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Özer Y, Anık A, Sayılı U, Tercan U, Deveci Sevim R, Güneş S, Buhur Pirimoğlu M, Elmaoğulları S, Dündar I, Ökdemir D, Besci Ö, Jalilova A, Çiçek D, Singin B, Ulu ŞE, Turan H, Albayrak S, Kocabey Sütçü Z, Eklioğlu BS, Eren E, Çetinkaya S, Savaş-Erdeve Ş, Esen I, Demir K, Darcan Ş, Hatipoğlu N, Parlak M, Dursun F, Şıklar Z, Berberoğlu M, Keskin M, Orbak Z, Tezel B, Yürüker E, Keskinkılıç B, Kara F, Erginöz E, Darendeliler F, Evliyaoğlu O. High frequency of transient congenital hypothyroidism among infants referred for suspected congenital hypothyroidism from the Turkish National screening program: thyroxine dose may guide the prediction of transients. J Endocrinol Invest 2024; 47:2213-2224. [PMID: 38546931 PMCID: PMC11369008 DOI: 10.1007/s40618-024-02348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/20/2024] [Indexed: 09/03/2024]
Abstract
PURPOSE We aimed to determine the frequency of transient congenital hypothyroidism (TCH) in 17 participating centers in Türkiye, evaluate the etiological distribution in permanent congenital hypothyroidism (PCH) cases, and investigate the role of laboratory and clinical findings in predicting TCH. METHODS This retrospective observational multicenter study included patients from 17 pediatric endocrinology centers identified by "National Newborn Screening Program" (NNSP) who were born in 2015 and followed for 6 years. Demographic, clinical, and laboratory information of the cases were compiled through the database http://cedd.saglik-network.org (CEDD-NET). RESULTS Of the 239 cases initially treated for CH, 128 (53.6%) were determined as transient in whom a trial of levothyroxine (LT4) withdrawal was performed at a median age of 36 (34-38) months. Among the patients with PCH (n = 111), thyroid dysgenesis was diagnosed in 39.6% (n = 44). The predictive factors for TCH were: LT4 dose at the withdrawal of treatment, and initial newborn blood screening (NBS)-TSH level. Based on the receiver operating characteristic (ROC) curve analysis to predict optimal cut-offs for TCH predictors, LT4 dose < 2.0 µg/kg/day at treatment discontinuation was predictive for TCH and was associated with 94.5% specificity and 55.7% sensitivity, with an area under the curve (AUC) of 0.802. The initial NBS-TSH level value < 45 µIU/mL was predictive for TCH with 93.1% specificity and 45.5% sensitivity, with an AUC of 0.641. In patients with eutopic thyroid gland only LT4 dose < 1.1 µg/kg/day at withdrawal time was predictive for TCH with 84.7% sensitivity and 40.4% specificity, with an AUC of 0.750. CONCLUSION According to our national follow-up data, the frequency of TCH was 53.6%. We determined the LT4 dose < 2.0 µg/kg/day at discontinuation of treatment and the initial NBS-TSH level < 45 µIU/mL as the best cut-off limits to predict TCH.
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Affiliation(s)
- Y Özer
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - A Anık
- Department of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - U Sayılı
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - U Tercan
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - R Deveci Sevim
- Department of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - S Güneş
- Department of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - M Buhur Pirimoğlu
- Department of Pediatric Endocrinology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - S Elmaoğulları
- Department of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey
| | - I Dündar
- Department of Pediatric Endocrinology, Malatya Education and Research Hospital, Malatya, Turkey
| | - D Ökdemir
- Department of Pediatric Endocrinology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Ö Besci
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - A Jalilova
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - D Çiçek
- Department of Pediatric Endocrinology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - B Singin
- Department of Pediatric Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ş E Ulu
- Departments of Pediatric Endocrinology, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - H Turan
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - S Albayrak
- Department of Pediatric Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Z Kocabey Sütçü
- Department of Pediatric Endocrinology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - B S Eklioğlu
- Department of Pediatric Endocrinology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - E Eren
- Department of Pediatric Endocrinology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - S Çetinkaya
- Department of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey
| | - Ş Savaş-Erdeve
- Department of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey
| | - I Esen
- Department of Pediatric Endocrinology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - K Demir
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ş Darcan
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - N Hatipoğlu
- Department of Pediatric Endocrinology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - M Parlak
- Department of Pediatric Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - F Dursun
- Departments of Pediatric Endocrinology, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Z Şıklar
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - M Berberoğlu
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - M Keskin
- Department of Pediatric Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Z Orbak
- Department of Pediatric Endocrionology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - B Tezel
- Department of Child and Adolescents Health, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - E Yürüker
- Department of Child and Adolescents Health, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - B Keskinkılıç
- Department of Child and Adolescents Health, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - F Kara
- Department of Child and Adolescents Health, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - E Erginöz
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - F Darendeliler
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - O Evliyaoğlu
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ding X, Liu Z, Zhang B, Yang Y, Wang Y, Yu B, Long W. Permanent vs Transient Congenital Hypothyroidism in Chinese Children: Physical Growth and Predictive Nomogram. J Clin Endocrinol Metab 2024; 109:e1616-e1622. [PMID: 38104243 DOI: 10.1210/clinem/dgad739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
CONTEXT Few reliable markers are available to distinguish transient congenital hypothyroidism (TCH) and permanent congenital hypothyroidism (PCH). Additionally, the differences in growth between TCH and PCH remain unclear. OBJECTIVE To investigate the growth of children with TCH and PCH and develop a nomogram for early differentiation of these forms. METHODS This retrospective study included children with TCH or PCH. The predictive efficacy of the prognostic predictors was analyzed using receiver operating characteristic analysis. Multivariate prediction models were developed. Measurements of growth were compared between groups. RESULTS Patients with TCH had lower initial thyroid-stimulating hormone (TSH) than those with PCH at newborn screening (NBS). The supplementary dose of levothyroxine (L-T4) gradually decreased with age in TCH but not in PCH. The area under the curve (AUC) values of the initial TSH, L-T4 dose at 1 year of age, and L-T4 dose at 2 years of age for distinguishing TCH from PCH were 0.698, 0.71, and 0.879, respectively. The predictive efficacy of the multivariate models at 1 and 2 years of age improved, with AUC values of 0.752 and 0.922, respectively. A nomogram was built based on the multivariate model at 1 year of age. The growth did not differ between children with TCH and those with PCH. However, at 1 year of age, girls with CH exhibited higher z-scores in terms of height and weight than boys with CH. CONCLUSION TSH at NBS and L-T4 doses during treatment can be used to distinguish between PCH and TCH early in life, and the predictive efficacy can be improved using multivariable models with a visualized nomogram. At 3 years of age, patients with TCH and PCH showed similar growth.
