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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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de Andrade CLO, Machado GC, Magalhães LPF, Cerqueira TLDO, Fernandes LDC, Ramos HE, Alves CDAD. Cochlear dysfunction evidenced by reduction of amplitude of otoacoustic responses in patients with congenital hypothyroidism. Int J Pediatr Otorhinolaryngol 2019; 122:12-17. [PMID: 30928865 DOI: 10.1016/j.ijporl.2019.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The investigation of amplitudes of otoacoustic emissions in congenital hypothyroidism can provide information on cochlear function with more sensibility, when compared to other methods of auditory evaluation. AIM To investigate cochlear function through the amplitude of distortion product otoacoustic emissions in individuals with congenital hypothyroidism and to correlate with clinical aspects. METHODS An exploratory, analytical, cross-sectional study with a convenience sample, composed of 50 individuals with congenital hypothyroidism and a group of 42 individuals without the disease, mean age of 8.4 (±3.1) years. The subjects of the research were evaluated by means of tonal and speech audiometry, immittance and distortion product otoacoustic emissions (DPOAEs). Continuous variables were described as mean or median and standard deviation. The Spearman test evaluated the correlations between the variables. RESULTS Otoacoustic emission amplitudes were significantly reduced in the exposed group, with congenital hypothyroidism, when compared to the group of individuals without the disease, especially in the medium frequencies. The Spearman test showed a slight correlation between the amplitude values of the otoacoustic emissions of some frequencies and the variables: disease time, diagnostic age, irregular serum free thyroxine hormone levels and thyroid stimulating hormone, especially in the condition of less treatment, whose correlation was negative. CONCLUSION There was a correlation between the levels of signal amplitudes of otoacoustic emissions with clinical conditions and hormonal follow-up, suggesting probable subclinical auditory impairment in this population, as well as influence of some clinical aspects of congenital hypothyroidism on auditory function.
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Affiliation(s)
- Caio Leônidas Oliveira de Andrade
- Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Zipe Code: 40110100, Valley of Canela, Salvador, Bahia, Brazil; Department of Life Sciences, University of the State of Bahia, Street Silveira Martins, Zipe Code: 41150000, Cabula, Salvador, Bahia, Brazil.
| | - Gabriela Carvalho Machado
- Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Zipe Code: 40110100, Valley of Canela, Salvador, Bahia, Brazil.
| | - Luan Paulo Franco Magalhães
- Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Zipe Code: 40110100, Valley of Canela, Salvador, Bahia, Brazil.
| | - Taíse Lima de Oliveira Cerqueira
- Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Zipe Code: 40110100, Valley of Canela, Salvador, Bahia, Brazil.
| | - Luciene da Cruz Fernandes
- Department of Speech Therapy, Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Zipe Code: 40110100, Valley of Canela, Salvador, Bahia, Brazil.
| | - Helton Estrela Ramos
- Department of Bioregulation, Health & Sciences Institute, Federal University Bahia, Avenue Rector Miguel Calmon, Zipe Code: 40110100, Valley of Canela, Salvador, Bahia, Brazil.
| | - Crésio de Aragão Dantas Alves
- Medical School, Institute of Health Science- Federal University of Bahia, Avenue Rector Miguel Calmon, Zipe Code: 40110100, Valley of Canela, Salvador, Bahia, Brazil.
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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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Raymaekers SR, Darras VM. Thyroid hormones and learning-associated neuroplasticity. Gen Comp Endocrinol 2017; 247:26-33. [PMID: 28390960 DOI: 10.1016/j.ygcen.2017.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/11/2022]
Abstract
Thyroid hormones (THs) are crucial for brain development and maturation in all vertebrates. Especially during pre- and perinatal development, disruption of TH signaling leads to a multitude of neurological deficits. Many animal models provided insight in the role of THs in brain development, but specific data on how they affect the brain's ability to learn and adapt depending on environmental stimuli are rather limited. In this review, we focus on a number of learning processes like spatial learning, fear conditioning, vocal learning and imprinting behavior and on how abnormal TH signaling during development shapes subsequent performance. It is clear from multiple studies that TH deprivation leads to defects in learning on all fronts, and interestingly, changes in local expression of the TH activator deiodinase type 2 seem to have an important role. Taking into account that THs are regulated in a very space-specific manner, there is thus increasing pressure to investigate more local TH regulators as potential factors involved in neuroplasticity. As these learning processes are also important for proper adult human functioning, further elucidating the role of THs in developmental neuroplasticity in various animal models is an important field for advancing both fundamental and applied knowledge on human brain function.
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Affiliation(s)
- Sander R Raymaekers
- Laboratory of Comparative Endocrinology, Biology Department, KU Leuven, Naamsestraat 61, 3000 Leuven, Belgium
| | - Veerle M Darras
- Laboratory of Comparative Endocrinology, Biology Department, KU Leuven, Naamsestraat 61, 3000 Leuven, Belgium.
