester can affect thyroid function. The correction of invisible iron deficiency with inadequate sFer status prior to pregnancy or during early pregnancy is imperative, not only to prevent anemia, but also for maintaining optimum thyroid function and normal fetal development. For clinicians, sFer status of pregnant women should be attached great importance apart from attention to iron level.
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Affiliation(s)
- Xing Li
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Zhuyuan Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Wen Cai
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Xuexin Zhou
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Cailiang Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Xianming Xu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Hao Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
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Năstase L, Cristea O, Diaconu A, Stoicescu SM, Mohora R, Pascu BM, Tala ST, Roșca I. Two Cases of Congenital Hypothyroidism Revealing Thyroid Agenesis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1887. [PMID: 37893606 PMCID: PMC10608129 DOI: 10.3390/medicina59101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Congenital hypothyroidism (CH) may have major detrimental effects on growth and neurological development, but early intervention leads to excellent outcomes. CH is classified as transient or permanent, primary or secondary, with primary CH being the most common neonatal endocrine disorder. Most patients with CH do not present any typical signs and symptoms of hypothyroidism shortly after birth, partly due to transplacental maternal thyroid hormone transfer and residual neonatal thyroid function. This paper reports on two CH cases. During the initial Neonatal Intensive Care Unit (NICU) admission phase, CH was not suspected due to nonspecific signs. The distinct characteristics of our cases are as follows: both infants were admitted to the NICU for respiratory distress syndrome, requiring invasive mechanical ventilation, and both were born to diabetic mothers. Following extubation, they both showed similar neurological issues, including reduced muscle tone and feeding difficulties. Initially, those symptoms were attributed to delayed clearance of analgesic and sedative medication. However, symptoms progressively worsened over time. Subsequent tests revealed both meeting CH diagnostic criteria: an unusual ultrasound indicating thyroid agenesis and abnormal hormone levels. Guided by the pediatric endocrinology team, prompt hormonal treatment was started with improvements in neurocognitive function and feeding. Usually, CH screening involves blood samples from healthy newborns at 2-3 days of life. Abnormal results require confirmation, prompting treatment within two weeks. Certain NICU-admitted infants face higher diagnosis delays, as seen in those two cases where CH screening was postponed. Thus, for all neonates with persistent pathologies unresponsive to standard etiological treatment, conducting a comprehensive anamnestic evaluation of the medical history, along with maternal preconceptional and prenatal nutrition, is recommended.
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Affiliation(s)
- Leonard Năstase
- Neonatology Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 011061 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Octaviana Cristea
- Neonatology Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 011061 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandra Diaconu
- Neonatology Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 011061 Bucharest, Romania
| | - Silvia-Maria Stoicescu
- Neonatology Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 011061 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ramona Mohora
- Neonatology Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 011061 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Bogdan Mihai Pascu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Endocrinology Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania
| | - Simona Tania Tala
- Endocrinology Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 020395 Bucharest, Romania
| | - Ioana Roșca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Neonatology Department, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. P. Sârbu”, 060251 Bucharest, Romania
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Shi R, Jiang J, Wang B, Liu F, Liu X, Yang D, Li Z, He H, Sun X, Liu Q, Li H, He J, Yu J, Zhang M, Reddy S, Yu Y, Zhao J. Dynamic Screening of Thyroid Function for the Timely Diagnosis of Congenital Hypothyroidism in Very Preterm Infants: A Prospective Multicenter Cohort Study. Thyroid 2023; 33:1055-1063. [PMID: 37566523 DOI: 10.1089/thy.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Background: Preterm infants presented a high prevalence of congenital hypothyroidism (CH), while the optimal screening pattern is still under debate. This study aimed at evaluating the characteristics of thyroid function by conducting weekly screening during the first month of life in very preterm infants (VPIs) to achieve timely diagnosis and treatment of CH. Methods: A prospective cohort study was carried out on VPIs born with gestational age (GA) <32 weeks (w) and admitted to the participating institutes from January 1, 2019 to December 31, 2022. Serial serum thyroid hormone levels were measured weekly within the first month after birth, and at 36 w of corrected age, or before discharge. Datasets for serial thyroid hormone levels and general information were obtained. Results: A total of 5992 VPIs were enrolled in this study, of which 456 (7.6%) [95% confidence interval (CI), 6.9-8.3%] were diagnosed with CH. The incidence of CH increased with lower GA, moving from 4.8% [CI, 3.4-6.1%] at GA 31 w to 16.9% [CI, 8.3-25.4%] at GA <26 w. Among the CH subjects, 57.7% [CI, 53.1-62.2%] were identified after the first screening and classified as delayed thyrotropin elevation (dTSH). With the decrease of GA, the proportion of dTSH also increased, moving from 38.1% [CI, 27.5-48.7%] at GA 31 w to 82.6% [CI, 65.8-99.4%] at GA <26 w. Through conducting weekly screening of thyroid function, it was remarkable that only 42.3% [CI, 37.8-46.9%] of CH subjects were diagnosed during the first screening. The cumulative rate of CH identified by rescreening performed at the second, third, and fourth week was 76.1% [CI, 72.2-80.0%], 90.6% [CI, 87.9-93.3%], and 98.9% [CI, 97.9-99.9%], respectively. Conclusion: The incidence of CH and dTSH both increase with lower GA in VPIs. Dynamic screening of thyroid function by weeks within the first month of life is crucial for the timely diagnosis and treatment of CH in VPIs, and it might effectively reduce the implications of missed diagnosis and delayed treatment. Clinical Trials Registration: ChiCTR1900025234 and ChiCTR2000037918 (Registration number).