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Affiliation(s)
- Xuejing Ding
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Zhiwei Liu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Bin Zhang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Yuqi Yang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Ying Wang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Bin Yu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Wei Long
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
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Lee SH, Lee HG, Yang EM, Kim CJ. Comparison between transient and permanent congenital hypothyroidism on a thyroid function test after re-evaluation. Ann Pediatr Endocrinol Metab 2023; 28:245-250. [PMID: 38173380 PMCID: PMC10765033 DOI: 10.6065/apem.2244260.130] [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: 11/25/2022] [Revised: 01/31/2023] [Accepted: 07/07/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE Congenital hypothyroidism (CH) is diagnosed with neonatal screening and is treated early in the neonatal period. Among these patients, transient CH (TCH) is included and requires re-evaluation. The purpose of this study was to find the best way to discontinue levothyroxine and to find trends in thyroid function tests (TFTs) after re-evaluation. METHODS We retrospectively reviewed 388 patients diagnosed with CH. They were classified as permanent CH (PCH) and TCH. The total number of the PCH and TCH groups was 83 (51 boys and 32 girls). We compared clinical parameters to predict TCH and to identify the trends of TFT. RESULTS The first thyroid-stimulating hormone (TSH) value after discontinuation and the average TSH value for 1, 2, and 3 years were all significantly higher in the PCH group (P<0.01). The first fT4 value after discontinuation and the average fT4 value for 1, 2, and 3 years were all significantly higher in the TCH group (P<0.01). The optimal cutoff value on the receiver operating characteristic curve for PCH prediction with an average of 3 years of TSH was greater than 9.05 μIU/mL, which was predicted with a sensitivity of 100% and a specificity of 100%. CONCLUSION When the TSH value ranges from 10 μIU/mL to 20 μIU/mL, clinicians can discontinue levothyroxine if the next result is around 10 μIU/mL or shows a decreasing trend.
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Affiliation(s)
- Song Han Lee
- Department of Pediatrics, Chonnam National University Medical School & Children's Hospital, Gwangju, Korea
| | - Hyun Gyung Lee
- Department of Pediatrics, Chonnam National University Medical School & Children's Hospital, Gwangju, Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Medical School & Children's Hospital, Gwangju, Korea
| | - Chan Jong Kim
- Department of Pediatrics, Chonnam National University Medical School & Children's Hospital, Gwangju, Korea
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Danner E, Niuro L, Huopio H, Niinikoski H, Viikari L, Kero J, Jääskeläinen J. Incidence of primary congenital hypothyroidism over 24 years in Finland. Pediatr Res 2023; 93:649-653. [PMID: 35661828 PMCID: PMC9988686 DOI: 10.1038/s41390-022-02118-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/22/2022] [Accepted: 05/08/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND A rise in the incidence of congenital hypothyroidism (CH) has been reported worldwide. This nationwide study aimed to describe the secular trends and current incidence of CH in Finland. METHODS Two independent study cohorts, a national and a regional, were collected from national registers and patient records. The national cohort represents all CH cases born in Finland between 1994 and 2017. Birth data, results of the screening test, and the incidence of CH were reviewed. RESULTS Between 1994 and 2017, 1,400,028 children were born in Finland. Of these children, 503 were diagnosed with primary CH (incidence 1:2783). Male-to-female sex ratio was 1:2.0. The nationwide incidence was 33 cases per 100,000 live births between 1994 and 1999, 38 cases per 100,000 live births between 2000 and 2005, 40 cases per 100,000 live births between 2006 and 2011, and 33 cases per 100,000 live births between 2012 and 2017. In the regional cohort (n = 139), the incidence of transient CH was 3.6%. The incidence of mild, moderate, and severe CH remained constant. CONCLUSIONS In Finland, the incidence of CH has not changed during the 24-year study period. IMPACT As opposed to recent reports worldwide, the incidence of congenital hypothyroidism has not changed between 1994 and 2017 in Finland. The proportions of mild, moderate, and severe congenital hypothyroidism did not change significantly over the study period. Lowering the TSH cut-off limit or increasing immigration did not affect the incidence rate of primary congenital hypothyroidism in Finland.
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Affiliation(s)
- Emmi Danner
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
| | - Laura Niuro
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Hanna Huopio
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Harri Niinikoski
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Liisa Viikari
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jukka Kero
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jarmo Jääskeläinen
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
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Liu H, Li W, Zhang W, Sun S, Chen C. Levothyroxine: Conventional and novel drug delivery formulations. Endocr Rev 2022; 44:393-416. [PMID: 36412275 PMCID: PMC10166268 DOI: 10.1210/endrev/bnac030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/18/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
Despite the fact that levothyroxine is one of the most prescribed medications in the world, its bioavailability has been reported to be impaired by many factors, including interfering drugs or foods and concomitant diseases, and persistent hypothyroidism with a high dose of levothyroxine is thus elicited. Persistent hypothyroidism can also be induced by noninterchangeability between formulations and poor compliance. To address these issues, some strategies have been developed. Novel formulations (liquid solutions and soft-gel capsules) have been designed to eliminate malabsorption. Some other delivery routes (injections, suppositories, sprays, and sublingual and transdermal administrations) are aimed at circumventing different difficulties in dosing, such as thyroid emergencies and dysphagia. Moreover, nanomaterials have been used to develop delivery systems for the sustained release of levothyroxine to improve patient compliance and reduce costs. Some delivery systems encapsulating nanoparticles show promising release profiles. In this review, we first summarize the medical conditions that interfere with the bioavailability of oral levothyroxine and discuss the underlying mechanisms and treatments. The efficacy of liquid solutions and soft-gel capsules are systematically evaluated. We further summarize the novel delivery routes for levothyroxine and their possible applications. Nanomaterials in the levothyroxine field are then discussed and compared based on their load and release profile. We hope the article provides novel insights into the drug delivery of levothyroxine.
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Affiliation(s)
- Hanqing Liu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Wei Li
- Key Laboratory of Combinatorial Biosynthesis and Drug Discovery (Ministry of Education), School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Wen Zhang
- Key Laboratory of Combinatorial Biosynthesis and Drug Discovery (Ministry of Education), School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
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Chooprasertsuk N, Dejkhamron P, Unachak K, Wejaphikul K. Iatrogenic hyperthyroidism in primary congenital hypothyroidism: prevalence and predictive factors. J Pediatr Endocrinol Metab 2022; 35:1250-1256. [PMID: 36100363 DOI: 10.1515/jpem-2022-0152] [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: 03/22/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Primary congenital hypothyroidism (CH) is a preventable cause of mental retardation. Iatrogenic hyperthyroidism has occasionally been reported using the recommended LT4 dosage. Currently, information regarding iatrogenic hyperthyroidism and predictive factors for permanent hypothyroidism (P-CH) among Thai patients is lacking. The aim of this study is to determine the prevalence and factors for predicting iatrogenic hyperthyroidism at one month after LT4 initiation and for predicting P-CH in primary CH infants. METHODS This retrospective cohort study involved 87 infants with primary CH. Patients were classified by thyroid status at one month after LT4 initiation. At 3 years, patients were reevaluated after LT4 cessation and assigned as P-CH or transient CH (T-CH). Differences between groups were analyzed. RESULTS One month after LT4 initiation, 35.6% of patients were classified as having iatrogenic hyperthyroidism. An initial LT4 dose of 10.2 μg/kg/day (sensitivity 64.5%, specificity 71.4%) was a suitable cutoff value for predicting iatrogenic hyperthyroidism, wherein 55.6 and 21.6% of patients were treated with initial doses of ≥10.2 and <10.2 μg/kg/day, respectively (p=0.004). Initial LT4 dose was the only predictive factor for thyroid status after initial treatment. At reevaluation, 47.4% of patients were diagnosed with P-CH. LT4 dosage at 3 years of age was significantly higher in patients with P-CH (3.3 vs. 2.85 μg/kg/day, p=0.02) and the only relevant factor for predicting P-CH. CONCLUSIONS Iatrogenic hyperthyroidism is common among infants with primary CH when treated with the recommended LT4 dosage. LT4 dose was the only factor for predicting iatrogenic hyperthyroidism after LT4 initiation and the diagnosis of P-CH.
