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Sanaiee A, Hassanpour S, Vazir B. Protective role of the ginsenoside Rg1 against methimazole-induced gestational hypothyroidism on reflexive behaviors, conditioned fear and cortical antioxidant levels in mice offspring. IBRO Neurosci Rep 2024; 16:485-496. [PMID: 38634016 PMCID: PMC11021994 DOI: 10.1016/j.ibneur.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
Ginsenoside Rg1(Rg1), a monomer of a tetracyclic triterpenoid derivative, possesses diverse medicinal properties attributed to its unique chemical structure and may have beneficial effects on fetal development. This study aimed to investigate the protective effects of prenatal exposure to Rg1 against Methimazole-induced gestational hypothyroidism on reflexive behaviors, conditioned fear, and cortical antioxidant levels in mouse offspring.40 female virgin mice and 12 male NMRI mice were assigned to four groups: group 1 served as the control, group 2 received Methimazole(MMI) at a concentration of 0.02% in their drinking water, group 3 received Rg1(150 mg/kg), and group 4 received both MMI and Rg1.Groups of 2-4 were administered the substances from days 1-9 of gestation. After delivery, pups were selected, and reflexive motor behaviors and conditioned fear were assessed. Additionally, levels of brain tissue catalase(CAT), malondialdehyde(MDA), superoxide dismutase(SOD), and glutathione peroxidase(GPx) levels were measured. Furthermore, postpartum immobility time in the forced swimming test (FST), tail suspension test (TST), and the number of squares crossed in the open field test (OFT)were determined. The results demonstrated that maternal exposure to Rg1 improved ambulation score, hind-limb suspension score, grip strength, front-limb suspension, hind-limb foot angle, negative geotaxis, surface righting, and conditioned fear in hypothyroidism-induced offspring(P<0.05). Rg1 decreased immobility time in the FST, and TST, and increased the number of squares crossed in the OFT in postpartum hypothyroidism-induced mice(P<0.05). Moreover, Rg1 reduced brain tissue MDA levels and increased brain tissue CAT, SOD, and GPx levels in mice and their offspring(P<0.05). These findings indicate that Rg1 mitigated postpartum depression in mice and improved reflexive motor behaviors in their pups.
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Affiliation(s)
- Ali Sanaiee
- Faculty of Veterinary Medicine, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Shahin Hassanpour
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Bita Vazir
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Graziose BB, Flemming BC, Schulz EV, Groomes CL. Follow-up of a Term Infant with Congenital Hypothyroidism. Neoreviews 2024; 25:e312-e317. [PMID: 38688883 DOI: 10.1542/neo.25-5-e312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Brian B Graziose
- Division of Neonatal-Perinatal Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Brittany C Flemming
- Division of Neonatal-Perinatal Medicine, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Elizabeth V Schulz
- Division of Neonatal-Perinatal Medicine, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Charles L Groomes
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
- Division of Neonatal-Perinatal Medicine, Naval Medical Center Portsmouth, Portsmouth, VA
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Grob F, Bedregal P, Viviani P, Torres C, Becerra C, Leyton B. Cognitive Outcomes in Congenital Hypothyroidism: Impact of Socioeconomic Status - A Case-Control Study. Horm Res Paediatr 2022; 95:224-232. [PMID: 35447623 DOI: 10.1159/000522257] [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: 09/29/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Chile is one of the few high-income countries in Latin America, being a pioneer in implementing a national newborn screening (NBS) program in 1992. Currently, it covers 98% of the population, but no long-term outcomes have been described so far. The aim of this study was to report the neurocognitive outcomes of children with congenital hypothyroidism (CH) diagnosed by the NBS program in Chile between 2005 and 2012 and to identify variables associated with the outcomes. METHODS We performed a case-control study in children with CH born in the two largest regions of the country. The Leiter-R and TEVI-R tests were administered at home to 69 children with CH and 68 matched control subjects. Other variables affecting cognition were obtained. Multivariate logistic regression analyses were performed for Leiter-R and TEVI-R tests, using a model for cases alone and another model for cases and controls. RESULTS No differences in Leiter-R and TEVI-R results were observed between children with CH and the control group. Children who performed better, regardless of whether they had CH, had a higher family income and more assets. CONCLUSIONS These results suggest that the Chilean NBS program strategy results in children with normal language, attention, and memory development. Socioeconomic disadvantage represents a significant detriment in cognitive function.
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Affiliation(s)
- Francisca Grob
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Bedregal
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paola Viviani
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Torres
- Guillermo Grant Benavente Hospital, Concepción, Chile
| | - Carlos Becerra
- Department of Life Cycle, Head of the National Child Health Program, Ministry of Health of Chile, Santiago, Chile
| | - Bárbara Leyton
- Department of Life Cycle, National Child Health Program, Ministry of Health of Chile, Santiago, Chile
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Stagi S, Municchi G, Ferrari M, Wasniewska MG. An Overview on Different L-Thyroxine (l-T 4) Formulations and Factors Potentially Influencing the Treatment of Congenital Hypothyroidism During the First 3 Years of Life. Front Endocrinol (Lausanne) 2022; 13:859487. [PMID: 35757415 PMCID: PMC9218053 DOI: 10.3389/fendo.2022.859487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022] Open
Abstract
Congenital hypothyroidism (CH) is a relatively frequent congenital endocrine disorder, caused by defective production of thyroid hormones (THs) at birth. Because THs are essential for the development of normal neuronal networks, CH is also a common preventable cause of irreversible intellectual disability (ID) in children. Prolonged hypothyroidism, particularly during the THs-dependent processes of brain development in the first years of life, due to delays in diagnosis, inadequate timing and dosing of levothyroxine (l-thyroxine or l-T4), the non-compliance of families, incorrect follow-up and the interference of foods, drugs and medications affecting the absorption of l-T4, may be responsible for more severe ID. In this review we evaluate the main factors influencing levels of THs and the absorption of l-T4 in order to provide a practical guide, based on the existing literature, to allow optimal follow-up for these patients.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
- *Correspondence: Stefano Stagi,
| | - Giovanna Municchi
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Marta Ferrari
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
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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: 166] [Impact Index Per Article: 55.3] [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
- Address correspondence to: Michel Polak, MD, PhD, Pediatric Endocrinology Gynecology and Diabetology Department, Hôpital Universitaire Necker Enfants Malades, 149 Rue de Sèvres, Paris 75015, France
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Braga H, Duarte JL, da Cruz Fernandes L, Salles IC, Oliveira de Andrade CL, Ramos HE, Alves CDAD. Congenital hypothyroidism as a risk factor for hearing and parents' knowledge about its impact on hearing. J Otol 2020; 16:71-79. [PMID: 33777118 PMCID: PMC7985011 DOI: 10.1016/j.joto.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/22/2020] [Accepted: 09/02/2020] [Indexed: 12/25/2022] Open
Abstract
Aim To evaluate the hearing of children with congenital hypothyroidism (CH) and to analyze the knowledge that parents’ have on the possible auditory impacts of the disease. Methods A total of 263 parents/guardians were interviewed about aspects of CH and hearing. Audiological evaluation was performed on 80 participants, divided into two groups: with CH (n= 50) and without CH (n=30). Clinical and laboratory CH data were obtained from medical records, pure tone auditory thresholds and acoustic reflexes were analyzed. The auditory data was compared between groups. Student’s t-test and Chi-square were used for statistical analysis at a significance level of 5% (p ≤0.05). Results The majority (78%), of the parents were unaware that CH when not treated early is a potential risk to hearing. There was no correlation between socioeconomic class and level of information about CH and hearing (p>0,05; p=0.026). There was a statistically significant difference between the auditory tone thresholds of the groups and between the levels of intensity necessary for the triggering of the acoustic reflex. The group with CH presented the worst results (p≤0.05) and absence of acoustic reflex in a normal tympanometric condition. Conclusions Children with CH are more likely to develop damage to the auditory system involving retrocochlear structures when compared to healthy children, and that the disease may have been a risk factor for functional deficits without deteriorating hearing sensitivity. The possible impacts of CH on hearing, when not treated early, should be more publicized among the parents/guardians of this population.