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Affiliation(s)
- Ranran Shi
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jie Jiang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Baohong Wang
- Department of Neonatology, Yantai Yuhuangding Hospital, Yantai, China
| | - Fengmin Liu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, China
| | - Xinjian Liu
- Department of Neonatology, Hebei PetroChina Central Hospital, Langfang, China
| | - Dejuan Yang
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhongliang Li
- Department of Neonatology, W.F. Maternal and Child Health Hospital, Weifang, China
| | - Haiying He
- Department of Neonatology, The Third Hospital of Bao Gang Group, Baotou, China
| | - Xuemei Sun
- Department of Neonatology, Linyi People's Hospital, Linyi, China
| | - Qiongyu Liu
- Department of Neonatology, Women and Children's Healthcare Hospital of Linyi, Linyi, China
| | - Huimin Li
- Department of Neonatology, Jinan Maternity and Child Health Care Hospital, Jinan, China
| | - Jinrong He
- Department of Neonatology, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Jiabi Yu
- Department of Neonatology, Qilu Hospital of Shandong University, Jinan, China
| | - Ming Zhang
- Department of Neonatology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China
| | - Simmy Reddy
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, China
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Yilmaz A, Ozer Y, Kaya N, Cakir AD, Culpan HC, Perk Y, Vural M, Evliyaoglu O. Clinical indicators that influence a clinician's decision to start L-thyroxine treatment in prematurity with transient hypothyroxinemia. Ital J Pediatr 2023; 49:105. [PMID: 37644575 PMCID: PMC10466863 DOI: 10.1186/s13052-023-01516-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Transient hypothyroxinemia of prematurity (THOP) is defined as a low level of circulating thyroxine (T4), despite low or normal thyroid-stimulating hormone (TSH) levels. AIMS We aimed to evaluate the incidence of THOP, the clinical and laboratory findings of preterm infants with this condition and the levothyroxine (L-T4) treatment. METHODS Preterm infants (n = 181) delivered at 24-34 weeks of gestation were evaluated by their thyroid function tests that were performed between the 10th and 20th days of postnatal life and interpreted according to the gestational age (GA) references. Clinical and laboratory characteristics of the patients with THOP and normal thyroid function tests were compared. Patients with THOP and treated with L-T4 were compared with the ones who were not regarding laboratory, and clinical characteristics. RESULTS Incidence of hypothyroxinemia of prematurity was 45.8% (n = 83). Euthyroidism, primary hypothyroidism, and subclinical hypothyroidism were diagnosed in 47.5% (n = 86), 5% (n = 9) and 1.7% (n = 3) of the patients, respectively. Mean birth weight (BW) and GA were significantly lower in the hypothyroxinemia group than in the euthyroid group (p < 0.001). L-T4 was started in 43% (n = 36) of the patients with THOP. Treatment initiation rate was 44.4% (n = 16) in 24-27 wk, 41.6% (n = 15) in 28-30 wk, and 13.8% (n = 5) in 31-34 wk. As the GA increased, the incidence of THOP and the rate of treatment initiation decreased (p < 0.001). The lowest free thyroxine (FT4) cut-off value was 0.72 ng/dl in the treated group. In addition, incidences of vancomycin + amikacin, caffeine, dopamine treatments, RDS, IVH, BPD, central catheter, FFP transfusion, and ventilator support were higher in the treated group (P < 0.05). CONCLUSION This study revealed that prevalence of THOP increased as the GA and BW decreased. As the GA decreased, THOP patients requiring L-T4 treatment increased. Additionally, association with comorbid diseases increased the requirement of treatment.
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Affiliation(s)
- Aslan Yilmaz
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey.
| | - Yavuz Ozer
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Nesrin Kaya
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Aydilek Dagdeviren Cakir
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Hazal Cansu Culpan
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Yildiz Perk
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Mehmet Vural
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
| | - Olcay Evliyaoglu
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, Istanbul, 34098, Turkey
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Yu A, Alder N, Lain SJ, Wiley V, Nassar N, Jack M. Outcomes of lowered newborn screening thresholds for congenital hypothyroidism. J Paediatr Child Health 2023. [PMID: 37184332 DOI: 10.1111/jpc.16425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Newborn screening (NBS) has largely eliminated the physical and neurodevelopmental effects of untreated congenital hypothyroidism (CH). Many countries, including Australia, have progressively lowered NBS bloodspot thyroid-stimulating hormone (b-TSH) thresholds. The impact of these changes is still unclear. OBJECTIVES To evaluate the performance of CH NBS following the reduction of b-TSH thresholds in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia, from 15 to 8 mIU/L, and to determine the clinical outcomes of cases detected by these thresholds. METHODS NBS data of 346 849 infants born in NSW/ACT, Australia from 1 November, 2016-1 March, 2020 inclusive were analysed. A clinical audit was conducted on infants with a preliminary diagnosis of CH born between 1 January, 2016-1 December, 2020 inclusive. RESULTS The lowered b-TSH threshold (≥8 mIU/L, ~99.5th centile) detected 1668 infants (0.48%), representing an eight-fold increase in recall rate, of whom 212 of 1668 (12.7%) commenced thyroxine treatment. Of these 212 infants, 62 (29.2%) (including eight cases with a preliminary diagnosis of thyroid dysgenesis) had an initial b-TSH 8-14.9 mIU/L. The positive predictive value for a preliminary diagnosis of CH decreased from 74.3% to 12.8% with the lowered threshold. Proportionally, more pre-term infants received a preliminary CH diagnosis on screening with the lower threshold (16.1% of 62) than with the higher threshold (8.0% of 150). CONCLUSION Clinically relevant CH was detected using the lowered threshold, albeit at the cost of an eight-fold increase in recall rate. Further clinical and economic studies are required to determine whether benefits of lowered screening thresholds outweigh potential harms from false-positive results on infants, their families and NBS programs.
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Affiliation(s)
- Aolei Yu
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nelson Alder
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Samantha J Lain
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Veronica Wiley
- New South Wales Newborn Screening Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Disciplines of Genetic Medicine and Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Jack
- University Centre for Rural Health, Lismore, NSW 2480, University of Sydney, Lismore, Australia, Australia
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Liu L, He W, Zhu J, Deng K, Tan H, Xiang L, Yuan X, Li Q, Huang M, Guo Y, Yao Y, Li X. Global prevalence of congenital hypothyroidism among neonates from 1969 to 2020: a systematic review and meta-analysis. Eur J Pediatr 2023:10.1007/s00431-023-04932-2. [PMID: 37071175 DOI: 10.1007/s00431-023-04932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/13/2023] [Accepted: 03/11/2023] [Indexed: 04/19/2023]
Abstract
Little is known about the global prevalence of congenital hypothyroidism (CH), though it is known to vary across countries and time periods. This meta-analysis aims to estimate the global and regional prevalence of CH among births between 1969 and 2020. PubMed, Web of Sciences, and Embase databases were searched for relevant studies between January 1, 1975, and March 2, 2020. Pooled prevalence was calculated using a generalized linear mixed model, and expressed as a rate per 10,000 neonates. The meta-analysis involved 116 studies, which analyzed 330,210,785 neonates, among whom 174,543 were diagnosed with CH. The pooled global prevalence of CH from 1969 to 2020 was 4.25 (95% confidence interval (CI) 3.96-4.57). The geographic region with highest prevalence was the Eastern Mediterranean (7.91, 95% CI 6.09-10.26), where the prevalence was 2.48-fold (95% CI 2.04-3.01) that in Europe. The national income level with the highest prevalence was upper-middle (6.76, 95% CI 5.66-8.06), which was 1.91-fold (95% CI 1.65-2.22) that in high-income countries. Global prevalence of CH was 52% (95% CI 4-122%) higher in 2011-2020 than in 1969-1980, after adjusting for geographic region, national income level, and screening strategy. Conclusion: The global prevalence of CH increased from 1969 to 2020, which may reflect the implementation of national neonatal screening, neonatal testing for thyroid-stimulating hormone, and a lowering of the diagnostic level of this hormone. Additional factors are likely to be driving the increase, which should be identified in future research. What is Known: • Cumulated evidence had suggested that the occurrences of congenital hypothyroidism (CH) among newborns were varied in different countries.. • Up-trends of the birth prevalence of CH were observed in many European and American countries. What is New: • This is the first meta-analysis to estimate global and regional prevalence of CH among newborns. • The global prevalence of CH has increased by 127% since 1969. The Eastern Mediterranean has the highest prevalence and stands out with the most pronounced escalation in the prevalence of CH.