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Affiliation(s)
- Nuanpan Chooprasertsuk
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prapai Dejkhamron
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kevalee Unachak
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Karn Wejaphikul
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Donbaloğlu Z, Çetinkaya S, Aycan Z, Karacan Küçükali G, Şakar M, Savaş-Erdeve Ş. Evaluation of permanent and transient congenital hypothyroidism in cases referred from National Neonatal Screening Program. J Paediatr Child Health 2022; 58:1431-1438. [PMID: 35686887 DOI: 10.1111/jpc.16025] [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: 01/21/2022] [Revised: 04/15/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
AIM The incidence of congenital hypothyroidism (CH) has increased world-wide. Lowering cut-off in screening programs has led to an increase in the rate of transient CH. We aimed to evaluate the rates of permanent and transient CH in cases referred from the screening program and to investigate the clinical and laboratory factors which predict transient CH. METHODS In 109 cases referred from the neonatal screening program to our hospital, from September 2015 to April 2018, 52 primarily diagnosed CH cases were prospectively evaluated. Regularly followed up, 44 CH cases were included in the study at the end of 3 years. RESULTS 38.2 ± 1.31 weeks (w) and mean birthweight 3021.3 ± 389.6 gram (g) in the transient CH group; both were significantly lower compared to permanent CH cases with 39.06 ± 1.33 w and 3375.3 ± 425.3 g (P = 0.025, P = 0.007) respectively. Transient CH rate was found to be 50% (all hypoplastic) in the dysgenesis group and 73.3% in groups with normal and hyperplasic thyroid gland. While fT4 , thyroid-stimulating hormone, and thyroglobulin levels at diagnosis do not predict transient/permanent CH, levothyroxine (LT-4) dosage was significantly lower in the transient CH group in all years. The optimal cut-off value with highest sensitivity and specificity for LT-4 dosage as a predictive marker to differentiate transient CH from permanent CH was 2.27 μg/kg/day (P = 0.004; sensitivity: 71%, specificity: 83%) at 1st year, 1.85 μg /kg/day (P = 0.013; sensitivity: 66%, specificity: 72%) at 2nd year and 1.69 μg /kg/day at 3rd year (P < 0.0001; sensitivity: 90%, specificity: 83%). CONCLUSION Transient CH is more frequent than expected. Our results suggest that LT-4 requirement may be a good marker for predicting transient CH, while thyroid hormone levels at the time of diagnosis do not significantly predict permanent and transient CH. Therefore, infants with CH requiring LT-4 doses <2.27 μg/kg/day at 1st year, <1.85 μg /kg/day at 2nd year may be re-evaluated earlier to discriminate transient CH rather than at 3 years of age.
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Affiliation(s)
- Zeynep Donbaloğlu
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Semra Çetinkaya
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Zehra Aycan
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Gülin Karacan Küçükali
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Merve Şakar
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Şenay Savaş-Erdeve
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
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Peters C, Schoenmakers N. MECHANISMS IN ENDOCRINOLOGY: The pathophysiology of transient congenital hypothyroidism. Eur J Endocrinol 2022; 187:R1-R16. [PMID: 35588090 PMCID: PMC9254299 DOI: 10.1530/eje-21-1278] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/19/2022] [Indexed: 11/08/2022]
Abstract
Transient congenital hypothyroidism (TCH) refers to congenital hypothyroidism which spontaneously resolves in the first few months or years of life. Currently, there is a paucity of reliable markers predicting TCH at diagnosis, and the diagnosis is established following the withdrawal of levothyroxine therapy around 3 years of age. The incidence of TCH is increasing, and it is a major contributor to the overall increase in the incidence of CH in recent studies. Both genetic factors, in particular mutations affecting DUOX2 and DUOXA2, and environmental factors, for example, iodine deficiency and excess, anti- TSHR antibodies and exposure to antithyroid or iodine-rich medications, may cause TCH. Resolution of TCH in childhood may reflect both normal thyroid physiology (decreased thyroid hormone biosynthesis requirements after the neonatal period) and clearance or cessation of environmental precipitants. The relative contributions and interactions of genetic and environmental factors to TCH, and the extent to which TCH may be prevented, require evaluation in future population-based studies.
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Affiliation(s)
- Catherine Peters
- Department of Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - Nadia Schoenmakers
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Correspondence should be addressed to N Schoenmakers;
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Heidari MM, Madani Manshadi SA, Eshghi AR, Talebi F, Khatami M, Bragança J, Ordooei M, Chamani R, Ghasemi F. Mutational and bioinformatics analysis of the NKX2.1 gene in a cohort of Iranian pediatric patients with congenital hypothyroidism (CH). Physiol Int 2022; 109:261-277. [DOI: https:/doi.org/10.1556/2060.2022.00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Congenital hypothyroidism (CH) occurs with a relatively alarming prevalence in infants, and if not diagnosed and treated in time, it can have devastating consequences for the development of the nervous system. CH is associated with genetic changes in several genes that encode transcription factors responsible for thyroid development, including mutations in the NK2 homeobox 1 (NKX2.1) gene, which encodes the thyroid transcription factor-1 (TTF-1). Although CH is frequently observed in pediatric populations, there is still a limited understanding of the genetic factors and molecular mechanisms contributing to this disease. The sequence of the NKX2.1 gene was investigated in 75 pediatric patients with CH by polymerase chain reaction (PCR), single-stranded conformation polymorphism (SSCP), and direct DNA sequencing. Four missense heterozygous variations were identified in exon 3 of the NKX2.1 gene, including three novel missense variations, namely c.708A>G, p.Gln202Arg; c.713T>G, p.Tyr204Asp; c.833T>G, p.Tyr244Asp, and a previously reported variant rs781133468 (c.772C>G, p.His223Gln). Importantly, these variations occur in highly conserved residues of the TTF-1 DNA-binding domain and were predicted by bioinformatics analysis to alter the protein structure, with a probable alteration in the protein function. These results indicate that nucleotide changes in the NKX2.1 gene may contribute to CH pathogenesis.
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Affiliation(s)
| | | | | | | | | | - José Bragança
- Faculty of Medicine and Biomedical Sciences, Algarve Biomedical Centre Research Institute, University of Algarve, Faro, Portugal
| | - Mahtab Ordooei
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Heidari MM, Madani Manshadi SA, Eshghi AR, Talebi F, Khatami M, Bragança J, Ordooei M, Chamani R, Ghasemi F. Mutational and bioinformatics analysis of the NKX2.1 gene in a cohort of Iranian pediatric patients with congenital hypothyroidism (CH). Physiol Int 2022; 109:261-277. [DOI: 10.1556/2060.2022.00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/01/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
Abstract
Abstract
Congenital hypothyroidism (CH) occurs with a relatively alarming prevalence in infants, and if not diagnosed and treated in time, it can have devastating consequences for the development of the nervous system. CH is associated with genetic changes in several genes that encode transcription factors responsible for thyroid development, including mutations in the NK2 homeobox 1 (NKX2.1) gene, which encodes the thyroid transcription factor-1 (TTF-1). Although CH is frequently observed in pediatric populations, there is still a limited understanding of the genetic factors and molecular mechanisms contributing to this disease. The sequence of the NKX2.1 gene was investigated in 75 pediatric patients with CH by polymerase chain reaction (PCR), single-stranded conformation polymorphism (SSCP), and direct DNA sequencing. Four missense heterozygous variations were identified in exon 3 of the NKX2.1 gene, including three novel missense variations, namely c.708A>G, p.Gln202Arg; c.713T>G, p.Tyr204Asp; c.833T>G, p.Tyr244Asp, and a previously reported variant rs781133468 (c.772C>G, p.His223Gln). Importantly, these variations occur in highly conserved residues of the TTF-1 DNA-binding domain and were predicted by bioinformatics analysis to alter the protein structure, with a probable alteration in the protein function. These results indicate that nucleotide changes in the NKX2.1 gene may contribute to CH pathogenesis.