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Affiliation(s)
- Hélida Braga
- Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Science - Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
| | - Josilene Luciene Duarte
- Department of Speech Therapy, Institute of Health Science - Federal University of Sergipe, Av. Marechal Rondon, 49100-000, São Cristóvão, Sergipe, Brazil
| | - Luciene da Cruz Fernandes
- Department of Speech Therapy, Institute of Health Science - Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
| | - Iza Cristina Salles
- Department of Bioregulation, Health & Sciences Institute - Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil.,Medical School, Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
| | - Caio L Oliveira de Andrade
- Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Science - Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
| | - Helton E Ramos
- Medical School, Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
| | - Crésio de Aragão D Alves
- Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Science - Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil.,Medical School, Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Valley of Canela, 40110100, Salvador, Bahia, Brazil
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Sustained attention in school-age children with congenital hypothyroidism: influence of episodes of overtreatment in the first three years of life. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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García Morales L, Rodríguez Arnao MD, Rodríguez Sánchez A, Dulín Íñiguez E, Álvarez González MA. Sustained attention in school-age children with congenital hypothyroidism: Influence of episodes of overtreatment in the first three years of life. Neurologia 2017; 35:226-232. [PMID: 29162287 DOI: 10.1016/j.nrl.2017.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/24/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Children with congenital hypothyroidism (CH) are at risk of developing mild cognitive impairment despite normal overall intellectual performance. These deficits may be caused by disease-related and treatment-related factors. This study explores the impact of abnormal thyroid function during the first 3 years of life on attention performance at school age. METHODS We included 49 children diagnosed with CH and receiving treatment for the condition: 14 boys (mean age 9.5±2.8 years) and 35 girls (9.6±2.6 years). The number of episodes of normal, under-, and overtreatment were estimated based on TSH levels during their first 3 years of life (at 12, 18, 24, 30, and 36 months). Children were assessed using a computerised version of a Sustained attention test. General linear models were calculated with the attention index as the dependent variable and sex, aetiology, and number of episodes of normal, under-, and overtreatment as independent variables. RESULTS Higher numbers of episodes of overtreatment (low TSH level) were associated with poorer attention performance at school age (P=.005, r=-0.45). CONCLUSIONS Children with CH should be monitored closely during the first 3 years of life in order to prevent not only hypothyroidism but also any adverse effects of overtreatment that may affect attentional function at school age.
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Affiliation(s)
| | - M D Rodríguez Arnao
- Unidad Endocrina Pediátrica, Laboratorio de Desórdenes Metabólicos del Hospital Universitario Gregorio Marañón, Madrid, España
| | - A Rodríguez Sánchez
- Unidad Endocrina Pediátrica, Laboratorio de Desórdenes Metabólicos del Hospital Universitario Gregorio Marañón, Madrid, España
| | - E Dulín Íñiguez
- Laboratorio de Desórdenes Metabólicos del Hospital Universitario Gregorio Marañón, Madrid, España
| | - M A Álvarez González
- Instituto Superior de Diseño, Universidad de La Habana, Instituto de Neurología y Neurocirugía de La Habana, La Habana, Cuba
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Thaker VV, Galler MF, Marshall AC, Almodovar MC, Hsu HW, Addis CJ, Feldman HA, Brown RS, Levine BS. Hypothyroidism in Infants With Congenital Heart Disease Exposed to Excess Iodine. J Endocr Soc 2017; 1:1067-1078. [PMID: 29264559 PMCID: PMC5686596 DOI: 10.1210/js.2017-00174] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/06/2017] [Indexed: 12/05/2022] Open
Abstract
Thyroid hormone is critical for neonatal brain development, and even transient hypothyroidism can cause adverse neurocognitive outcomes. Infants exposed to excess iodine are at risk of developing hypothyroidism, especially those with congenital heart disease (CHD), because they are routinely exposed to excess iodine from intravenous iodinated contrast media and topical antiseptics. The aim of the present study was to identify the proportion of neonates with CHD exposed to iodine who developed hypothyroidism and to identify the associated risk factors. This was a retrospective study of neonates undergoing cardiac catheterization at Boston Children's Hospital during a 3-year period, some of whom also underwent cardiac surgery. Hypothyroidism was defined as an elevated thyroid-stimulating hormone level (>20 mIU/L at 24 to 96 hours of age and >15 mIU/L at >96 hours of age by heel-stick sampling and >9.1 mIU/L at 1 to 20 weeks of age by serum testing). Multivariate logistic regression was performed to predict the odds of developing hypothyroidism. Hypothyroidism was diagnosed incidentally in 46 of 183 infants (25%) with CHD after iodine exposure. Controlling for baseline cardiac risk, postnatal age, and gestational age, we found a fourfold increase in odds of developing hypothyroidism in neonates with serum creatinine >0.9 mg/dL and a fourfold increase in those who underwent more than three procedures. Hypothyroidism in neonates with CHD exposed to excess iodine is associated with multiple procedures and impaired renal function. Routine serial monitoring of thyroid function in these neonates is warranted. Future studies should examine the association between hypothyroidism and neurocognitive function in this population.