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Affiliation(s)
- Lei Liu
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Wenchong He
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Jun Zhu
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance, West China Second Hospital, Sichuan University, Chengdu, 610041, China
| | - Huiwen Tan
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Liangcheng Xiang
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xuelian Yuan
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qi Li
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Menglan Huang
- School of Resource and Environmental Engineering, Mianyang Teachers' College, Mianyang, 621000, China
| | - Yingkun Guo
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Yongna Yao
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Xiaohong Li
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, 20 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China.
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11
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Chen S, Lu X, Yang B, Wu J, Huang H, Zou Y, Tang W, Xu P, Yang Y. Developmental Trends in Postnatal Thyroid Hormones and Thyroid Dysfunction in Preterm Infants Born at less than 34 weeks Gestation. Fetal Pediatr Pathol 2023:1-11. [PMID: 37053007 DOI: 10.1080/15513815.2023.2195520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To analyse the trends in thyroid function tests (TFT) in preterm infants, evaluate the frequency of thyroid dysfunction, and identify the factors that influence thyroid function. METHODS The TFT results and risk factors for thyroid dysfunction in preterm infants with gestational ages (GA) between 25 and 34 weeks were analysed. RESULTS In total, 535 infants were enrolled in this study. Thyroid hormone levels vary with gestational and postnatal age, and the total frequency of thyroid dysfunction is 50.3%. Thirty-one infants (5.8%) had delayed TSH elevation. Transient hypothyroxinaemia of prematurity remained significantly associated with both lower birth weight and GA. Congenital hypothyroidism was significantly associated with lower birth weight, 5 min Apgar score, and dopamine use. CONCLUSIONS Thyroid hormone levels in preterm infants are related to gestation and postnatal age, the frequency of thyroid dysfunction in premature infants is high, and is negatively correlated with GA and birth weight.
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Affiliation(s)
- Shaohong Chen
- Medical College of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Xiaoyan Lu
- Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Bicheng Yang
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Jieru Wu
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Hui Huang
- Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Yang Zou
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Wenyan Tang
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Ping Xu
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Yu Yang
- Medical College of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
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12
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Pande A, Anjankar A. A Narrative Review on the Effect of Maternal Hypothyroidism on Fetal Development. Cureus 2023; 15:e34824. [PMID: 36923193 PMCID: PMC10008768 DOI: 10.7759/cureus.34824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
The thyroid is a butterfly-shaped gland located in the human body's neck region. The thyroid produces three hormones that are essential for regulating body temperature, energy production, weight, hair and nail growth, and menstrual cycle maintenance. The production of these hormones is controlled by a feedback mechanism. Various factors cause changes in the stimulation and inhibition of these hormones, which ultimately causes either excessive release or a decrease in the levels of thyroid hormones. These causes can be physiological or pathological. One of the physiological causes is pregnancy. Pregnancy is a very complex process in which many changes occur in the body and its functioning. One of which is changes in the maternal thyroid gland. The inability to adequately adapt to the changes leads to the abnormal functioning of the thyroid gland. During pregnancy, there is a variation in the concentration of thyroid hormones which may cause a decrease in levels or inhibition in the production of thyroid hormones. This condition is called hypothyroidism. Hypothyroidism in pregnant mothers can either be gestational or may be a condition that is present way before her pregnancy. Often, gestational hypothyroidism reverts after delivery during the postpartum period but can also be present as subclinical hypothyroidism. In such cases, they pose a significant threat to development, cause growth hindrance to the infant in the womb, and cause abnormalities in the offspring in the future. Some of the changes occur in the gland because of enhancement in levels of thyroid binding globulin, increased clearance rate of iodine from the body in kidneys, altered effects in human chorionic gonadotropin hormone, and decreased consumption of iodine in meals. Iodine disbalance in maternal hypothyroidism is associated with severe health issues like cretinism and mental retardation. Thyroid hormones are crucial for the infant's neural, cognitive, and intelligence quotient development in the womb. Thus, the disturbances in the maternal hormone levels disturb typical early developmental characteristics. In the world of rapidly advancing scientific research, there are many ways in which this condition can be detected early, diagnosed correctly, and given apt and required attention and treatment for causing the least harm to the fetus and the mother.
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Affiliation(s)
- Arundhati Pande
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Ashish Anjankar
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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13
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Sakornyutthadej N, Mahachoklertwattana P, Poomthavorn P. Thyroid function and long-term outcomes of children born to mothers with Graves' disease: A 20-year review. J Paediatr Child Health 2023; 59:526-532. [PMID: 36722797 DOI: 10.1111/jpc.16343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/22/2022] [Accepted: 01/14/2023] [Indexed: 02/02/2023]
Abstract
AIM Thyroid dysfunction in infants born to mothers with Graves' disease (GD) is influenced by maternal factors including thyroid status, thyroid-stimulating hormone (TSH) receptor antibody (TRAb) concentration and antithyroid drug use. Thyroid dysfunction during early life could affect growth and development later in life. The aim of this study is to evaluate thyroid function tests (TFTs), and long-term growth and development of children born to mothers with GD. METHODS A retrospective chart review of children born to mothers with GD at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, between January 2000 and December 2019 was performed. Clinical data including age of children at enrolment, sex, gestational age, birthweight, maternal thyroid status, maternal TRAb level, maternal GD treatment during pregnancy, neonatal TSH screening and TFT results, and growth and development outcomes of children were collected. RESULTS There were 262 children (148 males) enrolled. Twelve (4%) infants had neonatal GD. Five (2%) infants had hypothyroidism requiring levothyroxine treatment: four had secondary hypothyroidism and one patient had congenital primary hypothyroidism. Seven (3%) infants had transient TSH elevation, which fell to normal by 2 weeks of age. The remaining 238 children had normal TFT results. Three out of 12 children with neonatal GD had either delayed growth or development. CONCLUSIONS A number of infants born to mothers with GD had abnormal TFTs requiring specific management, and some of them had abnormal growth and development. Careful evaluation of TFTs and long-term follow-up are mandatory for those children.
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Affiliation(s)
- Natee Sakornyutthadej
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pat Mahachoklertwattana
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preamrudee Poomthavorn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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14
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Is Thyroid Monitoring Warranted in Infants and Young Children After Intravascular Administration of Iodine-Based Contrast Media? AJR Am J Roentgenol 2023; 220:144-145. [PMID: 35731099 DOI: 10.2214/ajr.22.28007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
On March 30, 2022, the U.S. FDA issued a drug safety communication recommending that infants and young children through 3 years of age undergo monitoring of thyroid function within 3 weeks of intravascular administration of iodine-based contrast media. This article considers the literature that was referenced for this decision and provides an outlook on thyroid monitoring after diagnostic imaging from pediatric radiology and pediatric endocrinology perspectives.
