SERUM THYROXINE (T4) AND THYROTROPHIN STIMULATING HORMONE (TSH) LEVELS IN CHILDREN TREATED FOR CONGENITAL HYPOTHYROIDISM

CONTEXT: Screening programs not only offer the opportunity to trace and treat almost all cases of congenital hypothyroidism but also mean large savings to the health system. However, carefully planned strategies are necessary to extend their benefits and reduce costs. OBJECTIVE: To determine the possible influence of maternal diseases that affect maternal-fetal placenta dynamics on primary thyroid stimulating hormone (TSH) screening for congenital hypothyroidism. DESIGN: Prospective non-randomized clinical trial with at least 3 months of follow-up. SETTING: A public university referral center [CAISM/Hospital das Clínicas, Faculty of Medicine, University of Campinas, Campinas, SP]. PARTICIPANTS: 415 neonates divided into 5 groups: eighty-three infants born from cardiac mothers; 98 from mothers that had toxemia; 54 of the mothers had diabetes mellitus; 40 were HIV positive and 140 had no diseases. INTERVENTION: All newborns had cord blood samples collected on filter paper at birth. MAIN MEASUREMENTS: TSH was measured from dried blood spots using a homemade immunofluorescence assay (sensitivity in dried blood spots = 0.1 mU/L). RESULTS: There was no significant difference in the mean TSH levels among the 5 groups. Moreover, TSH levels were around 5 mU/L in 48% of the newborns, indicating that our region is severely deficient in iodine. CONCLUSIONS: Our results indicate that primary TSH screening programs using cord blood are not affected by maternal diseases. We suggest that, besides its technical advantages over heel punctures with T4 primary approaches, neonatal screening using primary cord blood TSH may also be used as a monitoring tool for evaluation and control of iodine deficiency disorders (IDD).

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Serum thyroxine and thyroid stimulating hormone concentrations after treatment of congenital hypothyroidism.

Archives of Disease in Childhood ◽

10.1136/adc.63.11.1368 ◽

1988 ◽

Vol 63 (11) ◽

pp. 1368-1371 ◽

Cited By ~ 15

Author(s):

S S Abusrewil ◽

L Tyfield ◽

D C Savage

Keyword(s):

Congenital Hypothyroidism ◽

Thyroid Stimulating Hormone ◽

Serum Thyroxine ◽

Stimulating Hormone

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Association of maternal serum trace elements with newborn screening-thyroid stimulating hormone

Turkish Journal of Biochemistry ◽

10.1515/tjb-2019-0372 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Yasemin Ucal ◽

Muhittin Serdar ◽

Cansu Akın-Levi ◽

Zeynep Zulfiye Yıldırım-Keles ◽

Cem Turam ◽

...

Keyword(s):

Trace Elements ◽

Newborn Screening ◽

Thyroid Stimulating Hormone ◽

Maternal Serum ◽

Blood Samples ◽

Free T3 ◽

Flame Atomic Absorption ◽

Serum Trace Elements ◽

Tsh Levels ◽

Stimulating Hormone

AbstractObjectivesTrace elements are essential in thyroid functioning as they incorporate into biologically important enzymes as cofactors. The placenta can either activate or inhibit the transfer of maternal trace elements to the unborn. An imbalance of maternal trace elements in pregnancy may affect both maternal and newborn thyroid function.MethodsBlood samples from 315 lactating mothers were collected in the first 48 h after delivery and evaluated for selenium (Se), copper (Cu), manganese (Mn), and zinc (Zn) using flame atomic absorption spectroscopy (FAAS) and quadrupole inductively coupled plasma-mass spectrometer (ICP-MS). Thyroid hormones and auto-antibodies (thyroid-stimulating hormone (TSH), free T3 (fT3), free T3 (fT4), anti–thyroid peroxidase (anti-TPO), and antithyroglobulin (anti-TG)) were analyzed in maternal blood using an electro-chemiluminescence immunoassay (ECLIA). Between 48 and 72 postpartum hours, spot blood samples were used for newborn screening-TSH measurement. Correlation and multivariate analyses were performed to evaluate the effect of maternal trace element levels on newborn screening-TSH levels.ResultsThe medians (min-max) of maternal Se (45.16 µg/L (21.28–79.04)), Cu (210.10 µg/dL (117.04–390.64)), Mn (2.11 µg/L (0.20–3.46)), and Zn (0.43 mg/L (0.24–0.66)) were determined. A positive correlation was detected between Zn and maternal TSH levels (r=0.12, p < 0.05). Newborn screening-TSH was significantly correlated with maternal Cu (r=0.14, p < 0.01). Similarly, Cu exhibited weak associations in clustering analysis while others shared common clusters with newborn-screening TSH.ConclusionsThere was no significant association between most of the maternal serum trace elements and maternal thyroid hormone parameters, with an only exception between maternal Zn and maternal serum TSH. Finally, the association between maternal serum Cu levels and newborn screening-TSH levels may highlight the importance of maternal Cu levels on the newborn thyroid health.