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Affiliation(s)
- Vidhu V Thaker
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
- Columbia University Medical Center, New York, New York 10032
| | - Marjorie F Galler
- Medstar Georgetown University Hospital, Washington, District of Columbia 20007
| | - Audrey C Marshall
- Harvard Medical School, Boston, Massachusetts 02115
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts 02115
| | | | - Ho-Wen Hsu
- New England Newborn Screening Program, Jamaica Plain, Massachusetts 02130
- University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | | | - Henry A Feldman
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
| | - Rosalind S Brown
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
| | - Bat-Sheva Levine
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
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Mehran L, Khalili D, Yarahmadi S, Amouzegar A, Mojarrad M, Ajang N, Azizi F. Worldwide Recall Rate in Newborn Screening Programs for Congenital Hypothyroidism. Int J Endocrinol Metab 2017; 15:e55451. [PMID: 29201074 PMCID: PMC5702453 DOI: 10.5812/ijem.55451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/03/2017] [Accepted: 04/16/2017] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Neonatal mass screening program for congenital hypothyroidism provides the best tool for prevention of its devastating effects on mental development. Despite the overall success of the screening programs in detecting congenital hypothyroidism and eliminating its sequelae and new developments made in the program design, high recall rate and false positive results impose a great challenge worldwide. Lower recall rate and false positive results may properly organize project expenses by reducing the unnecessary repeated laboratory tests, increase physicians and parents' assurance and cooperation, as well as reduce the psychological effects in families. EVIDENCE ACQUISITION In this review, we assessed the recall rate in different programs and its risk factors worldwide. METHODS Publications reporting the results of the CH screening program from 1997 to 2016 focusing on the recall rate have been searched. RESULTS Recall rates vary from 0.01% to 13.3% in different programs; this wide range may be due to different protocols of screening (use of T4 or TSH or both), different laboratory techniques, site of sample collection, recall cutoff, iodine status, human error, and even CH incidence as affected by social, cultural, and regional factors of the population. CONCLUSIONS It is suggested to implement suitable interventions to reduce the contributing factors by improving the quality of laboratory tests, selecting conservative cut off points, control iodine deficiency, use of iodine free antiseptic during delivery, and use of more specific markers or molecular tests. Applying an age dependent criteria for thyrotropin levels can be helpful in regions with a varied time of discharge after delivery or for preterm babies.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Shahin Yarahmadi
- Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, Tehran, IR Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Mojarrad
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Nasrin Ajang
- Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Fereidoun Azizi, Professor of Internal Medicine and Endocrinology, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, IR Iran. Tel: +98-2122432503, Fax: +98-2122402463, E-mail:
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Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G, Polak M, Butler G. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. Horm Res Paediatr 2015; 81:80-103. [PMID: 24662106 DOI: 10.1159/000358198] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim was to formulate practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). EVIDENCE A systematic literature search was conducted to identify key articles relating to the screening, diagnosis, and management of CH. The evidence-based guidelines were developed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. CONSENSUS PROCESS Thirty-two participants drawn from the European Society for Paediatric Endocrinology and five other major scientific societies in the field of pediatric endocrinology were allocated to working groups with assigned topics and specific questions. Each group searched the literature, evaluated the evidence, and developed a draft document. These papers were debated and finalized by each group before presentation to the full assembly for further discussion and agreement. RECOMMENDATIONS The recommendations include: worldwide neonatal screening, approaches to assess the cause (including genotyping) and the severity of the disorder, the immediate initiation of appropriate L-T4 supplementation and frequent monitoring to ensure dose adjustments to keep thyroid hormone levels in the target ranges, a trial of treatment in patients suspected of transient CH, regular assessments of developmental and neurosensory functions, consulting health professionals as appropriate, and education about CH. The harmonization of diagnosis, management, and routine health surveillance would not only optimize patient outcomes, but should also facilitate epidemiological studies of the disorder. Individuals with CH require monitoring throughout their lives, particularly during early childhood and pregnancy.
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Affiliation(s)
- Juliane Léger
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G, Polak M, Butler G. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab 2014; 99:363-84. [PMID: 24446653 PMCID: PMC4207909 DOI: 10.1210/jc.2013-1891] [Citation(s) in RCA: 250] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim was to formulate practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). EVIDENCE A systematic literature search was conducted to identify key articles relating to the screening, diagnosis, and management of CH. The evidence-based guidelines were developed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. CONSENSUS PROCESS Thirty-two participants drawn from the European Society for Paediatric Endocrinology and five other major scientific societies in the field of pediatric endocrinology were allocated to working groups with assigned topics and specific questions. Each group searched the literature, evaluated the evidence, and developed a draft document. These papers were debated and finalized by each group before presentation to the full assembly for further discussion and agreement. RECOMMENDATIONS The recommendations include: worldwide neonatal screening, approaches to assess the cause (including genotyping) and the severity of the disorder, the immediate initiation of appropriate L-T4 supplementation and frequent monitoring to ensure dose adjustments to keep thyroid hormone levels in the target ranges, a trial of treatment in patients suspected of transient CH, regular assessments of developmental and neurosensory functions, consulting health professionals as appropriate, and education about CH. The harmonization of diagnosis, management, and routine health surveillance would not only optimize patient outcomes, but should also facilitate epidemiological studies of the disorder. Individuals with CH require monitoring throughout their lives, particularly during early childhood and pregnancy.