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15
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Huang Y, Xu Y, Xu M, Zhao X, Chen M. Application of oral inorganic iodine in the treatment of Graves' disease. Front Endocrinol (Lausanne) 2023; 14:1150036. [PMID: 37077352 PMCID: PMC10106709 DOI: 10.3389/fendo.2023.1150036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Iodine is a crucial trace element for the human body and the basic raw material for the synthesis of thyroid hormones. Oral inorganic iodine includes dietary iodine and therapeutic iodine, both of which are closely associated with thyroid immunity and metabolism. Graves' disease (GD), also known as diffuse toxic goiter, is characterized by hyperthyroidism and high iodine metabolism. Clinically, patients diagnosed with GD are often asked to limit iodine intake or even avoid iodine in their diet. The latest research has demonstrated that the interference of dietary iodine with antithyroid drugs (ATDs) treatment may be overestimated. In addition, as a medication for GD treatment, the administration of inorganic iodine has shown positive results in patients with mild hyperthyroidism, a low thyroid autoantibody concentration, a small thyroid volume, a high iodine diet and so on. Inorganic iodine may also be used as an alternative when patients experience side effects with traditional ATDs and for those who still prefer conservative treatment. Due to its low teratogenicity, blood toxicity and bone marrow toxicity, inorganic iodine plays a unique role in special populations, such as pregnant or lactating patients and patients receiving tumor radiotherapy or chemotherapy. In this review, the research progress, biological function, doses and effects, applicable populations and specific applications of dietary iodine and therapeutic iodine are summarized to provide references for the diagnosis and treatment of GD, thus improving the quality of life of GD patients.
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16
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González Martínez S, Prieto García B, Escudero Gomis AI, Delgado Álvarez E, Menéndez Torre EL. Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:375-382. [PMID: 36241542 DOI: 10.1016/j.anpede.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/12/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Neonatal thyroid stimulating hormone (nTSH) is a marker of iodine nutrition status in the population. The WHO considers a prevalence of less than 3% of nTSH levels greater than 5 mIU/L in samples obtained within 72h from birth indicative of iodine sufficiency. The aim of this study was to determine the prevalence of nTSH levels greater than 5 mIU/L in an iodine-sufficient population and its association with maternal, neonatal and obstetric factors. MATERIALS AND METHODS A total of 243 pregnant women were recruited between May and June 2017 in our health area. A questionnaire of iodine intake was administered, in addition to determination of ioduria, thyroid function and autoimmunity in the first trimester of gestation. We analysed nTSH levels in samples collected between 48 and 72h post birth and other obstetric and neonatal factors. RESULTS The mean nTSH level (standard deviation) was 2.43 (1.68 mIU/L), with 7.8% of neonates having levels greater than 5 mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (P = 0.021) or TSH levels greater than 2.5 mIU/L, in both the case of negative (P = 0.049) and positive (P = 0.006) thyroid autoimmunity results. Maternal ioduria less than 150 μg/L was a risk factor for nTSH levels greater than 5 mIU/L (3.70 [1.06-14.60]; P = 0.046), while a neonatal weight of 2500 g or greater was a protective factor (0.14 [0.02-1.00]; P = 0.038). CONCLUSIONS The prevalence of nTSH levels greater than 5 mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels greater than 5 mIU/L. Given that nTSH is currently measured before 72h post birth, we need new cut-off points to keep on using nTSH as a marker of iodine nutritional status.
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Affiliation(s)
- Silvia González Martínez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain.
| | - Belén Prieto García
- Servicio de Bioquímica Clínica, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Elías Delgado Álvarez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Edelmiro Luis Menéndez Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
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17
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Campos-Martorell A, Montaner Ramon A, Narváez Barros K, Marin Soria JL, López Galera RM, Fernández DY, León MC. Thyroid Function in 509 Premature Newborns Below 31 Weeks of Gestational Age: Evaluation and Follow-up. J Clin Res Pediatr Endocrinol 2022; 14:453-462. [PMID: 35860376 PMCID: PMC9724057 DOI: 10.4274/jcrpe.galenos.2022.2022-2-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Preterm and low birth weight (LBW) neonates may present with thyroid dysfunction during a critical period for neurodevelopment. These alterations can be missed on routine congenital hypothyroidism (CH) screening which only measures thyroid stimulating hormone (TSH). The objective of this study was to evaluate a protocol for thyroid function screening (TFS) six years after national implementation. METHODS Serum TSH and free thyroxine (fT4) were measured during the second week of life in neonates below 31 weeks. Patients with abnormal TFS (fT4 <0.8 ng/dL and/or TSH >5 mU/L) were followed up with repeated tests until normal levels were reported. Patients who were still on levothyroxine (LT4) at three years of age were re-evaluated. RESULTS Five-hundred and nine neonates were included. Thyroid dysfunction was detected in 170 neonates (33%); CH n=20 (3.9%) including typical CH n=1; delayed TSH elevation CH n=19; hypothyroxinemia of prematurity (HOP) n=15 (2.9%); and transient hyperthyrotropinemia n=135 (26.5%). Twenty-one neonates (4.1%) were treated (20 for CH and 1 for HOP). At 3-year follow-up only three patients were diagnosed with permanent CH and still need treatment. LBW infants tended to have TSH levels higher than those with adequate weight. CONCLUSION This protocol was able to detect thyroid dysfunction in preterm neonates who were not identified by the current program based on TSH determination in whole-blood. This thyroid dysfunction seems to resolve spontaneously in a few months in the great majority of neonates, but in some cases LT4 could be needed. There is a critical need for specific guidelines regarding the follow-up and re-evaluation of transient CH in preterm neonates.