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Affiliation(s)
| | | | | | | | | | - José Bragança
- Faculty of Medicine and Biomedical Sciences, Algarve Biomedical Centre Research Institute, University of Algarve, Faro, Portugal
| | - Mahtab Ordooei
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Barry Y, Mandereau-Bruno L, Bonaldi C, Cheillan D, Coutant R, Léger J, Regnault N. Prevalence and Determinants of Transient Congenital Hypothyroidism in Children With Eutopic Gland in France: A Retrospective Cohort Study. J Clin Endocrinol Metab 2022; 107:e1501-e1509. [PMID: 34850038 DOI: 10.1210/clinem/dgab854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The increase in the incidence of congenital hypothyroidism (CH) reported worldwide may partly be explained by an increase in the transient form of CH. OBJECTIVE We aimed to estimate the proportion of transient CH (TCH) in France, and to identify associated neonatal and young child characteristics. METHODS We used probabilistic record linkage to link children with eutopic gland born between 2006 and 2012 recorded in the national French CH registry and the French national health data system (SNDS). Of the 703 children recorded, 484 (68.8%) were linked. We retrospectively examined reimbursement for oral levothyroxine (LT4) between January 1, 2006, and December 31, 2017. Children who had discontinued treatment for 6 months or more before December 31, 2017, were classified as having TCH. We used a Cox model to examine the factors associated with TCH. RESULTS Among the main study sample (n = 471), 53.5% were female, 14.2% were preterm, and 13.8% had low birth weight. One-quarter (n = 111, 24.3%) had mild CH (thyroid-stimulating hormone [TSH] < 50 mU/L, serum) at diagnosis and a median LT4 dose at treatment initiation of 30 μg/day. One-third (n = 155, 32.9%) had TCH. Premature birth (adjusted hazard ratio = 2.1 [1.0-4.2]), a TSH < 50 mU/L at CH screening (7.4 [3.2-17.1]), LT4 dose received at 12 months of age (0.98 [0.97-0.99, P = 0.003]), congenital cardiac malformations (6.6 [1.5-29.0]), and year of birth (1.2 [1.1-1.4]) were all associated with TCH. CONCLUSION One-third of the children had TCH, and it was associated with several characteristics at birth and postpartum. These data are useful for CH medical management and epidemiological surveillance.
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Affiliation(s)
- Yaya Barry
- Santé Publique France, the French National Public Health Agency, Non-Communicable Diseases and Trauma Division, Saint-Maurice, France
| | - Laurence Mandereau-Bruno
- Santé Publique France, the French National Public Health Agency, Data Science Division, Saint-Maurice, France
| | - Christophe Bonaldi
- Santé Publique France, the French National Public Health Agency, Data Science Division, Saint-Maurice, France
| | - David Cheillan
- Univ Lyon, CarMeN laboratory, INSERM- U1060, INRAE, INSA Lyon, Université Claude Bernard Lyon 1, Charles Mérieux Medical School, Pierre-Bénite, France
- Hospices Civils de Lyon, Lyon, France
- Unité Maladies Héréditaires du Métabolisme, Service de Biochimie et Biologie Moléculaire Grand Est, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
| | - Régis Coutant
- CHU-Angers, Unité Endocrinologie Diabétologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, Angers, France
| | - Juliane Léger
- Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR, DHU Protect, Paris, France
- Paris Diderot University, Sorbonne Paris Cite´, Paris, France
| | - Nolwenn Regnault
- Santé Publique France, the French National Public Health Agency, Non-Communicable Diseases and Trauma Division, Saint-Maurice, France
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Marr A, Yokubynas N, Tang K, Saleh D, Wherrett DK, Stein R, Bassilious E, Chakraborty P, Lawrence SE. Transient vs Permanent Congenital Hypothyroidism in Ontario, Canada: Predictive Factors and Scoring System. J Clin Endocrinol Metab 2022; 107:638-648. [PMID: 34726229 PMCID: PMC8851917 DOI: 10.1210/clinem/dgab798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Indexed: 12/14/2022]
Abstract
CONTEXT The apparent increased incidence of congenital hypothyroidism (CH) is partly due to increased detection of transient disease. OBJECTIVE This work aims to identify predictors of transient CH (T-CH) and establish a predictive tool for its earlier differentiation from permanent CH (P-CH). METHODS A retrospective cohort study was conducted of patients diagnosed with CH from 2006 to 2015 through Newborn Screening Ontario (NSO). RESULTS Of 469 cases, 360 (76.8%) were diagnosed with P-CH vs 109 (23.2%) with T-CH. Doses of levothyroxine predicting T-CH were less than 3.9 μg/kg at age 6 months, less than 3.0 μg/kg at ages 1 and 2 years, and less than 2.5 μg/kg at age 3 years. Descriptive statistics and multivariable logistic modeling demonstrated several diverging key measures between patients with T-CH vs P-CH, with optimal stratification at age 1 year. Thyroid imaging was the strongest predictor (P < .001). Excluding imaging, significant predictors in the first year of life included thyroxine dose/kg (P < .001-.002), increase in thyrotropin (TSH) above the reference interval during treatment (P = .002), screening TSH (P = .03), and a history of maternal thyroid disease (P = .02). Based on the 1-year model without imaging, a risk score was developed to identify children with T-CH who may benefit from an earlier trial off therapy, to reduce excess medicalization and health care costs. CONCLUSION A levothyroxine dose of less than 3 μg/kg at ages 1 and 2 years and less than 2.5 μg/kg at age 3 years can be predictive of T-CH. A novel risk score was developed that can be clinically applied to predict the likelihood of a successful trial off therapy for a given patient at age 1 year.
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Affiliation(s)
- Alexa Marr
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, K1H 8M5, Canada
- Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, Ontario, K1H 8L1, Canada
| | - Nicole Yokubynas
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, K1H 8M5, Canada
| | - Ken Tang
- CHEO Research Institute, Ottawa, Ontario, K1H 5B2, Canada
| | - David Saleh
- Department of Pediatrics, Queen’s University, Kingston, Ontario, K7L 3N6, Canada
| | - Diane K Wherrett
- Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Robert Stein
- Division of Endocrinology and Metabolism, London Health Sciences Center, London, Ontario, N6A 5W9, Canada
| | - Ereny Bassilious
- Division of Endocrinology and Metabolism, McMaster Children’s Hospital, Hamilton, Ontario, L8N 3Z5, Canada
| | - Pranesh Chakraborty
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, K1H 8M5, Canada
- Division of Metabolics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada
- Newborn Screening Ontario, Ottawa, Ontario, K1H 8L1, Canada
| | - Sarah E Lawrence
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, K1H 8M5, Canada
- Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, Ontario, K1H 8L1, Canada
- Correspondence: Sarah E. Lawrence, MD, Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, 5109-401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
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Tuli G, Munarin J, De Sanctis L. Diagnostic Re-Evaluation and Potential Predictor Factors of Transient and Permanent Congenital Hypothyroidism in Eutopic Thyroid Gland. J Clin Med 2021; 10:jcm10235583. [PMID: 34884283 PMCID: PMC8658106 DOI: 10.3390/jcm10235583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022] Open
Abstract
Background: The incidence of congenital hypothyroidism (CH) has increased over the years, and many predictors for detecting newborns with transient forms (TCH) as early as possible have been considered. Methods: All newborns diagnosed with primary CH and eutopic gland in the Piedmont region of Italy in the period of January 2014–June 2019 were enrolled and re-evaluated at the age of 2 years. Results: 105 newborns were diagnosed with CH during the study period. Dyshormonogenesis was observed in 55/105. At re-evaluation, we found that 52.7% had permanent CH (PCH), while 47.3% had TCH. Male/female rate, TSH levels at diagnosis, levothyroxine requirement at withdrawal and extra-thyroid congenital malformations rate were higher in the PCH group (p = 0.02, p = 0.009, p = 0.02 and p = 0.01), while fT4 levels at diagnosis were lower (p = 0.03). Sensitivity of 72.4% and specificity of 80.7% for serum TSH above 60 mcUI/mL, sensitivity of 73% and specificity of 72.4% for serum fT4 level below 7.2 pg/mL and sensitivity of 66% and specificity of 68% for drug requirement above 2.25 mcg/kg/day were observed in PCH. Conclusions: Demographic, clinical and hormonal data at diagnosis and levothyroxine requirement during the first two years should be adequately monitored to identify infants who are most likely to discontinue therapy after the age of 24 months.