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Affiliation(s)
- Juliane Léger
- Université Paris Diderot (J.L.), Sorbonne Paris Cité, F-75019 Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche 676, F-75019 Paris, France; Department of Cell Biology and Neurosciences (A.O.), Istituto Superiore di Sanità, 00161 Rome, Italy; Child Health Section of Glasgow University School of Medicine (M.D.), Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, United Kingdom; Swiss Neonatal Screening Laboratory (T.T.), University Children's Hospital, CH-8032 Zurich, Switzerland; Department of Pediatric Endocrinology and Diabetes (H.K.), Charite Children's Hospital, Berlin 10117, Germany; Endocrinology Service and Research Center (G.v.V.), Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, University of Montreal, Montreal, Canada H3T 1C5; AP-HP, Hôpital Necker Enfants-Malades, Endocrinologie, Gynécologie et Diabétologie Pédiatriques (M.P.), Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Université Paris Descartes, Sorbonne Paris Cité, INSERM, Unité 845, F-75015 Paris, France; and Department of Paediatric and Adolescent Medicine and Endocrinology (G.B.), University College London Hospital, and University College London Institute of Child Health, London NW1 2PQ, United Kingdom
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Chen H, Zhang H, Tang W, Xi Q, Liu X, Duan Y, Liu C. Thyroid function and morphology in overweight and obese children and adolescents in a Chinese population. J Pediatr Endocrinol Metab 2013; 26:489-96. [PMID: 23509206 DOI: 10.1515/jpem-2012-0299] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/04/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the changes in thyroid function and morphology in overweight and obese school-aged children and adolescents in Chinese population. METHODS Altogether, 880 children and adolescents were enrolled in a cross-sectional survey in Anhui Province and we assessed thyroid function, thyroid ultrasound, metabolic indicators and high-sensitivity C-reactive protein (hs-CRP) levels in 781 subjects, which were divided into obesity (n=327), overweight (n=242), and normal-weight (n=212) groups. Overweight and obese subjects were further divided into four subgroups according to thyroid peroxidase antibody and ultrasound pattern to compare thyroid function and morphology with or without thyroid autoimmune evidence. RESULTS Thyroid-stimulating hormone (TSH) and free 3,5,3'-triiodothyronine (FT3), as well as thyroid volume, were found to be positively associated with body mass index Z-score, waist/hip ratio, waist/height ratio and/or waist circumference (WC). Conversely, free thyroxine was negatively associated with WC. The detection rates of thyroid nodules among these groups were not significantly different (p=0.828). Among the four subgroups in 569 overweight or obese subjects, the changes in thyroid function and volume were more obvious in group D which showed no autoimmune evidence. The levels of hs-CRP were also higher in the overweight and obese groups with or without autoimmune evidence than in the normal-weight group (p<0.05). CONCLUSION Thyroid function and morphology may be affected in obese and overweight children and adolescents with elevated TSH, FT3 and thyroid volume. The detection rates of thyroid nodules may not be affected by obesity. Alterations in thyroid function and morphology cannot be completely explained by local autoimmune responses. Low-grade inflammation may be involved in the changes in thyroid function and morphology in obesity.
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Affiliation(s)
- Huanhuan Chen
- Department of Endocrinology, First Affiliated Hospital, Nanjing Medical University, 210029, Nanjing, China
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Evaluation of cognitive and motor development in toddlers with congenital hypothyroidism diagnosed by neonatal screening. J Dev Behav Pediatr 2012; 33:633-40. [PMID: 23027136 DOI: 10.1097/dbp.0b013e3182690727] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Dutch neonatal congenital hypothyroidism (CH) screening procedure and treatment modality has been adapted several times since its national institution in 1981. These changes enabled us to investigate whether earlier treatment has resulted in improved cognitive and motor outcomes. The present study examined whether the advancement of treatment modality has resulted in improved cognitive and motor outcomes. METHODS In 95 toddlers with thyroidal CH (CH-T), born in 2002 through 2004 and treated at a median age of 9 days, cognitive and motor outcomes were assessed with the Bayley Scales of Infant Development-II-NL at 1 and 2 years of age. This outcome was also analyzed in relation to treatment variables. RESULTS The mean mental developmental index (MDI) scores of the severe (initial free thyroxine [FT4] ≤0.4 ng/dL (≤5 pmol/L), moderate (0.4 < initial FT4 ≤ 0.8 ng/dL (5.0 < initial FT4 ≤ 10.0 pmol/L), and mild (initial FT4 > 0.8 ng/dL (>10.0 pmol/l) CH-T groups at 1 year and the moderate and mild CH-T groups at 2 years were similar to the population mean. The mean MDI scores of the total CH-T group and severe CH-T group at 2 years were significantly lower than the population mean (p < .0001). In all 3 severity subgroups, significant lower psychomotor developmental index scores (p < .0001) were observed. No correlations were found between starting day of treatment and developmental outcome. Initial T4 concentration and initial T4 dose were weak predictors for developmental outcome. CONCLUSION Essentially, comparable with our earlier findings, children with CH, especially those with severe CH, are still at risk for motor and cognitive problems, which are probably due to the consequence of the prenatal hypothyroid state or the thyroid hormone deficiency in early life.
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Wise A, Parham F, Axelrad DA, Guyton KZ, Portier C, Zeise L, Zoeller RT, Woodruff TJ. Upstream adverse effects in risk assessment: a model of polychlorinated biphenyls, thyroid hormone disruption and neurological outcomes in humans. ENVIRONMENTAL RESEARCH 2012; 117:90-9. [PMID: 22770859 DOI: 10.1016/j.envres.2012.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 05/04/2012] [Accepted: 05/31/2012] [Indexed: 05/22/2023]
Abstract
BACKGROUND Increasing data on early biological changes from chemical exposures requires new interpretation tools to support decision-making. OBJECTIVES To test the possibility of applying a quantitative approach using human data linking chemical exposures and upstream biological perturbations to overt downstream outcomes. METHODS Using polychlorinated biphenyl (PCB) exposures and maternal thyroid hormone (TH) perturbations as a case study, we model three relationships: (1) prenatal PCB exposures and TH changes, using free T(4) (FT(4)); (2) prenatal TH and childhood neurodevelopmental outcomes; and (3) prenatal PCB exposures and childhood neurodevelopmental outcomes (IQ). We surveyed the epidemiological literature; extracted relevant quantitative data; and developed models for each relationship, applying meta-analysis where appropriate. RESULTS For relationship 1, a meta-analysis of 3 studies gives a coefficient of -0.27 pg/mL FT(4) per ln(sum of PCBs) (95% confidence interval [CI] -0.82 to 0.27). For relationship 2, regression coefficients from three studies of maternal FT(4) levels and cognitive scores ranged between 0.99 IQ points/(pg/mL FT(4)) (95% CI -0.31 to 2.2) and 7.6 points/(pg/mL FT(4)) (95% CI 1.2 to 16.3). For relationship 3, a meta-analysis of five studies produces a coefficient of -1.98 IQ points (95% CI -4.46 to 0.50) per unit increase in ln(sum of PCBs). Combining relationships 1 and 2 yields an estimate of -2.0 to -0.27 points of IQ per unit increase in ln(sum of PCBs). CONCLUSIONS Combining analysis of chemical exposures and early biological perturbations (PCBs and FT(4)) with analysis of early biological perturbations and downstream overt effects (FT(4) and IQ) yields estimates within the range of studies of exposures and overt effects (PCBs and IQ). This is an example approach using upstream biological perturbations for effect prediction.