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Affiliation(s)
- Ariadna Campos-Martorell
- Autonomous University of Barcelona, Vall d’Hebron University Hospital, Clinic of Pediatric Endocrinology, Barcelona, Spain,* Address for Correspondence: Autonomous University of Barcelona, Vall d’Hebron University Hospital, Clinic of Pediatric Endocrinology, Barcelona, Spain E-mail:
| | | | | | - Jose Luis Marin Soria
- University of Barcelona, Spain School of Medicine, Neonatal Screening Program of Catalonia, Inborn Errors Metabolism Unit Biochemistry and Molecular Genetics Department Center for Biomedical Diagnosis (CDB) Hospital Clinic, Barcelona, Spain
| | - Rosa Maria López Galera
- University of Barcelona, Spain School of Medicine, Neonatal Screening Program of Catalonia, Inborn Errors Metabolism Unit Biochemistry and Molecular Genetics Department Center for Biomedical Diagnosis (CDB) Hospital Clinic, Barcelona, Spain
| | - Diego Yeste Fernández
- Autonomous University of Barcelona, Vall d’Hebron University Hospital, Clinic of Pediatric Endocrinology; Vall d’Hebron Research Institute, Clinic of Paediatric Endocrinology, Barcelona, Spain
| | - María Clemente León
- Autonomous University of Barcelona, Vall d’Hebron University Hospital, Clinic of Pediatric Endocrinology; Vall d’Hebron Research Institute, Clinic of Paediatric Endocrinology, Barcelona, Spain
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18
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Artificial Dim Light at Night during Pregnancy Can Affect Hormonal and Metabolic Rhythms in Rat Offspring. Int J Mol Sci 2022; 23:ijms232314544. [PMID: 36498872 PMCID: PMC9740453 DOI: 10.3390/ijms232314544] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/11/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Artificial light at night (ALAN) is considered an environmental risk factor that can interfere with the circadian control of the endocrine system and metabolism. We studied the impact of ALAN during pregnancy on the hormonal and biochemical parameters in rat pups at postnatal (P) days P3, P10, and P20. Control dams (CTRL) were kept in a standard light-dark regime, and ALAN dams were exposed to dim ALAN (<2 lx) during the whole pregnancy. A plasma melatonin rhythm was found in all CTRL groups, whereas in ALAN pups, melatonin was not rhythmic at P3, and its amplitude was lowered at P10; no differences were found between groups at P20. Plasma corticosterone was rhythmic at P20 in both groups, with decreased mesor in ALAN pups. Plasma thyroid hormones exhibited an inconsistent developmental pattern, and vasopressin levels were suppressed at the beginning of the dark phase at P20 in ALAN compared to CTRL. Glucose and cholesterol showed significant daily rhythms in CTRL but not in ALAN offspring at P3. Exposure to ALAN during pregnancy disturbed the development of daily rhythms in measured hormones and metabolites, suggesting that ALAN during pregnancy can act as an endocrine disruptor that can interfere with the normal development of the progeny.
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Kim Y, Kim Y, Chang M, Lee B. Association between Thyroid Function and Respiratory Distress Syndrome in Preterm Infants. Pediatr Rep 2022; 14:497-504. [PMID: 36412665 PMCID: PMC9680353 DOI: 10.3390/pediatric14040058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Thyroid hormones are known to influence the production and secretion of pulmonary surfactant. The objective of this study was to explore the relationship between respiratory distress syndrome (RDS) and thyroid hormones. This was a retrospective study of preterm infants at 24−33 weeks gestational age from April 2017 to February 2019. T3, free T4 (fT4), and thyroid-stimulating hormone (TSH) were measured 1, 3, and 6 weeks after birth. Multivariate logistic regression analyses were performed to determine the relationship between RDS and TSH. A total of 146 infants were enrolled. Of these, 60 had RDS, 72 had no RDS, and 14 were excluded. T3 and TSH were lower in the RDS groups (p < 0.05) on the day of birth. Multivariate logistic regression analysis indicated that lower serum TSH levels immediately after birth were associated with a higher incidence of RDS (OR, 0.89; 95% CI, 0.81−0.97). The TSH level was associated with the incidence of RDS. This suggests that suppression of the hypothalamus−pituitary axis function contributes to RDS, which is the result of surfactant deficiency.
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Affiliation(s)
- Yonghyuk Kim
- Department of Pediatrics, Wonju Severance Christian Hospital, 20, Ilsan-ro, Wonju-si 26426, Korea
| | - Youngjin Kim
- Department of Pediatrics, Wonju Severance Christian Hospital, 20, Ilsan-ro, Wonju-si 26426, Korea
| | - Meayoung Chang
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Korea
| | - Byoungkook Lee
- Department of Pediatrics, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si 30099, Korea
- Correspondence: ; Tel.: +82-44-995-3822
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Ureta-Velasco N, Keller K, Escuder-Vieco D, Serrano JCE, García-Lara NR, Pallás-Alonso CR. Assessment of Iodine Concentration in Human Milk from Donors: Implications for Preterm Infants. Nutrients 2022; 14:nu14204304. [PMID: 36296988 PMCID: PMC9612023 DOI: 10.3390/nu14204304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Preterm infants are particularly vulnerable to developing iodine deficiency. Donor human milk (DHM) is the preferred feeding option if the mother’s own milk (MOM) is not available, but information on DHM iodine concentration (DHMIC) is lacking. Hence, we aimed to assess DHMIC to further evaluate the adequacy of iodine provision in preterm infants. Finally, associations that might influence DHMIC were studied. In 113 donors, we measured iodine intake by evaluating dietary records for five consecutive days with the DIAL® Software. From the second day of dietary record, donors provided human milk samples (at least one per day) for four consecutive days. Daily human milk samples were analyzed for DHMIC. A DHMIC ≥ 200 µg/L was considered an adequate iodine content for preterm infants. DHMIC and urine iodine concentration (UIC) were determined using ICP-MS. In our study, 83.2% of donors had a full-term infant. Breastfeeding time range was 1.5−49.4 months. During the dietary record, 55.8% took iodine-containing supplements, providing 40−200 µg/day of iodine. The medians (p25, p75) UIC and DHMIC were 112.4 (75.8, 160.1) and 148.5 (97.6, 206.1) µg/L, respectively. In this iodine-sufficient population, 70% had a DHMIC of <200 µg/L. Donors’ intake of iodine-containing supplements was associated with higher DHMIC.
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Affiliation(s)
- Noelia Ureta-Velasco
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
- Correspondence: ; Tel.: +34-913901929
| | - Kristin Keller
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - Diana Escuder-Vieco
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - José C. E. Serrano
- Department of Experimental Medicine, Medicine Faculty, Lleida University, 25008 Lleida, Spain
| | - Nadia Raquel García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
- “Aladina-MGU”—Regional Human Milk Bank, 12 de Octubre University Hospital, Research Institute i+12, 28041 Madrid, Spain
| | - Carmen R. Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Research Institute i+12, Complutense University of Madrid, 28041 Madrid, Spain
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Luo J, Yuan J. Effects of Levothyroxine Therapy on Pregnancy and Neonatal Outcomes in Subclinical Hypothyroidism. Int J Gen Med 2022; 15:6811-6820. [PMID: 36051566 PMCID: PMC9427119 DOI: 10.2147/ijgm.s366981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the effects of levothyroxine (LT4) therapy on pregnancy and neonatal outcomes in pregnant women with subclinical hypothyroidism (SCH) who had different thyroid peroxidase antibody (TPOAb) status. Methods The data of pregnant women from the Chengdu Hospital of Integrated Traditional Chinese and Western Medicine between January 2017 and August 2019 were collected. SCH was defined as 11.88 < free thyroxine (FT4) < 20.06pmol/L in conjunction with thyroid-stimulating hormone (TSH) >4.00 mU/L. Some clinical characteristics have been collected, including body mass index (BMI) before pregnancy, number of pregnancies, number of miscarriages (spontaneous abortion), parity, family history of diabetes, history of smoking, history of drinking, TSH, FT4, and TPOAb levels. The prevalence of pregnancy and neonatal outcomes in the LT4 and non-LT4 groups, and in the LT4 and euthyroid control groups were compared, respectively. Univariate and multivariate logistic regression analyses were used to assess the effects of LT4 therapy on pregnancy and neonatal outcomes in SCH pregnant women with TPOAb. Results A total of 985 subjects were enrolled and divided into LT4 group with 478 patients, non-LT4 group with 156 patients and euthyroid control group with 351 patients. The prevalence of amniotic fluid abnormalities and premature delivery in the LT4 group was lower than that in the non-LT4 group in participants with TPOAb-positive (TPOAb+). After adjusting age, BMI prior to pregnancy, number of pregnancies, number of miscarriages, parity, TSH and FT4 level, the SCH pregnant women with TPOAb+ in the LT4 group had a lower risk of amniotic fluid abnormalities and premature delivery than that in the non-LT4 group. Conclusion LT4 therapy could reduce the risk of premature delivery and amniotic fluid abnormalities in the SCH pregnant women with TPOAb+. However, more randomized trials are required to confirm this association before the unequivocal advocacy of LT4 therapy in pregnant women with SCH.