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Pimentel J, Chambers M, Shahid M, Chawla R, Kapadia C. Comorbidities of Thyroid Disease in Children. Adv Pediatr 2016; 63:211-26. [PMID: 27426902 DOI: 10.1016/j.yapd.2016.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Janiel Pimentel
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa Chambers
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Madhia Shahid
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Reeti Chawla
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Chirag Kapadia
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
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Abstract
Congenital hypothyroidism (CH) is the most common congenital endocrine disorder. The early treatment of CH patients has successfully improved the prognosis and management of this disorder. Optimal treatment and management throughout the patient's life, beginning in the neonatal period, are required to ensure long-term health. Affected patients should be offered assessments of associated medical conditions and provided with accurate information about their condition throughout their lives, but particularly during the transition from pediatric to adult services. This review provides a summary of current knowledge about the long-term outcomes of these patients and appropriate management into early adulthood. We carried out a systematic search of the Medline database to identify relevant articles. Despite major improvements in prognosis, the impact of CH is clearly not uniform, and management should take into account a broader range of relevant indicators, including CH severity, associated comorbid conditions and the adequacy of treatment during childhood and adulthood. The early diagnosis and management of associated medical conditions, and better educational strategies to improve compliance with treatment, should improve the long-term prognosis. Further studies are required to explore changes with aging.
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Affiliation(s)
- Juliane Léger
- Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, FranceUniversité Paris DiderotSorbonne Paris Cité, F-75019 Paris, FranceInstitut National de la Santé et de la Recherche Médicale (Inserm)Unité 1141, DHU Protect, F-75019 Paris, France Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, FranceUniversité Paris DiderotSorbonne Paris Cité, F-75019 Paris, FranceInstitut National de la Santé et de la Recherche Médicale (Inserm)Unité 1141, DHU Protect, F-75019 Paris, France Assistance Publique-Hôpitaux de ParisHôpital Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, F-75019 Paris, FranceUniversité Paris DiderotSorbonne Paris Cité, F-75019 Paris, FranceInstitut National de la Santé et de la Recherche Médicale (Inserm)Unité 1141, DHU Protect, F-75019 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. 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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Wheeler SM, McLelland VC, Sheard E, McAndrews MP, Rovet JF. Hippocampal Functioning and Verbal Associative Memory in Adolescents with Congenital Hypothyroidism. Front Endocrinol (Lausanne) 2015; 6:163. [PMID: 26539162 PMCID: PMC4610202 DOI: 10.3389/fendo.2015.00163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/05/2015] [Indexed: 11/13/2022] Open
Abstract
Thyroid hormone (TH) is essential for normal development of the hippocampus, which is critical for memory and particularly for learning and recalling associations between visual and verbal stimuli. Adolescents with congenital hypothyroidism (CH), who lack TH in late gestation and early life, demonstrate weak verbal recall abilities, reduced hippocampal volumes, and abnormal hippocampal functioning for visually associated material. However, it is not known if their hippocampus functions abnormally when remembering verbal associations. Our objective was to assess hippocampal functioning in CH using functional magnetic resonance imaging (fMRI). Fourteen adolescents with CH and 14 typically developing controls (TDC) were studied. Participants studied pairs of words and then, during fMRI acquisition, made two types of recognition decisions: in one they judged whether the pairs were the same as when seen originally and in the other, whether individual words were seen before regardless of pairing. Hippocampal activation was greater for pairs than items in both groups, but this difference was only significant in TDC. When we directly compared the groups, the right anterior hippocampus was the primary region in which the TDC and CH groups differed for this pair memory effect. Results signify that adolescents with CH show abnormal hippocampal functioning during verbal memory processing.
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Affiliation(s)
- Sarah M. Wheeler
- Neurosciences and Mental Health Research Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Victoria C. McLelland
- Neurosciences and Mental Health Research Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Erin Sheard
- Neurosciences and Mental Health Research Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mary Pat McAndrews
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, ON, Canada
| | - Joanne F. Rovet
- Neurosciences and Mental Health Research Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- *Correspondence: Joanne F. Rovet,
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Mouri A, Hoshino Y, Narusawa S, Ikegami K, Mizoguchi H, Murata Y, Yoshimura T, Nabeshima T. Thyrotoropin receptor knockout changes monoaminergic neuronal system and produces methylphenidate-sensitive emotional and cognitive dysfunction. Psychoneuroendocrinology 2014; 48:147-61. [PMID: 25016105 DOI: 10.1016/j.psyneuen.2014.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/10/2014] [Accepted: 05/27/2014] [Indexed: 11/15/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) has been reported in association with resistance to thyroid hormone, a disease caused by a mutation in the thyroid hormone receptor β (TRβ) gene. TRβ is a key protein mediating down-regulation of thyrotropin (TSH) expression by 3,3',5-tri-iodothyronine (T3), an active form of thyroid hormone. Dysregulation of TSH and its receptor (TSHR) is implicated in the pathophysiology of ADHD but the role of TSHR remains elusive. Here, we clarified a novel role for TSHR in emotional and cognitive functions related to monoaminergic nervous systems. TSHR knockout mice showed phenotypes of ADHD such as hyperactivity, impulsiveness, a decrease in sociality and increase in aggression, and an impairment of short-term memory and object recognition memory. Administration of methylphenidate (1, 5 and 10mg/kg) reversed impulsiveness, aggression and object recognition memory impairment. In the knockout mice, monoaminergic changes including decrease in the ratio of 3-methoxy-4-hydroxyphenylglycol/noradrenaline and increase in the ratio of homovanillic acid/dopamine were observed in some brain regions, accompanied by increase in the expression of noradrenaline transporter in the frontal cortex. When TSH was completely suppressed by the supraphysiological administration of T3 to the adult mice, some behavioral and neurological changes in TSHR KO mice were also observed, suggesting that these changes were not due to developmental hypothyroidism induced by the inactivation of TSHR but to the loss of the TSH-TSHR pathway itself. Taken together, the present findings suggest a novel role for TSHR in behavioral and neurological phenotypes of ADHD.