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Affiliation(s)
- Amber Wise
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, United States
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Soliman AT, Azzam S, ElAwwa A, Saleem W, Sabt A. Linear growth and neurodevelopmental outcome of children with congenital hypothyroidism detected by neonatal screening: A controlled study. Indian J Endocrinol Metab 2012; 16:565-568. [PMID: 22837917 PMCID: PMC3401757 DOI: 10.4103/2230-8210.98012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Different growth and neuro-developmental outcomes have been associated with different doses of thyroxine given to infants with congenital hypothyroidism (CH). MATERIALS AND METHODS We studied the longitudinal growth pattern and assessed the neurodevelopment of 45 children with CH(25 girls, 20 boys) diagnosed through the national screening program in Qatar, for 6 years or more to examine the effects of initial T4 dosage (50 μg/day) with adjustment of T4 dose to maintain serum free T4 concentrations within the upper quartile of normal range and thyroid stimulating hormone < 4 mIU/mLThe birth size of newborns with CH diagnosed through the screening program before January 2003, was recorded and their growth in weight and stature was monitored every 3 months for at least 6 years of life. The IQ of children was assessed between 3 and 6 years of age using The Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III). RESULTS Birth weight, length, and head circumference of patients (3.21 ± 0.43 kg, 50.5 ± 3.21 cm and 34.1 ± 1.5 cm, respectively) did not differ than those for 10,560 normal newborns with normal thyroid function (3.19 ± 0.59 kg, 50.5 ± 2.2 cm and 34.2 ± 1.7 cm). During the first year CH children growth (25.8 ± 2.8 cm/year) was similar to those for normal infants (25.5 ± 0.75 cm/year). During the first 6 years, stature growth was normal in all children with CH versus Center for disease control and prevention (CDC) data. The mean height standard deviation score (HtSDS) of children with CH showed adjustment (± 0.5 SD) toward their mid-parental height SDS (MPHtSDS) only during the second year of life. The children's mean HtSDS was higher by an average of 0.4 SD between the 2(nd) and 7(th) year of life. CONCLUSION These data proved that effective screening and treatment completely assures normal neurodevelopment and linear growth in patients with CH. The data showed that their HtSDS slightly exceeds their MPHtSDS during childhood.
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Affiliation(s)
| | - S. Azzam
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Ahmed ElAwwa
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Wael Saleem
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Aml Sabt
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
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Woodruff TJ. Bridging epidemiology and model organisms to increase understanding of endocrine disrupting chemicals and human health effects. J Steroid Biochem Mol Biol 2011; 127:108-17. [PMID: 21112393 PMCID: PMC6628916 DOI: 10.1016/j.jsbmb.2010.11.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
Abstract
Concerning temporal trends in human reproductive health has prompted concern about the role of environmentally mediated risk factors. The population is exposed to chemicals present in air, water, food and in a variety of consumer and personal care products, subsequently multiple chemicals are found human populations around the globe. Recent reviews find that endocrine disrupting chemicals (EDCs) can adversely affect reproductive and developmental health. However, there are still many knowledge gaps. This paper reviews some of the key scientific concepts relevant to integrating information from human epidemiologic and model organisms to understand the relationship between EDC exposure and adverse human health effects. Additionally, areas of new insights which influence the interpretation of the science are briefly reviewed, including: enhanced understanding of toxicity pathways; importance of timing of exposure; contribution of multiple chemical exposures; and low dose effects. Two cases are presented, thyroid disrupting chemicals and anti-androgens chemicals, which illustrate how our knowledge of the relationship between EDCs and adverse human health effects is strengthened and data gaps reduced when we integrate findings from animal and human studies.
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Affiliation(s)
- Tracey J Woodruff
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, CA 94612, United States.
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Balhara B, Misra M, Levitsky LL. Clinical monitoring guidelines for congenital hypothyroidism: laboratory outcome data in the first year of life. J Pediatr 2011; 158:532-7. [PMID: 21094953 DOI: 10.1016/j.jpeds.2010.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/31/2010] [Accepted: 10/04/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether current recommendations for thyroid status monitoring in children with congenital hypothyroidism (CH) (monthly in the first 6 months and every 3-4 months subsequently) are adequate, or whether monthly monitoring is necessary throughout the first year. STUDY DESIGN We reviewed charts of 70 children with CH for initial thyroid-stimulating hormone (TSH), frequency of follow-up, dose changes, and thyroxine (T(4)) and TSH levels in the first year. Need for monthly monitoring was determined on the basis of guidelines to maintain T(4)/free T(4) in the upper half of the normal range and rapidly normalize TSH. RESULTS Monthly monitoring was justified in 75% in the first 6 months and 36% in the next 6 months. Children requiring monthly monitoring in the second 6 months had higher baseline TSH (P = .02) and lower T(4) (P = .01) than those not requiring monthly monitoring. Thyroid dysgenesis, starting levothyroxine dose, sex, and ethnicity did not predict requirement for monthly monitoring. Thirty percent of children in the first and second 6 months had ≥1 high TSH level, with a T(4)/free T(4) not in the upper half of the normal range. CONCLUSION More than a third of children with CH require monthly monitoring between 6 to 12 months on the basis of study criteria. Current monitoring guidelines may need to be reexamined.
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Affiliation(s)
- Bharti Balhara
- Pediatric Endocrine Unit, Mass General Hospital for Children and Harvard Medical School, Boston, MA, USA
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Velilla TA, Rodríguez CG, Sánchez AB, Portillo CM, de la Vega JAB, Cerrato SB, Baldrich AG, Montávez JMG, Pérez AS, Arriero JMGDB, Ortiz RG. [Using newborn congenital hypothyroidism screening specimens to detect iodine deficiency in three regions of Spain]. An Pediatr (Barc) 2009; 72:121-7. [PMID: 20022570 DOI: 10.1016/j.anpedi.2009.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 09/21/2009] [Accepted: 09/23/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Neonatal hyperthyrotropinemia by measurements of thyrotropin (TSH) concentrations has been assessed in three different areas of Spain. The repercussions of a possible iodine deficiency in a congenital hypothyroidism screening program have also been analysed MATERIAL AND METHODS The study comprised 113,108 newborns, which were divided into two groups according to the time of blood sampling. In 78,646 newborns heel blood samples were obtained after 48h whereas in 34,462 newborns, samples were obtained at birth from the umbilical cord (early samples). Newborns came from three areas of the south of Spain, Seville, Huelva and Cordoba. TSH concentrations were measured by time-resolved fluoroimmunoassay. RESULTS The percentage of hyperthyrotropinemia was greater in Huelva (5.2%) than Seville (1.0%) (p<0.001), similar to that observed in early samples, which was higher in Huelva (5.3%) than in Seville (1.9%) and Cordoba (1.7%) (p<0.001). In the early samples group, 0.3% and 0.2% of the newborns from Seville and Cordoba respectively, had TSH >20mIU/L and 10 infants should have been recalled for a new sample for each case detected. While in Huelva 17 infants (0.9%) were recalled per case detected. CONCLUSIONS The heterogeneous distribution of TSH concentrations in newborns from several geographical areas appears to indicate an irregular and deficient iodine intake. Using early samples and a possible iodine deficiency, increase false positive results in a Neonatal Screening Program of congenital hypothyroidism.