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Affiliation(s)
- Jiaxi Luo
- Department of Obstetrics and Gynecology, Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, 610041, People's Republic of China
| | - Jialing Yuan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.,The Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China
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22
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Jiang X, Li T, Xie R, Mei H, Sun R, Xi Y, Chen X, Cui Y, Zhao J, Liu Y. The effects of topical iodine containing antiseptics on thyroidal status and early neurodevelopment of preterm infants. J Pediatr Endocrinol Metab 2022; 35:851-858. [PMID: 35591792 DOI: 10.1515/jpem-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/02/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The goal of this study was to determine the quality of these disinfectants' effects on thyroid function and neurological scores in premature newborns aged 28 to 36 gestational weeks (GW). METHODS This cohort study was conducted from October 2020 to September 2021 among 28-36 GW preterm infants at the neonatal care unit of Jiangnan University Hospital. We divided this 12 month period into two consecutive 6 month periods. Composite iodine disinfectants and alcohol are used for skin and umbilical cord disinfection of preterm infants, respectively. Urinary iodine concentration (UIC), thyroid hormone levels, and neonatal behavioral and neurological assessment (NBNA) scores were determined in both groups. RESULTS A total of 126 patients were included in the study, 65 in the iodine exposed group and 61 in the alcohol group. The second UIC and the incidence of serum T4≤5 μg/dL and TSH≥10 mIU/L in the iodine exposed group were significantly higher than those in the alcohol group (p<0.05). The first NBNA score was lower in the iodine exposed group than in the alcohol group (p<0.05). However, whether it has clinical significance remains to be explored. There was a linear relationship between the two NBNA scores (iodine exposure group, R 2=0.344; alcohol group, R 2=0.227). No sepsis or other adverse outcomes occurred in the two groups of preterm infants after disinfection with different disinfectants. CONCLUSIONS Iodine-containing disinfectants seem to have the potential to cause an increased rate of thyroid dysfunction and a decreased neurological score and should be evaluated in further studies.
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Affiliation(s)
- Xiaofan Jiang
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Tianxiao Li
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Ruijin Xie
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Huiya Mei
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Renjuan Sun
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Yuxiu Xi
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Xiaoyu Chen
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Ying Cui
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Jinling Zhao
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
| | - Yueying Liu
- Affiliated Hospital of Jiangnan University, Wuxi City, Jiangsu Province, P.R. China
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Thyroid Dysfunction and the Effect of Iodine-Deficient Parenteral Nutrition in Very Low Birth Weight Infants: A Nationwide Analysis of a Korean Neonatal Network Database. Nutrients 2022; 14:nu14153043. [PMID: 35893897 PMCID: PMC9331788 DOI: 10.3390/nu14153043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: To investigate the impact of nutritional iodine deficiency on thyroid dysfunction (TD) in very low birth weight (VLBW) infants, we analyzed the association between iodine-deficient parenteral nutrition (PN) and TD requiring L-thyroxine (TD-LT4). Methods: Data of VLBW infants were obtained from the Korean Neonatal Network registry. Factors including duration of PN were analyzed according to TD-LT4. Results: TD-LT4 occurred in 490 (8.7%) of 5635 infants, and more frequently occurred in infants requiring PN for ≥4 weeks (10.2%). PN ≥ 4 weeks was one of the risk factors for TD-LT4, with an odds ratio (OR) of 1.346, p = 0.002. However, multivariate analysis showed that TD-LT4 was more of a risk for infants that were small for gestational age (OR 2.987, p < 0.001) and for other neonatal morbidities such as seizures (OR 1.787, p = 0.002) and persistent pulmonary hypertension (OR 1.501, p = 0.039) than PN ≥ 4 weeks (OR 0.791, p = 0.080). Conclusions: Prolonged iodine-deficient PN might affect TD-LT4 in VLBW infants. However, the effect of nutritional iodine deficiency on TD-LT4 risk was less than that of SGA or severe neonatal morbidities in Korean VLBW infants.
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Docosahexaenoic Acid and Melatonin Prevent Impaired Oligodendrogenesis Induced by Intrauterine Growth Restriction (IUGR). Biomedicines 2022; 10:biomedicines10051205. [PMID: 35625940 PMCID: PMC9138514 DOI: 10.3390/biomedicines10051205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 01/08/2023] Open
Abstract
In this study, our aims were to characterize oligodendrogenesis alterations in fetuses with intrauterine growth restriction (IUGR) and to find therapeutic strategies to prevent/treat them using a novel rabbit in vitro neurosphere culture. IUGR was surgically induced in one uterine horn of pregnant rabbits, while the contralateral horn served as a control. Neural progenitor cells (NPCs) were obtained from pup’s whole brain and cultured as neurospheres mimicking the basic processes of brain development including migration and cell differentiation. Five substances, chosen based on evidence provided in the literature, were screened in vitro in neurospheres from untreated rabbits: Docosahexaenoic acid (DHA), melatonin (MEL), zinc, 3,3′,5-Triiodo-L-thyronine (T3), and lactoferrin (LF) or its metabolite sialic acid (SA). DHA, MEL and LF were further selected for in vivo administration and subsequent evaluation in the Neurosphere Assay. In the IUGR culture, we observed a significantly reduced percentage of oligodendrocytes (OLs) which correlated with clinical findings indicating white matter injury in IUGR infants. We identified DHA and MEL as the most effective therapies. In all cases, our in vitro rabbit neurosphere assay predicted the outcome of the in vivo administration of the therapies and confirmed the reliability of the model, making it a powerful and consistent tool to select new neuroprotective therapies.