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Affiliation(s)
- Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, City of Health and Science University Hospital of Turin, 10126 Turin, Italy; (J.M.); (L.D.S.)
- Department of Public Health and Pediatric Sciences, University of Turin, 10124 Turin, Italy
- Correspondence: ; Tel./Fex: +39-011-313-1775
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, City of Health and Science University Hospital of Turin, 10126 Turin, Italy; (J.M.); (L.D.S.)
- Department of Public Health and Pediatric Sciences, University of Turin, 10124 Turin, Italy
| | - Luisa De Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, City of Health and Science University Hospital of Turin, 10126 Turin, Italy; (J.M.); (L.D.S.)
- Department of Public Health and Pediatric Sciences, University of Turin, 10124 Turin, Italy
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Permana AD, Stewart SA, Domínguez-Robles J, Amir MN, Bahar MA, Donnelly RF, Larraneta E. Development and validation of a high-performance liquid chromatography method for levothyroxine sodium quantification in plasma for pre-clinical evaluation of long-acting drug delivery systems. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:5204-5210. [PMID: 34676387 DOI: 10.1039/d1ay01049b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Levothyroxine (LEVO) sodium is an FDA-approved drug that is used to treat underactive thyroid (hypothyroidism) and other conditions. It is generally used as a thyroid-stimulating hormone administered orally. However, this approach has some drawbacks such as this drug should be taken every day 30 min to 1 h prior to breakfast with an empty stomach, moreover, some food interactions must be monitored. Thus, alternative innovative approaches capable of providing sustained LEVO release should be developed. Our research was designed to establish a simple quantitative determination method for LEVO in rat plasma for pre-clinical evaluation of long acting formulations using a high-performance liquid chromatography method, to validate the analytical method according to ICH guidelines and to characterise its pharmacokinetic behavior in rats. After simple protein precipitation with acetonitrile, LEVO was eluted on a Xselect CSH™ C18 column (Waters, 3.0 × 150 mm) with a particle size of 3.5 μm using a mobile phase of water and acetonitrile at a ratio of 65 : 35% v/v, including 0.1% v/v of trifluoracetic acid. The calibration standards used for plasma ranged between 0.5-1000 ng mL-1 with a correlation coefficient (r2) of ≥0.998. The limit of detection was 0.44 ng mL-1 and the lower limit of quantitation was 1.33 ng mL-1. The extraction recovery of LEVO in rat plasma samples by this method was between 80 and 85%. The method was selective, sensitive, accurate and precise for detecting and quantifying LEVO in a pharmacokinetic study carried out in rats for pre-clinical evaluation of long acting formulations. The validated HPLC method meets the ICH established requirements and therefore offers a wide range of potential applications in pre-clinical therapeutic drug monitoring, pharmacokinetics and toxicology.
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Affiliation(s)
- Andi Dian Permana
- Department of Pharmaceutics, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia.
| | - Sarah A Stewart
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.
| | | | - Muh Nur Amir
- Department of Pharmacology-Toxicology, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | - Muh Akbar Bahar
- Department of Pharmacology-Toxicology, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.
| | - Eneko Larraneta
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.
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Chen SH, Yang BC, Li JY, Xu P, Wang F. Diagnostic re-evaluation and predictors of congenital hypothyroidism with eutopic thyroid gland in Jiangxi, China. J Pediatr Endocrinol Metab 2021; 34:1139-1146. [PMID: 34171937 DOI: 10.1515/jpem-2020-0733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES An increase in the incidence of congenital hypothyroidism (CH) with eutopic gland has been reported worldwide due to neonatal screening programs. In this study, we aimed to determine the prevalence of transient CH (TCH) and to investigate predictive factors that could distinguish between permanent and transient CH in patients with eutopic thyroid glands. METHODS We retrospectively reviewed 508 children treated for CH with eutopic thyroid glands between June 1998 and June 2020 in Jiangxi Newborn Screening Center. All patients were treated with levothyroxine and underwent Diagnostic re-evaluation after 2-3 years of age. Patients were classified as having TCH or permanent CH (PCH) during follow-up. RESULTS Of the 508 patients initially treated for CH with a normally located gland, 335 patients (65.9%) were classified in the TCH group and 173 (34.1%) in the PCH group based on the defined criteria. Multivariate analysis revealed that TCH was associated with a lower levothyroxine dose at 24 months of age (p<0.001) and a lower likelihood of having a first-degree family history of CH (p=0.026) than PCH. Gender, prematurity, low birth weight, initial CH severity such as serum TSH and FT4 levels, or bone maturation delay at diagnosis had no effect. Receiver operating characteristics curve analysis showed that a cutoff of 2.3 μg/kg/day for levothyroxine dose requirement at 24 months of age had a sensitivity of 71% and a specificity of 70% for predicting transient CH, with values below this threshold considered predictive of transient CH. CONCLUSIONS TCH presents a significant portion of patients with CH. The levothyroxine dose requirement at 24 months of age has a predictive role in differentiating TCH from PCH in CH patients with eutopic thyroid glands.
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Affiliation(s)
- Shao-Hong Chen
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Bi-Cheng Yang
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Jiang-Ying Li
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Ping Xu
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Feng Wang
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
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Stewart SA, Domínguez-Robles J, Utomo E, Picco CJ, Corduas F, Mancuso E, Amir MN, Bahar MA, Sumarheni S, Donnelly RF, Permana AD, Larrañeta E. Poly(caprolactone)-based subcutaneous implant for sustained delivery of levothyroxine. Int J Pharm 2021; 607:121011. [PMID: 34391850 DOI: 10.1016/j.ijpharm.2021.121011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/21/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022]
Abstract
This work aimed to develop a subcutaneous implant for prolonged delivery of LEVO to treat hypothyroidism. This could overcome challenges with patient compliance and co-administration and could improve treatment of this condition. For this purpose, implants were produced by solvent casting mixtures of poly(caprolactone) (PCL), poly(ethylene glycol) (PEG) and LEVO sodium. These implants contained mixtures of PCL of differing molecular weight, PEG and different LEVO sodium loadings (20% or 40% w/w). SEM images confirmed that the drug was evenly dispersed throughout the implant. In vitro release rates ranging from 28.37 ± 1.19 - 78.21 ± 19.93 µg/day and 47.39 ± 8.76 - 98.92 ± 4.27 µg/day were achieved for formulations containing 20% and 40% w/w drug loading, respectively. Implants containing higher amounts of low molecular weight PCL and 40% w/w of LEVO showed release profiles governed by zero order kinetics. On the other hand, implants containing higher amounts of high molecular weight PCL showed a release mechanism governed by Fickian diffusion. Finally, two representative formulations were tested in vivo. These implants were capable of providing detectable LEVO levels in plasma during the entire duration of the experiments (4 weeks) with LEVO plasma levels ranging between 5 and 20 ng/mL.