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Affiliation(s)
- T Arrobas Velilla
- Departamento de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
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Abstract
Congenital hypothyroidism and congenital adrenal hyperplasia are included in many newborn screening (NBS) panels worldwide and in all state-sponsored programs in the United States. Both conditions meet the fundamental prerequisites for NBS: high incidence in the population; biomarkers in the dried blood specimen that are easily detected; and, effective therapies to lessen, if not prevent, the sequelae of late or no treatment. In this review, the history of NBS is discussed for these 2 conditions. The technologies and protocols used in their detection, and related subjects such as genetics, and treatment and outcomes, are also discussed.
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Affiliation(s)
- Kenneth A Pass
- Wadsworth Center, NYS Department of Health, Albany, NY 12201-2002, USA.
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Zoeller RT, Crofton KM. Mode of Action: Developmental Thyroid Hormone Insufficiency—Neurological Abnormalities Resulting From Exposure to Propylthiouracil. Crit Rev Toxicol 2008; 35:771-81. [PMID: 16417044 DOI: 10.1080/10408440591007313] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Because thyroid hormone is essential for normal brain development before and after birth, environmental chemicals that interfere with thyroid hormone signaling can adversely affect brain development. Adverse consequences of thyroid hormone insufficiency depend both on severity and developmental timing, indicating that environmental antithyroid factors may produce different effects at different developmental windows of exposure. Mechanistic studies can provide important insight into the potential impact of chemicals on human thyroid function, but relevance to humans must be systematically evaluated. This kind of analysis depends on data sets that include information about animals and humans. The drug 6-n-propyl-2-thiouracil (PTU) is used in animals to experimentally manipulate serum thyroid hormone levels, and in humans to treat patients, including pregnant women, with Graves' disease. A systematic analysis of the mode of action (MOA) of PTU in rats and in humans discloses similar modes of action. While the analysis predicts that PTU doses that produce thyroid hormone insufficiency in humans would adversely affect the developing brain, careful monitoring of PTU administration in pregnant and lactating humans keeps infant serum thyroid hormone levels within the normal range.
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Affiliation(s)
- R Thomas Zoeller
- University of Massachusetts-Amherst, Department of Biology, Morrill Science Center, 01003, USA.
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Korada M, Kibirige M, Turner S, Day J, Johnstone H, Cheetham T. The implementation of revised guidelines and the performance of a screening programme for congenital Hypothyroidism. J Med Screen 2008; 15:5-8. [DOI: 10.1258/jms.2008.007080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To see whether revised screening standards and health-professional training are associated with changes in the performance of a neonatal screening programme for congenital hypothyroidism (CHT). Methods Screening data from the regional screening service in Durham and Newcastle, which covers north-east England and North Cumbria. Setting We assessed the timing of the different stages of the screening process leading up to the introduction of the revised guidelines between April 2004 and March 2005 (year 1) and afterwards between April 2005 and March 2006 (year 2) in all babies notified as having CHT. We also assessed the interval between sampling and specimen arrival in the laboratory at the beginning and end of year 2 in all babies screened. Results Twenty-three babies tested positive or borderline in year 1 and 18 babies in year 2. There was reduced variability in the overall time from birth to notification in year 2 versus year 1 ( P = 0.001). This reduction was a consequence of a reduced interval between sample collection and arrival in the laboratory ( P = 0.047) and for the laboratory to notify the positive test result ( P = 0.003). There was a reduction in the mean time from sampling to receipt by the laboratory in the 2997 babies screened in the final month compared with the 2498 babies screened in the first month of year 2 ( P = 0.01). Conclusion There was an improvement in neonatal screening programme performance around the time that revised neonatal screening guidelines were introduced. This highlights the importance of ongoing education and training for those involved in screening programmes.
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Affiliation(s)
- M Korada
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, UK
| | - M Kibirige
- Department of Paediatrics, James Cook University Hospital, Middlesborough TS4 3BW, UK
| | - S Turner
- Department of Clinical Biochemistry, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, UK
| | - J Day
- Department of Biochemistry, University Hospital of North Durham, Durham DH1 5TW, UK
| | - H Johnstone
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, UK
| | - T Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, UK
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Abstract
Thyroid hormone (TH) is essential for normal brain development, but the specific actions of TH differ across developmental time and brain region. These actions of TH are mediated largely by a combination of thyroid hormone receptor (TR) isoforms that exhibit specific temporal and spatial patterns of expression during animal and human brain development. In addition, TR action is influenced by different cofactors, proteins that directly link the TR protein to functional changes in gene expression. Considering the importance of TH signaling in development, it is important to consider environmental chemicals that may interfere with this signaling. Recent research indicates that environmental chemicals can interfere with thyroid function and with TH signaling. The key issues are to understand the mechanism by which these chemicals act and the dose at which they act, and whether adaptive responses intrinsic to the thyroid system can ameliorate potential adverse consequences (i.e., compensate). In addition, several recent studies show that TRs may be unintended targets of chemicals manufactured for industrial purposes to which humans and wildlife are routinely exposed. Polychlorinated biphenyls, polybrominated diphenyl ethers, bisphenol-A, and specific halogenated derivatives and metabolites of these compounds have been shown to bind to TRs and perhaps have selective effects on TR functions. A number of common chemicals, including polybrominated biphenyls and phthalates, may also exert such effects. When we consider the importance of TH in brain development, it will be important to pursue the possibilities that these chemicals-or interactions among chemical classes-are affecting children's health by influencing TH signaling in the developing brain.
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Affiliation(s)
- R Thomas Zoeller
- Biology Department, Program in Molecular and Cellular Biology, Morrill Science Center, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, USA.