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Postnatal Serum Total Thyroxine Level Associated with Short- and Long-Term Anthropometric Outcomes in Very Preterm Infants. Nutrients 2022; 14:nu14102056. [PMID: 35631197 PMCID: PMC9143878 DOI: 10.3390/nu14102056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/28/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Thyroxine (T4) importantly regulates the growth of newborns. Compared to fetuses with equivalent gestational ages, very preterm infants (VPIs) often experience relatively low thyroxinemia, with a normal thyroid-stimulating hormone (TSH) concentration < 10 μIU/mL. However, there is continued debate regarding postnatal thyroxine supplementation for VPIs with normal TSH and transitionally low thyroxinemia. Little research has explored the role of the postnatal total T4 (TT4) serum concentration on the growth of VPIs. In this study, we aim to clarify whether the postnatal thyroxine concentration is associated with the short- and long-term growth outcomes of VPIs. A total of 334 surviving VPIs in our previously reported cohort, born in the period August 2007−July 2016, were enrolled. The exposure variable was the postnatal TT4 concentration at 1 month old. The primary outcomes were body weight increments over 28 days after the screening and anthropometric outcomes at the corrected age of 24 months old. Infants with any hormonal replacement, severe brain injury, congenital anomaly, or cerebral palsy were excluded. In total, 290 (86.8%) VPIs were included for analysis. In the 28 days after thyroid function screening, the TT4 concentration was found to have a significant association with positive increments in body weight (mean increment: 25.7 g per 1 μg/dL; p < 0.001) and a positive body weight z-score (mean increment: 0.039 per 1 μg/dL; p = 0.037), determined by generalized estimating equation analysis. At the corrected age of 24 months old, a higher postnatal TT4 concentration was associated with a lower body mass index (mean coefficient: −0.136; 95% CI: −0.231 to −0.041, p = 0.005) and lower body mass index z-score (mean coefficient: −0.097; 95% CI: −0.170 to −0.024, p = 0.009). Infants with a TT4 concentration > 6.4 ug/dL had significantly lower odds of overweight status (odds ratio: 0.365; 95% CI: 0.177 to 0.754, p = 0.006). We conclude that the postnatal TT4 concentration is associated with a positive increment in body weight in the short term. At the same time, the postnatal TT4 concentration is associated with lower odds of overweight status after long-term follow-up.
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Andersson M, Braegger CP. The Role of Iodine for Thyroid Function in Lactating Women and Infants. Endocr Rev 2022; 43:469-506. [PMID: 35552681 PMCID: PMC9113141 DOI: 10.1210/endrev/bnab029] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 12/18/2022]
Abstract
Iodine is a micronutrient needed for the production of thyroid hormones, which regulate metabolism, growth, and development. Iodine deficiency or excess may alter the thyroid hormone synthesis. The potential effects on infant development depend on the degree, timing, and duration of exposure. The iodine requirement is particularly high during infancy because of elevated thyroid hormone turnover. Breastfed infants rely on iodine provided by human milk, but the iodine concentration in breast milk is determined by the maternal iodine intake. Diets in many countries cannot provide sufficient iodine, and deficiency is prevented by iodine fortification of salt. However, the coverage of iodized salt varies between countries. Epidemiological data suggest large differences in the iodine intake in lactating women, infants, and toddlers worldwide, ranging from deficient to excessive intake. In this review, we provide an overview of the current knowledge and recent advances in the understanding of iodine nutrition and its association with thyroid function in lactating women, infants, and toddlers. We discuss risk factors for iodine malnutrition and the impact of targeted intervention strategies on these vulnerable population groups. We highlight the importance of appropriate definitions of optimal iodine nutrition and the need for more data assessing the risk of mild iodine deficiency for thyroid disorders during the first 2 years in life.
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Affiliation(s)
- Maria Andersson
- Nutrition Research Unit, University Children's Hospital Zurich, CH-8032 Zürich, Switzerland
| | - Christian P Braegger
- Nutrition Research Unit, University Children's Hospital Zurich, CH-8032 Zürich, Switzerland
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27
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Thyroid and Corticosteroid Signaling in Amphibian Metamorphosis. Cells 2022; 11:cells11101595. [PMID: 35626631 PMCID: PMC9139329 DOI: 10.3390/cells11101595] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 01/25/2023] Open
Abstract
In multicellular organisms, development is based in part on the integration of communication systems. Two neuroendocrine axes, the hypothalamic–pituitary–thyroid and the hypothalamic–pituitary–adrenal/interrenal axes, are central players in orchestrating body morphogenesis. In all vertebrates, the hypothalamic–pituitary–thyroid axis controls thyroid hormone production and release, whereas the hypothalamic–pituitary–adrenal/interrenal axis regulates the production and release of corticosteroids. One of the most salient effects of thyroid hormones and corticosteroids in post-embryonic developmental processes is their critical role in metamorphosis in anuran amphibians. Metamorphosis involves modifications to the morphological and biochemical characteristics of all larval tissues to enable the transition from one life stage to the next life stage that coincides with an ecological niche switch. This transition in amphibians is an example of a widespread phenomenon among vertebrates, where thyroid hormones and corticosteroids coordinate a post-embryonic developmental transition. The review addresses the functions and interactions of thyroid hormone and corticosteroid signaling in amphibian development (metamorphosis) as well as the developmental roles of these two pathways in vertebrate evolution.
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28
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Uthayaseelan K, Kadari M, Subhan M, Saji Parel N, Krishna PV, Gupta A, Uthayaseelan K. Congenital Anomalies in Infant With Congenital Hypothyroidism: A Review of Pathogenesis, Diagnostic Options, and Management Protocols. Cureus 2022; 14:e24669. [PMID: 35663669 PMCID: PMC9162097 DOI: 10.7759/cureus.24669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 12/02/2022] Open
Abstract
Thyroid hormones (TH) regulate growth, nervous system myelination, metabolism, and physiologic functions in nearly every organ system. Congenital hypothyroidism (CH) is one of the most common endocrinopathies in children and has potentially devastating neurologic and developmental consequences. The etiology and clinical manifestations of hypothyroidism in children differ from adults. And hence, pediatric medical care requires a detailed understanding of thyroid function and dysfunction in children. The perinatal risk factors include female sex, preterm birth, low birth weight, postmature birth, additional birth abnormalities, and being delivered in multiple births. In countries where newborn screening is practiced, CH is detected after birth through screening tests. It aids in determining the underlying cause, though some patients may be able to start treatment without these tests. Early detection and treatment prevent irreversible and permanent nervous system damage. Thus, in addition to exploring the development of CH, this article has also covered the epidemiological data, clinical aspects, and management stemming from pediatric hypothyroidism.