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Affiliation(s)
- Sarah A Stewart
- School of Pharmacy, Queen's University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK
| | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK
| | - Emilia Utomo
- School of Pharmacy, Queen's University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK
| | - Camila J Picco
- School of Pharmacy, Queen's University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK
| | - Francesca Corduas
- Nanotechnology and Integrated Bio-Engineering Centre (NIBEC), Ulster University, Jordanstown Campus, Newtownabbey BT37 0QB, UK
| | - Elena Mancuso
- Nanotechnology and Integrated Bio-Engineering Centre (NIBEC), Ulster University, Jordanstown Campus, Newtownabbey BT37 0QB, UK
| | - Muh Nur Amir
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Muh Akbar Bahar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Sumarheni Sumarheni
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK
| | - Andi Dian Permana
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Hasanuddin, Makassar 90245, Indonesia.
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, Lisburn Road 97, Belfast BT9 7BL, UK.
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17
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Mehran L, Azizi F, Mousapour P, Cheraghi L, Yarahmadi S, Amirshekari G, Khalili D. Development of a risk prediction model for early discrimination between permanent and transient congenital hypothyroidism. Endocrine 2021; 73:374-383. [PMID: 33616836 DOI: 10.1007/s12020-021-02641-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop a risk prediction model for early discrimination between transient and permanent congenital hypothyroidism (CH). DESIGN AND SETTING In a retrospective cohort, 1047 confirmed CH neonates, from 15 randomly selected provinces in Iran, were entered to the study. Clinical and biochemical information of transient and permanent cases, distinct at the age of 3 years were retrospectively gathered. RESULTS Among CH neonates, the overall prevalence of permanent CH was 57.1%. Using forward stepwise multivariable logistic regression analysis, confirmatory venous TSH, total T4 < 8.2 ng/dl, requiring levothyroxine dosage increase, venous TSH ≥ 10 mU/l between 6 and 12 months of age, parental consanguinity and family history of thyroid diseases were associated with increased risk of permanent CH. The prediction model achieved a very good power in discriminating patients with transient and permanent CH with an optimism-corrected area under the ROC curve of 0.86 (95% CI:0.84-0.88) with a very good calibration. Integrated discrimination improvement (IDI) test indicated significantly greater diagnostic performance of the model compared to serum TSH alone. CONCLUSIONS Using several potential predictors for permanent CH, we developed a relatively powerful risk prediction model as a cost-saving screening tool in order to avoid unnecessary long-term treatment of transient cases which might empower clinicians for prognostication of the CH course and tailoring treatment up to 1 year of age.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouria Mousapour
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yarahmadi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golshan Amirshekari
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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van Trotsenburg P, Stoupa A, Léger J, Rohrer T, Peters C, Fugazzola L, Cassio A, Heinrichs C, Beauloye V, Pohlenz J, Rodien P, Coutant R, Szinnai G, Murray P, Bartés B, Luton D, Salerno M, de Sanctis L, Vigone M, Krude H, Persani L, Polak M. Congenital Hypothyroidism: A 2020-2021 Consensus Guidelines Update-An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology. Thyroid 2021; 31:387-419. [PMID: 33272083 PMCID: PMC8001676 DOI: 10.1089/thy.2020.0333] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: An ENDO-European Reference Network (ERN) initiative was launched that was endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology with 22 participants from the ENDO-ERN and the two societies. The aim was to update the practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). A systematic literature search was conducted to identify key articles on neonatal screening, diagnosis, and management of primary and central CH. The evidence-based guidelines were graded with the Grading of Recommendations, Assessment, Development and Evaluation system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. Summary: The recommendations include the various neonatal screening approaches for CH as well as the etiology (also genetics), diagnostics, treatment, and prognosis of both primary and central CH. When CH is diagnosed, the expert panel recommends the immediate start of correctly dosed levothyroxine treatment and frequent follow-up including laboratory testing to keep thyroid hormone levels in their target ranges, timely assessment of the need to continue treatment, attention for neurodevelopment and neurosensory functions, and, if necessary, consulting other health professionals, and education of the child and family about CH. Harmonization of diagnostics, treatment, and follow-up will optimize patient outcomes. Lastly, all individuals with CH are entitled to a well-planned transition of care from pediatrics to adult medicine. Conclusions: This consensus guidelines update should be used to further optimize detection, diagnosis, treatment, and follow-up of children with all forms of CH in the light of the most recent evidence. It should be helpful in convincing health authorities of the benefits of neonatal screening for CH. Further epidemiological and experimental studies are needed to understand the increased incidence of this condition.
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Affiliation(s)
- Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Athanasia Stoupa
- Pediatric Endocrinology, Gynecology and Diabetology Department, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université de Paris, Paris, France
- INSERM U1163, IMAGINE Institute, Paris, France
- INSERM U1016, Cochin Institute, Paris, France
| | - Juliane Léger
- Department of Pediatric Endocrinology and Diabetology, Reference Center for Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1141, Paris, France
| | - Tilman Rohrer
- Department of Pediatric Endocrinology, University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Catherine Peters
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Cassio
- Department of Pediatric Endocrinology, Unit of Pediatrics, Department of Medical & Surgical Sciences, University of Bologna, Bologna Italy
| | - Claudine Heinrichs
- Pediatric Endocrinology Unit, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Veronique Beauloye
- Unité d'Endocrinologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Joachim Pohlenz
- Department of Pediatrics, Johannes Gutenberg University Medical School, Mainz, Germany
| | - Patrice Rodien
- Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Service EDN, CHU d'Angers, Institut MITOVASC, Université d'Angers, Angers, France
| | - Regis Coutant
- Unité d' Endocrinologie Diabetologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, CHU-Angers, Angers, France
| | - Gabor Szinnai
- Department of Pediatric Endocrinology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Murray
- European Society for Pediatric Endocrinology
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Beate Bartés
- Thyroid Group, European Patient Advocacy Group Patient Representative (ePAG), Association Vivre sans Thyroide, Léguevin, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine (HUPNVS), Assistance Publique Hôpitaux de Paris (APHP), Bichat Hospital, Paris, France
- Department Risks and Pregnancy (DHU), Université de Paris, Inserm U1141, Paris, France
| | - Mariacarolina Salerno
- Pediatric Endocrine Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Mariacristina Vigone
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Heiko Krude
- Institut für Experimentelle Pädiatrische Endokrinologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology Department, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université de Paris, Paris, France
- INSERM U1163, IMAGINE Institute, Paris, France
- INSERM U1016, Cochin Institute, Paris, France
- Paris Regional Newborn Screening Program, Centre régional de dépistage néonatal, Paris, France
- Centre de Référence Maladies Endocriniennes de la Croissance et du Développement, INSERM U1016, IMAGINE Institute, Paris, France
- ENDO-European Reference Network, Main Thematic Group 8, Paris, France
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19
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Scavone M, Giancotti L, Anastasio E, Pensabene L, Sestito S, Concolino D. Evolution of congenital hypothyroidism in a cohort of preterm born children. Pediatr Neonatol 2020; 61:629-636. [PMID: 32771362 DOI: 10.1016/j.pedneo.2020.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Congenital hypothyroidism (CH) is reported to be more common in preterm infants than in term infants, especially in sick preterm infants. Though a frequent possibility of transitory thyroidal alterations in this category of neonates, the evolution of CH to transient or permanent forms is unpredictable. METHODS We retrospectively analyzed medical records of 28 preterm infants (<37 weeks gestation) who had exhibited a positive screening for CH at birth during the period 2000-2015 followed in our Center. Children were divided into three groups: permanent CH (PCH) with thyroid dysgenesis, PCH with eutopic normal-sized thyroid gland, and transient CH (TCH) with eutopic normal-sized thyroid gland. In all groups we described clinical and biochemical characteristics. Secondly, we analyzed the differences between patients with thyroid dysgenesis and patients with eutopic normal-sized gland and we compared PCH and TCH groups with normal-sized thyroid gland in order to identify clinical or biochemical data for early detection of transient forms. RESULTS Of all patients, 21.4% showed thyroid dysgenesis while 78.6% presented eutopic normal-sized gland. Infants with thyroid dysgenesis had higher median (IQR) baseline s-TSH and levothyroxine (L-T4) dose per weight at 12 months (12 m-dose) than patients with eutopic normal-sized gland. At re-evaluation of the patients with eutopic normal-sized gland, 36% showed PCH and 64% had TCH. The age of the patients at the beginning of L-T4 treatment, gestational age (GA), birth weight, blood thyroid stimulating hormone levels (b-TSH) at first newborn screening (NBS), baseline serum thyroid stimulating hormone (s-TSH), and L-T4 12 m-dose were statistically different between the two groups. CONCLUSIONS Our results demonstrate that factors as GA, birth weight, b-TSH levels at first NBS, baseline s-TSH, L-T4 12 m-dose and age at the start of the treatment may be considered useful predictive elements for the evolution of CH.