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Ginsberg GL, Hattis DB, Zoeller RT, Rice DC. Evaluation of the U.S. EPA/OSWER preliminary remediation goal for perchlorate in groundwater: focus on exposure to nursing infants. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:361-9. [PMID: 17431484 PMCID: PMC1849902 DOI: 10.1289/ehp.9533] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 12/11/2006] [Indexed: 05/03/2023]
Abstract
BACKGROUND Perchlorate is a common contaminant of drinking water and food. It competes with iodide for uptake into the thyroid, thus interfering with thyroid hormone production. The U.S. Environmental Protection Agency's Office of Solid Waste and Emergency Response (OSWER) set a groundwater preliminary remediation goal (PRG) of 24.5 microg/L to prevent exposure of pregnant women that would affect the fetus. This does not account for the greater exposure that is possible in nursing infants or for the relative source contribution (RSC), a factor normally used to lower the PRG due to nonwater exposures. OBJECTIVES Our goal was to assess whether the OSWER PRG protects infants against exposures from breast-feeding, and to evaluate the perchlorate RSC. METHODS We used Monte Carlo analysis to simulate nursing infant exposures associated with the OSWER PRG when combined with background perchlorate. RESULTS The PRG can lead to a 7-fold increase in breast milk concentration, causing 90% of nursing infants to exceed the reference dose (RfD) (average exceedance, 2.8-fold). Drinking-water perchlorate must be < 6.9 microg/L to keep the median, and < 1.3 microg/L to keep the 90th-percentile nursing infant exposure below the RfD. This is 3.6- to 19-fold below the PRG. Analysis of biomonitoring data suggests an RSC of 0.7 for pregnant women and of 0.2 for nursing infants. Recent data from the Centers for Disease Control and Prevention (CDC) suggest that the RfD itself needs to be reevaluated because of hormonal effects in the general population. CONCLUSIONS The OSWER PRG for perchlorate can be improved by considering infant exposures, by incorporating an RSC, and by being responsive to any changes in the RfD resulting from the new CDC data.
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Affiliation(s)
- Gary L Ginsberg
- Connecticut Department of Public Health, Hartford, Connecticut 06134, USA.
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Oerbeck B, Reinvang I, Sundet K, Heyerdahl S. Young adults with severe congenital hypothyroidism: Cognitive event related potentials (ERPs) and the significance of an early start of thyroxine treatment. Scand J Psychol 2007; 48:61-7. [PMID: 17257370 DOI: 10.1111/j.1467-9450.2006.00545.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Congenital hypothyroidism (CH) has devastating effects upon brain development if left untreated. Despite early start of thyroxine treatment, patients still show subtle cognitive deficits compared to controls. We aimed to study auditory event related potentials (ERPs) in young CH adults (N = 12) to verify previous reports of normal attention functions measured by P3 in CH children. We also include ERP components (P1, N1, P2) allowing assessment of a wider range of auditory processing functions. No significant change in P3 latency or amplitude was found in the CH group, but a more subtle change in amplitude topography. A later start of thyroxine treatment was related to increased P3 latency and reduced amplitude. Group differences were found in early ERP components tapping sensory processing, sensory gating and selective attention. The results suggest persisting abnormalities in auditory processing and selective attention that may have influenced cognitive development.
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Affiliation(s)
- Beate Oerbeck
- Centre for Child and Adolescent Mental Health, Eastern & Southern Norway, Taasen, Oslo, Norway.
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26
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Nakamizo M, Toyabe SI, Asami T, Akazawa K. Mental development of infants with congenital hypothyroidism: a longitudinal study. Clin Pediatr (Phila) 2007; 46:53-8. [PMID: 17164510 DOI: 10.1177/0009922806289326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to assess the relationship between the clinical findings before starting treatment and the development quotient in children treated for congenital hypothyroidism. Patients with congenital hypothyroidism (n = 129) were divided into favorable and unfavorable groups according to intellectual performance. Children with congenital hypothyroidism generally have a similar intellectual outcome to that of healthy children. However, a low birth weight, the presence of complications, and a high serum thyroid-stimulating hormone value are the risk factors for unfavorable cases, who consistently have a development quotient score of less than 100.
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Affiliation(s)
- Makiko Nakamizo
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata City, Japan
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27
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van Trotsenburg ASP, Smit BJ, Koelman JHTM, Dekker-van der Sloot M, Ridder JCD, Tijssen JGP, de Vijlder JJM, Vulsma T. Median nerve conduction velocity and central conduction time measured with somatosensory evoked potentials in thyroxine-treated infants with Down syndrome. Pediatrics 2006; 118:e825-32. [PMID: 16923926 DOI: 10.1542/peds.2006-0324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine whether thyroxine treatment would improve nerve conduction in infants with Down syndrome. METHODS A single-center, nationwide, randomized, double-blind, clinical trial was performed. Neonates with Down syndrome were assigned randomly to thyroxine (N = 99) or placebo (N = 97) treatment for 2 years. Daily thyroxine doses were adjusted regularly to maintain plasma thyrotropin levels in the normal range and free thyroxine concentrations in the high-normal range. The outcome measures were nerve conduction velocity and central conduction time, determined through median nerve somatosensory evoked potential recording, at the age of 24 months. RESULTS At the age of 24 months, somatosensory evoked potential recordings for 81 thyroxine-treated and 84 placebo-treated infants were available for analysis. Nerve conduction velocity and central conduction time did not differ significantly between the 2 treatment groups (nerve conduction velocity: thyroxine: 51.0 m/second; placebo: 50.1 m/second; difference: 0.9 m/second; central conduction time: thyroxine: 8.83 milliseconds; placebo: 8.73 milliseconds; difference: 0.1 milliseconds). CONCLUSIONS Postnatal thyroxine treatment of infants with Down syndrome did not alter somatosensory evoked potential-measured peripheral or central nerve conduction significantly. The absence of favorable effects suggests that pathologic mechanisms other than mild postnatal hypothyroidism underlie the impaired nerve conduction. The absence of adverse effects suggests that longstanding plasma free thyroxine concentrations in the high-normal range are not harmful to nerve maturation.
