Impact of compliance to therapy of congenital hypothyroidism on the neurodevelopmental outcome in Sharkia Governorate

Both insufficient and excessive maternal iodine consumption can result in congenital hypothyroidism. In East Asian cultures, seaweed is traditionally consumed in high quantities by peripartum women as it is thought to improve lactation. We present a case of transient congenital hypothyroidism due to maternal seaweed consumption at a daily basis during pregnancy and lactation in a Dutch family without Asian background. This case highlights that even in families of non-Asian background, high maternal intake of iodine-rich seaweed occurs and can result in transient or permanent hyperthyrotropinemia in the neonate with risk of impaired neurodevelopmental outcome if untreated.

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Diagnosis and Management of Central Congenital Hypothyroidism

Frontiers in Endocrinology ◽

10.3389/fendo.2021.686317 ◽

2021 ◽

Vol 12 ◽

Author(s):

Peter Lauffer ◽

Nitash Zwaveling-Soonawala ◽

Jolanda C. Naafs ◽

Anita Boelen ◽

A. S. Paul van Trotsenburg

Keyword(s):

Thyroid Hormone ◽

Thyroid Gland ◽

Congenital Hypothyroidism ◽

Neonatal Period ◽

Neurodevelopmental Outcome ◽

Pituitary Hormone ◽

Feeding Problems ◽

Severe Condition ◽

Diagnosis And Management ◽

Prolonged Jaundice

Central congenital hypothyroidism (CH) is defined as thyroid hormone (TH) deficiency at birth due to insufficient stimulation by the pituitary of the thyroid gland. The incidence of central CH is currently estimated at around 1:13,000. Central CH may occur in isolation, but in the majority of cases (60%) it is part of combined pituitary hormone deficiencies (CPHD). In recent years several novel genetic causes of isolated central CH have been discovered (IGSF1, TBL1X, IRS4), and up to 90% of isolated central CH cases can be genetically explained. For CPHD the etiology usually remains unknown, although pituitary stalk interruption syndrome does seem to be the most common anatomic pituitary malformation associated with CPHD. Recent studies have shown that central CH is a more severe condition than previously thought, and that early detection and treatment leads to good neurodevelopmental outcome. However, in the neonatal period the clinical diagnosis is often missed despite hospital admission because of feeding problems, hypoglycemia and prolonged jaundice. This review provides an update on the etiology and prognosis of central CH, and a practical approach to diagnosis and management of this intriguing condition.

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Neurodevelopmental outcome of children with congenital hypothyroidism diagnosed in a national screening program in Turkey

Indian Pediatrics ◽

10.1007/s13312-017-1111-5 ◽

2017 ◽

Vol 54 (5) ◽

pp. 381-384 ◽

Cited By ~ 1

Author(s):

Bahar Toklu Baysal ◽

Bora Baysal ◽

Ferah Genel ◽

Baris Erdur ◽

Erhan Ozbek ◽

...

Keyword(s):

Congenital Hypothyroidism ◽

Screening Program ◽

Neurodevelopmental Outcome

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Approach to the Diagnosis and Treatment of Neonatal Hypothyroidism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2011-1175 ◽

2011 ◽

Vol 96 (10) ◽

pp. 2959-2967 ◽

Cited By ~ 84

Author(s):

Stephen H. LaFranchi

Keyword(s):

Newborn Screening ◽

Congenital Hypothyroidism ◽

Neurodevelopmental Outcome ◽

Diagnosis And Treatment ◽

Thyroid Function Tests ◽

Free T4 ◽

Neonatal Hypothyroidism ◽

Serum Free ◽

Screening Programs ◽

Diagnostic Studies

Abstract Congenital hypothyroidism, occurring in 1:3000 newborns, is one of the most common preventable causes of mental retardation. Neurodevelopmental outcome is inversely related to the age of diagnosis and treatment. Infants detected through newborn screening programs and started on l-T4 in the first few weeks of life have a normal or near-normal neurodevelopmental outcome. The recommended starting dose of l-T4 (10–15 μg/kg · d) is higher on a weight basis than the dose for children and adults. Tailoring the starting l-T4 dose to the severity of the hypothyroidism will normalize serum T4 and TSH as rapidly as possible. It is important to obtain confirmatory serum thyroid function tests before treatment is started. Further diagnostic studies, such as radionuclide uptake and scan and ultrasonography, may be performed to determine the underlying cause of hypothyroidism. Because results from these tests generally do not alter the initial treatment decision, however, these diagnostic studies are rarely indicated. The developing brain has a critical dependence on thyroid hormone for the first 2–3 yr of life; thus, monitoring occurs at more frequent intervals than in older children and adults. Serum free T4 and TSH should be checked at intervals frequent enough to ensure timely adjustment of l-T4 dosing and to keep serum free T4 and TSH levels in target ranges. Given the success of early detection and treatment of neonates with congenital hypothyroidism, a public health mandate should be to develop similar programs for the 75% of babies worldwide who are born in areas without newborn screening programs.

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Postnatal Serum Total Thyroxine of Very Preterm Infants and Long-Term Neurodevelopmental Outcome

Nutrients ◽

10.3390/nu13041055 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1055

Author(s):

Yung-Chieh Lin ◽

Chen-Yueh Wang ◽

Yu-Wen Pan ◽

Yen-Ju Chen ◽

Wen-Hao Yu ◽

...

Keyword(s):

Preterm Infants ◽

Congenital Hypothyroidism ◽

Brain Injuries ◽

Neurodevelopmental Outcome ◽

Term Infants ◽

Very Preterm Infants ◽

Very Preterm ◽

Total Thyroxine ◽

Tsh Levels

Primary congenital hypothyroidism is a disease associated with low serum thyroxine and elevated thyroid-stimulating hormone (TSH) levels. The processes of screening and treating congenital hypothyroidism, in order to prevent neurodevelopmental impairment (NDI) in newborns, have been well investigated. Unlike term infants, very preterm infants (VPIs) may experience low thyroxine with normal TSH levels (<10.0 μIU/mL) during long-stay hospitalization. In the current literature, thyroxine treatment has been evaluated only for TSH-elevated VPIs. However, the long-term impact of low thyroxine levels in certain VPIs with normal TSH levels deserves more research. Since July 2007, VPIs of this study unit received screenings at 1 month postnatal age (PNA) for serum TSH levels and total thyroxine (TT4), in addition to two national TSH screenings scheduled at 3–5 days PNA and at term equivalent age. This study aimed to establish the correlation between postnatal 1-month-old TT4 concentration and long-term NDI at 24 months corrected age among VPIs with serial normal TSH levels. VPIs born in August 2007–July 2016 were enrolled. Perinatal demography, hospitalization morbidities, and thyroid function profiles were analyzed, and we excluded those with congenital anomalies, brain injuries, elevated TSH levels, or a history of thyroxine treatments. In total, 334 VPIs were analyzed and 302 (90.4%) VPIs were followed-up. The postnatal TT4 concentration was not associated with NDI after multivariate adjustment (odd ratios 1.131, 95% confidence interval 0.969–1.32). To attribute the NDI of TSH-normal VPIs to a single postnatal TT4 concentration measurement may require more research.

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