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Affiliation(s)
- Maria Scavone
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Laura Giancotti
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elisa Anastasio
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Simona Sestito
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Daniela Concolino
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy.
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20
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Yamamura H, Kokumai T, Furuya A, Suzuki S, Tanahashi Y, Azuma H. Increase in doses of levothyroxine at the age of 3 years and above is useful for distinguishing transient and permanent congenital hypothyroidism. Clin Pediatr Endocrinol 2020; 29:143-149. [PMID: 33088013 PMCID: PMC7534519 DOI: 10.1297/cpe.29.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/29/2020] [Indexed: 12/28/2022] Open
Abstract
There are no recommended diagnostic criteria for transient congenital hypothyroidism (CH) during early childhood. In this study, we aimed to identify the factors that distinguish permanent (P)- and transient (T)-CH. We retrospectively analyzed the clinical, biochemical, and imaging data of 42 children with a definitive diagnosis of P- or T-CH by re-evaluation tests at our institution from November 1986 to October 2019. Patients who continued levothyroxine (L-T4) treatment after the re-evaluation tests were classified as group P (n = 19), while patients who were diagnosed with T-CH and discontinued L-T4 treatment were classified as group T (n = 23). Initial testing performed during infancy showed that the mean serum TSH and free T4 (FT4) levels did not differ significantly between groups P and T. None of the patients in group T required an increased dosage of L-T4 at the age of 3 yr and above while 85% of the patients in group P required increased dosages of L-T4. Hence, T-CH was suspected in patients who did not require an increase in L-T4 dosage at the age of 3 yr and above.
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Affiliation(s)
- Hinako Yamamura
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Takahide Kokumai
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Akiko Furuya
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Shigeru Suzuki
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Yusuke Tanahashi
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
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21
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Pitts L, McCormick W, Mick GJ. Congenital Hypothyroidism: 8-Year Experience Using 2 Newborn Screens in Alabama. Horm Res Paediatr 2020; 91:319-328. [PMID: 31390650 DOI: 10.1159/000501395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/06/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Newborn screening protocols for congenital hypothyroidism (CH) vary as to whether a TSH or T4 algorithm or some combination is performed. We aimed to determine the 3-year clinical outcome of infants diagnosed with CH and screen-positive for CH using a 2-screen protocol that measures both T4 and TSH on all specimens. METHODS Retrospective analysis of patients with CH who were detected by first (NBS1) or second (NBS2) newborn screen in Alabama (2009-2016) and followed at our university-based practice. Clinical follow-up established the final diagnoses in 146 patients, including a subset of 72 patients with eutopic glands. RESULTS 168 patients were studied: 139 (83%) were detected by NBS1 and 29 (17%) by NBS2. Screening T4 concentrations were 45% reduced in NBS2 compared to NBS1 (p= 0.0002). Thyroid dysgenesis was present in 55% of NBS1 patients while all in NBS2 were eutopic. Follow-up of 146 patients confirmed permanent CH in 92 patients in NBS1 (75%) and 5 in NBS2 (20%). Hispanic infants were only detected by NBS1, and 93% had permanent CH. Transient CH was associated with congenital heart disease. In patients with eutopic, permanent CH, dyshormonogenesis was confirmed in 23% of NBS1 patients and 40% of NBS2. One case of central CH was detected by each screen. CONCLUSIONS This 8-year, retrospective study buttresses the importance of a 2-screen approach for CH by identifying 5 infants with clinically significant permanent thyroid dysfunction including dyshormonogenesis and central hypothyroidism. It is the first 2-screen study to incorporate thyroid ultrasound. Disconcertingly, 4 of 5 second-screen infants with permanent CH had no risk factors for CH, and these infants would otherwise not have been detected.
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Affiliation(s)
- Leslie Pitts
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Gail J Mick
- University of Alabama at Birmingham, Birmingham, Alabama, USA,
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22
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Scavone M, Carboni E, Stefanelli E, Romano G, Vero A, Giancotti L, Miniero R, Talarico V. Prediction of Transient or Permanent Congenital Hypothyroidism from Initial Thyroid Stimulating Hormone Levels. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1442-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Ybarra M, Dos Santos TJ, Pinheiro CTC, Dichtchekenian V, Damiani D. Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study. Pediatrics 2018; 142:peds.2017-3317. [PMID: 30002138 DOI: 10.1542/peds.2017-3317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/24/2022] Open
Abstract
Transient hypothyroidism can present itself as clinically asymptomatic or with few symptoms. Early treatment with levothyroxine (L-T4) prevents complications related to this disorder. We report a case of a male infant with concomitant short bowel syndrome and transient hypothyroidism treated with rectal L-T4. A 4-month-and-10-day-old boy with previous gastroschisis underwent multiple surgical approaches for small bowel resection and developed short bowel syndrome. We suspected hypothyroidism because of jaundice (direct bilirubin up to 59 mg/dL), the absence of evacuation, oral diet intolerance, and intestinal dysmotility. Because of a thyrotropin level of 34.45 μIU/mL and a free thyroxine level of 0.64 ng/dL, the diagnosis was confirmed. Because fasting was demanding, we started the patient on rectal diluted L-T4. After 4 weeks, the patient had spontaneous peristalsis, improvement of jaundice (direct bilirubin: 4.6 mg/dL), and normalized free thyroxine and thyrotropin values. In the present case, the patient was diagnosed with hypothyroidism and was on absolute fasting. An alternative route of drug administration was warranted. We empirically prescribed rectal diluted L-T4 when intravenous and suppository L-T4 were not available. This method was proven to be safe and effective in improving the patient's clinical and biochemical status. Rectal L-T4 is a possible alternative route of administration to treat hypothyroidism in patients who are unable to take the medication orally.