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Affiliation(s)
- A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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28
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Zoeller RT. Collision of Basic and Applied Approaches to Risk Assessment of Thyroid Toxicants. Ann N Y Acad Sci 2006; 1076:168-90. [PMID: 17119202 DOI: 10.1196/annals.1371.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Thyroid hormone (TH) is essential for normal brain development; therefore, any environmental chemical that interferes sufficiently with thyroid function, TH metabolism, or TH action may exert adverse effects on brain development. Important known differences in aspects of thyroid endocrinology between the fetus, infant, and adult allow us to identify age-dependent vulnerabilities to thyroid toxicants with some confidence. These differences include the size of the hormone pool stored in the thyroid gland at different ages as well as the age-dependent sensitivity to mild TH insufficiency. Several recent studies that describe risk assessments of the environmental contaminant, ammonium perchlorate, provide good examples of conclusions based on the selective consideration of these known aspects of the thyroid system. Specifically, authors who consider age-dependent differences in thyroid endocrinology suggest that safe levels of perchlorate should be set at relatively low levels (low parts per billion). In contrast, authors who do not consider these known age-dependent differences in thyroid endocrinology recommend safe levels of perchlorate at high (hundreds) parts per billion to parts per million. Emerging evidence indicates that a variety of high production volume chemicals can directly interact with the TH receptor. As testing paradigms are designed by regulatory agencies, these age-dependent differences in thyroid endocrinology must be considered.
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Affiliation(s)
- R Thomas Zoeller
- Biology Department, Morrill Science Center, University of Massachusetts, Amherst, MA 01003, USA.
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Rose SR, Brown RS, Foley T, Kaplowitz PB, Kaye CI, Sundararajan S, Varma SK. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics 2006; 117:2290-303. [PMID: 16740880 DOI: 10.1542/peds.2006-0915] [Citation(s) in RCA: 434] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Unrecognized congenital hypothyroidism leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. The primary thyroid-stimulating hormone screening has become standard in many parts of the world. However, newborn thyroid screening is not yet universal in some countries. Initial dosage of 10 to 15 microg/kg levothyroxine is recommended. The goals of thyroid hormone therapy should be to maintain frequent evaluations of total thyroxine or free thyroxine in the upper half of the reference range during the first 3 years of life and to normalize the serum thyroid-stimulating hormone concentration to ensure optimal thyroid hormone dosage and compliance. Improvements in screening and therapy have led to improved developmental outcomes in adults with congenital hypothyroidism who are now in their 20s and 30s. Thyroid hormone regimens used today are more aggressive in targeting early correction of thyroid-stimulating hormone than were those used 20 or even 10 years ago. Thus, newborn infants with congenital hypothyroidism today may have an even better intellectual and neurologic prognosis. Efforts are ongoing to establish the optimal therapy that leads to maximum potential for normal development for infants with congenital hypothyroidism. Remaining controversy centers on infants whose abnormality in neonatal thyroid function is transient or mild and on optimal care of very low birth weight or preterm infants. Of note, thyroid-stimulating hormone is not elevated in central hypothyroidism. An algorithm is proposed for diagnosis and management. Physicians must not relinquish their clinical judgment and experience in the face of normal newborn thyroid test results. Hypothyroidism can be acquired after the newborn screening. When clinical symptoms and signs suggest hypothyroidism, regardless of newborn screening results, serum free thyroxine and thyroid-stimulating hormone determinations should be performed.
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Oerbeck B, Sundet K, Kase BF, Heyerdahl S. Congenital hypothyroidism: no adverse effects of high dose thyroxine treatment on adult memory, attention, and behaviour. Arch Dis Child 2005; 90:132-7. [PMID: 15665163 PMCID: PMC1720264 DOI: 10.1136/adc.2003.043935] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In congenital hypothyroidism (CH) it has been questioned whether high dose thyroxine replacement therapy has detrimental effects on memory, attention, and behaviour. AIMS To describe memory, attention, and behaviour problems in young adults with CH, and to study possible negative effects of high dose thyroxine replacement therapy. METHODS A cohort based follow up study of 49 young adults (mean age 20 years) with early treated CH, and sibling controls (n = 41). RESULTS Controlled for age and sex, the CH group attained significantly lower scores than sibling controls on some tests of memory (Wechsler Logical Memory part II: 12.9 versus 17.8; difference 5.2, 95% CI 3.6 to 6.8) and attention (Wechsler Freedom From Distractibility factor: 95.6 versus 104.8; difference 9.9, 95% CI 6.4 to 13.4). They rated themselves with more behaviour problems than did sibling controls (52.7 versus 44.7; difference -7.6, 95% CI -11.2 to -4.0) on the Achenbach Self Report. A high thyroxine starting dose, high serum thyroxine treatment levels during the first six childhood years, and high levels at assessment had no adverse effects on outcome measures at age 20. On the contrary, the results suggest better outcome with higher childhood treatment levels. CONCLUSIONS Long term outcome revealed deficits in some aspects of memory, attention, and behaviour in young adults with CH relative to sibling controls. No adverse effects of high dose thyroxine therapy were found on measures of memory, attention, and behaviour problems.
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Affiliation(s)
- B Oerbeck
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
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Wilcoxon JS, Redei EE. Prenatal programming of adult thyroid function by alcohol and thyroid hormones. Am J Physiol Endocrinol Metab 2004; 287:E318-26. [PMID: 15113703 DOI: 10.1152/ajpendo.00022.2004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Increasing evidence associates environmental challenges early in life with permanent alterations of physiological functions in adulthood. These changes in fetal environment can trigger physiological adaptations by the fetus, called fetal programming, which may be beneficial before birth but permanently influence the physiology of the organism. In this study, we investigated the potential connection between alcohol-induced decreased maternal thyroid function and the hypothalamic-pituitary-thyroid (HPT) function of adult rat offspring. Plasma 3,5,3'-triiodothyronine (T(3)), thyroxine (T(4)), and thyroid-stimulating hormone (TSH) levels were decreased in alcohol-consuming (E) dams on gestational day 21 compared with ad libitum- (C) and pair-fed (PF) controls. No significant differences were found in HPT function in young offspring (3 wk of age) between diet groups. However, adult fetal alcohol-exposed (FAE) offspring had significantly decreased levels of T(3) along with elevated TSH compared with control offspring. T(4) administration to the mother did not normalize the hypothyroid state of the adult FAE offspring. Interestingly, administration of T(4) to control pregnant dams decreased plasma T(3) of the adult female offspring only, whereas T(4) together with maternal alcohol consumption or pair-feeding led to decreased TSH and T(4) in the adult female offspring. Our results suggest that ethanol consumption and T(4) administration alter maternal HPT function, leading to prenatally programmed permanent alterations in the thyroid function of the adult offspring.
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Affiliation(s)
- Jennifer Slone Wilcoxon
- Department of Psychiatry and Behavioral Sciences, Northwestern University Medical School, The Asher Center, Chicago, Illinois 60611, USA.
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