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Impact of maternal thyroid disease on neonatal thyroid status

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0349 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Lakshmi Venugopalan ◽

Aishwarya Rajan ◽

Hemchand. K. Prasad ◽

Anupama Sankaran ◽

Gnanabalan Murugesan ◽

...

Keyword(s):

Congenital Hypothyroidism ◽

Thyroid Stimulating Hormone ◽

Study Group ◽

Thyroid Status ◽

Case Identification ◽

Group I ◽

Group Ii ◽

Maternal Thyroid ◽

Heel Prick ◽

Stimulating Hormone

AbstractObjectivesPrevalence of Maternal and congenital hypothyroidism is on the rise. To present the thyroid stimulating hormone screening results in babies born to hypothyroid mothers and assess the burden, aetiology of hypothyroidism in these babiesMethodsAll antenatal mothers attending our hospital during the study period were enrolled into the study. Group I includes 249 term babies born to hypothyroid mothers and group II comprises 2154 newborns born to mothers who are euthyroid. Heel prick thyroid stimulating hormone was done for all newborns on day 3 for both groups. Confirmatory venous testing was done for all for babies in group I and screen positives belonging to group II. Evaluation and therapy done as per standard guidelines.ResultsThyroid stimulating hormone values in the two groups are presented. There was significant correlation between peak maternal thyroid stimulating hormone and neonatal day 3 heel prick in group I (r=0.7, P<0.05). The prevalence of positive screening test in groups I and II was 3.8 and 1.03% (p<0.05) whereas corresponding values for confirmed disease was 4.3 and 0.6%, respectively (p<0.05). Aetiological evaluation revealed both transient hypothyroidism (33.3%) and permanent hypothyroidism (66.6%).Conclusion4.3% of babies born to hypothyroid mothers develop congenital hypothyroidism; aetiology being both transient and permanent. A venous test by 3 weeks is helpful in these babies to improve case identification.

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Incidence and Interrelated Factors in Patients With Congenital Hypothyroidism as Detected by Newborn Screening in Guangxi, China

Global Pediatric Health ◽

10.1177/2333794x14567193 ◽

2015 ◽

Vol 2 ◽

pp. 2333794X1456719 ◽

Cited By ~ 3

Author(s):

Xin Fan ◽

Shaoke Chen ◽

Jiale Qian ◽

Suren Sooranna ◽

Jingi Luo ◽

...

Keyword(s):

Newborn Screening ◽

Congenital Hypothyroidism ◽

Screening Program ◽

Thyroid Stimulating Hormone ◽

Who Guidelines ◽

Newborn Screening Program ◽

Study Results ◽

Stimulating Hormone

Background. A newborn screening program (NSP) for congenital hypothyroidism (CH) was carried out in Guangxi in order to understand the incidence of CH and the factors interrelated to major types of CH in this region of China. Methods. During 2009 to 2013, data from 930 612 newborns attending NSP in Guangxi were collected. Patients were classified with either permanent CH (PCH) or transient CH (TCH) after 2 years of progressive study. Results. A total of 1210 patients were confirmed with CH with an incidence of 1/769, including 68 PCH and 126 TCH cases with incidences of 1/6673 and 1/3385, respectively. The frequency of thyroid stimulating hormone values greater than 5 mIU/L was 7.2%, which, based on WHO guidelines, suggests that the population was mildly iodine deficient. Conclusions. The incidence of CH was high in Guangxi. Approximately two thirds of CH patients were TCH, which may be due to a deficiency in iodine within the population.

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Long-Term Cardiovascular Effects of Levothyroxine Therapy in Young Adults with Congenital Hypothyroidism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-2315 ◽

2008 ◽

Vol 93 (7) ◽

pp. 2486-2491 ◽

Cited By ~ 15

Author(s):

Mariacarolina Salerno ◽

Ugo Oliviero ◽

Teresa Lettiero ◽

Vincenzo Guardasole ◽

Dario Maria Mattiacci ◽

...