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Affiliation(s)
- Marina Ybarra
- Pediatric Endocrinology Unit, Children's Institute, University of São Paulo, São Paulo, Brazil
| | | | | | - Vaê Dichtchekenian
- Pediatric Endocrinology Unit, Children's Institute, University of São Paulo, São Paulo, Brazil
| | - Durval Damiani
- Pediatric Endocrinology Unit, Children's Institute, University of São Paulo, São Paulo, Brazil
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24
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Saba C, Guilmin-Crepon S, Zénaty D, Martinerie L, Paulsen A, Simon D, Storey C, Dos Santos S, Haignere J, Mohamed D, Carel JC, Léger J. Early Determinants of Thyroid Function Outcomes in Children with Congenital Hypothyroidism and a Normally Located Thyroid Gland: A Regional Cohort Study. Thyroid 2018; 28:959-967. [PMID: 29968521 DOI: 10.1089/thy.2018.0154] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND An increase in the incidence of congenital hypothyroidism (CH) with a normally located gland has been reported worldwide. Affected individuals display transient or permanent CH during follow-up in childhood. This study aimed to determine the prevalence of transient CH and to investigate the possibility of distinguishing between transient and permanent CH in early infancy. METHODS This observational cohort study included all patients identified by systematic neonatal screening for CH in the northern Parisian region between 2002 and 2012 and treated for CH with a normally sited gland. A standardized data collection form was completed prospectively at diagnosis. Patients were classified during follow-up as having transient or permanent CH. RESULTS Of the 92 patients initially treated for CH with a normally located gland during the neonatal period, 49 (54%) had a transient form of CH after the cessation of levothyroxine (LT4) treatment at 1.5 (0.6-3.2) years of age. Multivariate analysis revealed that transient CH was associated with a lower likelihood of having a first-degree family history of CH (p = 0.03) and a lower LT4 dose at six months of age (p = 0.03) than permanent CH. Sex, ethnicity, neonatal problems (e.g., prematurity, being small for gestational age, and/or neonatal distress), iodine status, coexisting malformations, initial CH severity, and thyroid morphology at diagnosis had no effect. Receiver operating characteristics curve analysis showed that a cutoff of 3.2 μg/kg/day for LT4 dose requirement at six months of age had a sensitivity of 71% and a specificity of 79% for predicting transient CH, with values below this threshold considered predictive of transient CH. CONCLUSION In patients with CH and a normally located gland, these findings highlight the need to evaluate LT4 dose requirements early, at six months of age, particularly in patients with no family history of CH, for early identification of the approximately 50% of patients for whom treatment should be stopped.
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Affiliation(s)
- Carole Saba
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
| | - Sophie Guilmin-Crepon
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 2 Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 3 Institut National de la Santé et de la Recherche Médicale (INSERM) , CIC-EC 1426, Paris, France
| | - Delphine Zénaty
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
| | - Laetitia Martinerie
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
- 5 Paris Diderot University , Sorbonne Paris Cité, Paris, France
| | - Anne Paulsen
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
| | - Dominique Simon
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
| | - Caroline Storey
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
| | - Sophie Dos Santos
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
| | - Jeremie Haignere
- 2 Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 3 Institut National de la Santé et de la Recherche Médicale (INSERM) , CIC-EC 1426, Paris, France
| | - Damir Mohamed
- 2 Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 3 Institut National de la Santé et de la Recherche Médicale (INSERM) , CIC-EC 1426, Paris, France
| | - Jean-Claude Carel
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
- 5 Paris Diderot University , Sorbonne Paris Cité, Paris, France
| | - Juliane Léger
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
- 5 Paris Diderot University , Sorbonne Paris Cité, Paris, France
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25
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Zdraveska N, Zdravkovska M, Anastasovska V, Sukarova-Angelovska E, Kocova M. Diagnostic re-evaluation of congenital hypothyroidism in Macedonia: predictors for transient or permanent hypothyroidism. Endocr Connect 2018; 7:278-285. [PMID: 29335252 PMCID: PMC5801559 DOI: 10.1530/ec-17-0332] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diagnostic re-evaluation is important for all patients with congenital hypothyroidism (CH) for determining the etiology and identifying transient CH cases. Our study is a first thyroxine therapy withdrawal study conducted in Macedonian CH patients for a diagnostic re-evaluation. We aimed to evaluate the etiology of CH, the prevalence of transient CH and identify predictive factors for distinguishing between permanent (PCH) and transient CH (TCH). MATERIALS AND METHODS Patients with CH aged >3 years underwent a trial of treatment withdrawal for 4 weeks period. Thyroid function testing (TFT), ultrasound and Technetium-99m pertechnetate thyroid scan were performed thereafter. TCH was defined when TFT remained within normal limits for at least 6-month follow-up. PCH was diagnosed when TFT was abnormal and classified according the imaging findings. RESULTS 42 (55%) patients had PCH and 34 (45.0%) patients had TCH. Thyroid agenesia was the most prevalent form in the PCH group. Patients with TCH had lower initial thyroid-stimulating hormone (TSH) values (P < 0.0001); higher serum thyroxine levels (P = 0.0023) and lower mean doses of levothyroxine during treatment period (P < 0.0001) than patients with PCH. Initial TSH level <30.5 IU/mL and levothyroxine dose at 3 years of age <2.6 mg/kg/day were a significant predictive factors for TCH; sensitivity 92% and 100%, specificity 75.6% and 76%, respectively. CONCLUSION TCH presents a significant portion of patients with CH. Initial TSH value and levothyroxine dose during treatment period has a predictive role in differentiating TCH from PCH. Earlier re-evaluation, between 2 and 3 years age might be considered in some patients requiring low doses of levothyroxine.
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Affiliation(s)
- Nikolina Zdraveska
- University Children's Hospital SkopjeFaculty of Medicine, Skopje, Republic of Macedonia
| | - Maja Zdravkovska
- Institute of Patophysiology and Nuclear MedicineFaculty of Medicine, Skopje, Republic of Macedonia
| | - Violeta Anastasovska
- University Children's Hospital SkopjeFaculty of Medicine, Skopje, Republic of Macedonia
| | | | - Mirjana Kocova
- University Children's Hospital SkopjeFaculty of Medicine, Skopje, Republic of Macedonia
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26
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Abstract
Transient congenital hypothyroidism (CH) refers to a temporary deficiency of thyroid hormone identified after birth, with low thyroxine (T4) and elevated thyrotropin (TSH), which later recovers to improved thyroxine production, typically in first few months of infancy. Approximately 17% to 40% of children diagnosed with CH by newborn screening (NBS) programs were later determined to have transient hypothyroidism. Causes of transient CH are prematurity, iodine deficiency, maternal thyrotropin receptor blocking antibodies, maternal intake of anti-thyroid drugs, maternal or neonatal iodine exposure, loss of function mutations and hepatic hemangiomas. The classic clinical symptoms and signs of CH are usually absent immediately after birth in vast majority of infants due to temporary protection from maternal thyroxine. NBS has been largely successful in preventing intellectual disability by early detection of CH by performing thyroid function tests in infants with abnormal screening results. In this review we present the evidence for decision making regarding treatment vs. withholding treatment in infants with transient CH and present a rational approach to identifying transient CH based on American Academy of Pediatrics (AAP) recommendation.
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Affiliation(s)
- Neelakanta Kanike
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ajuah Davis
- Department of Pediatrics, Division of Pediatric Endocrinology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Prem S Shekhawat
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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27
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Lin SJ. Fighting against congenital hypothyroidism - Old soldiers never die. Pediatr Neonatol 2017; 58:389-390. [PMID: 28916230 DOI: 10.1016/j.pedneo.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Shio-Jean Lin
- Department of Pediatrics, Genetic Counseling Center, Chi Mei Medical Center, #901, Zhonghua Rd., Yongkang, Tainan 710, Taiwan.
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