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TSH neonatal como marcador del estado de nutrición de yodo. Influencia de la yoduria y la función tiroidea maternas sobre la TSH neonatal. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Walsh JP. Thyroid Function across the Lifespan: Do Age-Related Changes Matter? Endocrinol Metab (Seoul) 2022; 37:208-219. [PMID: 35417936 PMCID: PMC9081302 DOI: 10.3803/enm.2022.1463] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
Circulating concentrations of thyrotropin (TSH) and thyroxine (T4) are tightly regulated. Each individual has setpoints for TSH and free T4 which are genetically determined, and subject to environmental and epigenetic influence. Pituitary-thyroid axis setpoints are probably established in utero, with maturation of thyroid function continuing until late gestation. From neonatal life (characterized by a surge of TSH and T4 secretion) through childhood and adolescence (when free triiodothyronine levels are higher than in adults), thyroid function tests display complex, dynamic patterns which are sexually dimorphic. In later life, TSH increases with age in healthy older adults without an accompanying fall in free T4, indicating alteration in TSH setpoint. In view of this, and evidence that mild subclinical hypothyroidism in older people has no health impact, a strong case can be made for implementation of age-related TSH reference ranges in adults, as is routine in children.
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Affiliation(s)
- John P. Walsh
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
- Medical School, University of Western Australia, Crawley, Australia
- Corresponding author: John P. Walsh Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia 6009, Australia Tel: +61-864572466, Fax: +61-864573221, E-mail:
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Stawerska R, Nowak-Bednarek M, Talar T, Kolasa-Kicińska M, Łupińska A, Hilczer M, Gulczyńska E, Lewiński A. The prevalence of hypothyroxinemia in premature newborns. Front Endocrinol (Lausanne) 2022; 13:940152. [PMID: 36034431 PMCID: PMC9399394 DOI: 10.3389/fendo.2022.940152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022] Open
Abstract
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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Affiliation(s)
- Renata Stawerska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Paediatric Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Marzena Nowak-Bednarek
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Tomasz Talar
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Marzena Kolasa-Kicińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
| | - Anna Łupińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Paediatric Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Maciej Hilczer
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
| | - Ewa Gulczyńska
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- *Correspondence: Andrzej Lewiński,
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Mikołajczak A, Kufel K, Bokiniec R. Correlation Between Thyroid Hormone Concentrations and Ultrasound Thyroid Volume in Preterm Infants Born Before 33 Weeks of Gestation. Front Endocrinol (Lausanne) 2022; 13:860716. [PMID: 35620396 PMCID: PMC9128814 DOI: 10.3389/fendo.2022.860716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Thyroid disorders are commonly concomitant with premature birth; however, indications to start therapy remain unclear due to a lack of gestational age (GA)-specific reference ranges. We aimed to evaluate the age-specific thyroid-stimulating hormone (TSH), free thyroxine (FT4) levels and the correlation between TSH and FT4 serum levels and ultrasound thyroid volume in preterm infants. MATERIALS AND METHODS This was an observational, prospective, single-center study of 98 preterm infants born before 33 weeks GA. The infants were divided into the 24-28 weeks and 29-32 weeks GA groups. TSH and FT4 serum levels were measured at two time points: at postnatal age (PNA) 2 weeks and at postmenstrual age (PMA) 32 weeks; the results were compared between groups at two consecutive time points. RESULTS There was a statistically significant between-group difference in FT4 concentration. There was a positive correlation between FT4 and GA at both screening times. FT4 in the 24-28 weeks GA group was significantly lower than in the 29-32 weeks GA group. The mean (standard deviation [SD]) FT4 at PNA 2 weeks was 11.72 ± 2.16 pmol/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p<0.001). The mean (SD) FT4 at PMA 32 weeks was 11.96 ± 1.98 pmo/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p=0.001). Our results reflect a slow and gradual upward trend of FT4 in the 24-28 weeks GA. It is of interest that the correlation between thyroid volume and FT4 was statistically significant (rho=0.25, p=0.019) for all studied preterm infants. The correlation between thyroid volume and weight was statistically significant for the entire study group (rho=0.37, p<0.001). We did not find statistically significant differences in TSH and FT4 values between consecutive time points at 24-28 weeks GA. The thyroid volume was not significantly different between both groups. The total thyroid volume was 0.26 vs. 0.27 ml for the 24-28 and 29-32 weeks GA groups, respectively. CONCLUSION The results of this study indicate that preterm infants require lower FT4 values depending on GA. Moreover, ultrasound thyroid imaging may facilitate the evaluation of questionable thyroid disorders.
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Affiliation(s)
| | - Katarzyna Kufel
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
| | - Renata Bokiniec
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Renata Bokiniec, ;
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Klosinska M, Kaczynska A, Ben-Skowronek I. Congenital Hypothyroidism in Preterm Newborns - The Challenges of Diagnostics and Treatment: A Review. Front Endocrinol (Lausanne) 2022; 13:860862. [PMID: 35370986 PMCID: PMC8972126 DOI: 10.3389/fendo.2022.860862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/23/2022] [Indexed: 12/26/2022] Open
Abstract
Preterm newborns are forced to adapt to harsh extrauterine conditions and endure numerous adversities despite their incomplete growth and maturity. The inadequate thyroid hormones secretion as well as the impaired regulation of hypothalamus-pituitary-thyroid axis may lead to hypothyroxinemia. Two first weeks after birth are pivotal for brain neurons development, synaptogenesis and gliogenesis. The decreased level of thyroxine regardless of cause may lead to delayed mental development. Congenital hypothyroidism (CH) is a disorder highly prevalent in premature neonates and it originates from maternal factors, perinatal and labor complications, genetic abnormalities, thyroid malformations as well as side effects of medications and therapeutic actions. Because of that, the prevention is not fully attainable. CH manifests clinically in a few distinctive forms: primary, permanent or transient, and secondary. Their etiologies and implications bear little resemblance. Therefore, the exact diagnosis and differentiation between the subtypes of CH are crucial in order to plan an effective treatment. Hypothyroxinemia of prematurity indicates dynamic changes in thyroid hormone levels dependent on neonatal postmenstrual age, which directly affects patient's maintenance and wellbeing. The basis of a successful treatment relies on an early and accurate diagnosis. Neonatal screening is a recommended method of detecting CH in preterm newborns. The preferred approach involves testing serum TSH and fT4 concentrations and assessing their levels according to the cut-off values. The possible benefits also include the evaluation of CH subtype. Nevertheless, the reference range of thyroid hormones varies all around the world and impedes the introduction of universal testing recommendations. Unification of the methodology in neonatal screening would be advantageous for prevention and management of CH. Current guidelines recommend levothyroxine treatment of CH in preterm infants only when the diagnose is confirmed. Moreover, they underline the importance of the re-evaluation among preterm born infants due to the frequency of transient forms of hypothyroidism. However, results from multiple clinical trials are mixed and depend on the newborn's gestational age at birth. Some benefits of treatment are seen especially in the preterm infants born <29 weeks' gestation. The discrepancies among trials and guidelines create an urgent need to conduct more large sample size studies that could provide further analyses and consensus. This review summarizes the current state of knowledge on congenital hypothyroidism in preterm infants. We discuss screening and treatment options and demonstrate present challenges and controversies.
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