Keyword(s):

Young Adults ◽

Replacement Therapy ◽

Exercise Capacity ◽

Congenital Hypothyroidism ◽

Intima Media Thickness ◽

Normal Range ◽

Levothyroxine Replacement ◽

Levothyroxine Treatment ◽

Tsh Levels

Abstract Context: Congenital hypothyroidism (CH) is the most prevalent endocrine disorder in the newborn and is routinely treated with life-long levothyroxine replacement therapy. Although several studies have demonstrated that such therapy may impact on the cardiovascular system, little is known with regard to the effects of long-term levothyroxine administration in patients with CH. Objective: The aim of the current study was to evaluate whether long-term levothyroxine replacement therapy in young adults with CH is associated with cardiovascular abnormalities. Patients and Methods: Thirty young adults with CH aged 18.1 ± 0.2 yr and 30 age- and sex-matched controls underwent cardiac and carotid Doppler ultrasound and symptom-limited cardiopulmonary exercise testing. Hypothyroidism was diagnosed by neonatal screening, and levothyroxine treatment was initiated within the first month of life and carefully adjusted to maintain TSH levels in the normal range and free T4 in the high-normal range. Results: Compared with controls, hypothyroid patients exhibited left ventricular diastolic dysfunction, impaired exercise capacity, and increased intima-media thickness. At multiple regression analysis, the number of episodes of plasma TSH levels less than 0.5 mU/liter and greater than 4.0 mU/liter from the age of 1 yr onward, and mean TSH plasma levels during puberty were independent predictors of diastolic filling and cardiopulmonary performance indexes (multiple r values: 0.61–0.75). Conclusions: Long-term levothyroxine treatment in young adults with congenital hypothyroidism is associated with impaired diastolic function and exercise capacity and increased intima-media thickness.

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Pituitary and Serum Levels of Prolactin (PRL), Thyroid Stimulating Hormone (TSH) and Serum Thyroxine (T4) in Hereditary Dwarf Rats (rdw/rdw)

EXPERIMENTAL ANIMALS ◽

10.1538/expanim1978.42.2_211 ◽

1993 ◽

Vol 42 (2) ◽

pp. 211-216 ◽

Cited By ~ 5

Author(s):

Motoaki UMEZU ◽

Tatsuya FUJIMURA ◽

Shichiro SUGAWARA ◽

Satosi KAGABU

Keyword(s):

Serum Levels ◽

Thyroid Stimulating Hormone ◽

Serum Thyroxine ◽

Stimulating Hormone

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In congenital hypothyroidism bone maturation at birth may be a predictive factor of psychomotor development during the first Year of life irrespective of other variables related to treatment

Acta Endocrinologica ◽

10.1530/eje.0.1490001 ◽

2003 ◽

pp. 1-6 ◽

Cited By ~ 42

Author(s):

M Wasniewska ◽

F De Luca ◽

A Cassio ◽

N Oggiaro ◽

P Gianino ◽

...

Keyword(s):

Congenital Hypothyroidism ◽

Psychomotor Development ◽

First Year ◽

X Rays ◽

Bone Maturation ◽

Gestation Age ◽

Group A ◽

One Year ◽

First Year Of Life ◽

Tsh Levels

OBJECTIVE: To evaluate in a cohort of infants with congenital hypothyroidism (CH): (a) the frequency of bone maturation (BM) retardation at birth and (b) whether BM delay at birth may be considered as a tool to make a prognosis of psychomotor status at the age of 1 Year, irrespective of other variables related to treatment. DESIGN: BM at birth, CH severity and developmental quotient (DQ) at the age of 1 Year were retrospectively evaluated in 192 CH infants selected by the following inclusion criteria: (a) gestation age ranging between 38 and 42 weeks; (b) onset of therapy within the first Month of life; (c) initial thyroxine (l-T(4)) dosage ranging from 10 to 12 microg/kg/day; (d) normalization of serum thyrotropin (TSH) levels before the age of 3 Months; (e) Monthly adjustments of l-T(4) dose during the first Year of life with serum TSH levels ranging from 0.5 to 4 mIU/l; (f) no major diseases and/or physical handicaps associated with CH; (g) availability of both thyroid scanning and knee X-rays at the time of treatment initiation; (h) availability of DQ assessment at an average age of 12 Months. METHODS: BM was considered normal if the distal femur bony nucleus diameter exceeded 3 mm (group A) or retarded if either this nucleus was absent (subgroup B1) or its diameter was <3 mm (subgroup B2). DQ was evaluated with the Brunet-Lezine test. RESULTS: In 44.3% of cases BM was either delayed (23.5%) or severely delayed (20.8%). The risk of BM retardation was higher in the patients with athyreosis than in the remaining patients (41/57 vs 44/135, chi(2)=25.13, P<0.005). BM-retarded infants showed a more severe biochemical picture of CH at birth and a lower DQ at the age of one Year compared with the group A patients. If compared with infants of subgroup B2 those of subgroup B1 exhibited significantly lower T(4) levels at birth and a more frequent association with athyreosis (70.0 vs 30.0%; chi(2)=7.49, P<0.01), whereas DQ was superimposable in both subgroups. CONCLUSIONS: (a) BM at birth is delayed in almost half of CH patients and (b) CH severity per se can affect DQ at the age of 1 Year irrespective of other variables related to therapy.

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