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Affiliation(s)
- Akihiro Mouri
- Department of Chemical Pharmacology, Meijo University Graduate School of Pharmaceutical Sciences, Nagoya 468-8503, Japan; Japanese Drug Organization of Appropriate Use and Research, Nagoya 468-0069, Japan
| | - Yuta Hoshino
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya 464-8601, Japan
| | - Shiho Narusawa
- Department of Chemical Pharmacology, Meijo University Graduate School of Pharmaceutical Sciences, Nagoya 468-8503, Japan
| | - Keisuke Ikegami
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya 464-8601, Japan
| | - Hiroyuki Mizoguchi
- Futuristic Environmental Simulation Center, Research Institute of Environmental Medicine, Nagoya University, Nagoya 464-8601, Japan
| | - Yoshiharu Murata
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya 464-8601, Japan
| | - Takashi Yoshimura
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya 464-8601, Japan
| | - Toshitaka Nabeshima
- Department of Chemical Pharmacology, Meijo University Graduate School of Pharmaceutical Sciences, Nagoya 468-8503, Japan; Department of Regional Pharmaceutical Care and Sciences, Meijo University, Nagoya 468-8503, Japan; Japanese Drug Organization of Appropriate Use and Research, Nagoya 468-0069, Japan.
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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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Dimitropoulos A, Molinari L, Etter K, Torresani T, Lang-Muritano M, Jenni OG, Largo RH, Latal B. Children with congenital hypothyroidism: long-term intellectual outcome after early high-dose treatment. Pediatr Res 2009; 65:242-8. [PMID: 18787501 DOI: 10.1203/pdr.0b013e31818d2030] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We aim to determine long-term intellectual outcome of adolescents with early high-dose treated congenital hypothyroidism (CH). Sixty-three prospectively followed children with CH were assessed at age of 14 y with the Wechsler Intelligence Scale for Children-Revised and compared with 175 healthy controls. Median age at onset of treatment was 9 d (range 5-18 d) and median starting dose of levothyroxine (L-T4) was 14.7 microg/kg/d (range 9.9-23.6 microg/kg/d). Full-scale intelligence quotient (IQ) was significantly lower than in controls after adjustment for socioeconomic status (SES) and gender (101.7 versus 111.4; p < 0.0001). Children with athyreosis had a lower performance IQ than those with dysgenesis (adjusted difference 7.6 IQ scores, p < 0.05). Lower initial thyroxine (T4) levels correlated with poorer IQ (r = 0.27, p = 0.04). Lower SES was associated with poorer IQ, in particular in children with CH (interaction, p = 0.03). Treatment during childhood was not related to IQ at age 14 y. Adolescents with CH manifest IQ deficits when compared with their peers despite early high-dose treatment and optimal substitution therapy throughout childhood. Those adolescents with athyreosis and lower SES are at particular risk for adverse outcome. Therefore, early detection of intellectual deficits is mandatory in children with CH.
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Hepworth SL, Pang EW, Rovet JF. Word and face recognition in children with congenital hypothyroidism: an event-related potential study. J Clin Exp Neuropsychol 2006; 28:509-27. [PMID: 16624781 DOI: 10.1080/13803390590949331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The repetition paradigm offers a useful technique for assessing recognition memory by evaluating how an individual responds to new versus old stimuli. While this paradigm has been extensively used in adults with and without clinical conditions, it has not, to our knowledge, been studied in a clinical pediatric population. Children with congenital hypothyroidism (CH) identified by newborn screening and treated early in life have normal intelligence but demonstrate residual cognitive deficits including selective memory problems that are attributed to their loss of thyroid hormone during hippocampal formation. Since the hippocampus is integral for recognition memory, we hypothesized that children with CH would perform atypically on the repetition paradigm. Event-related potentials (ERPs) were recorded during word and face recognition in nine children aged 11 to 13 years with CH and nine typically developing children matched for age. Results revealed that while the groups did not differ in accuracy or reaction time, they did differ significantly on selective ERP components. Like normal adults, the comparison children showed a positive elevation in P3 amplitude for repeated relative to new words at the parietal electrodes, whereas children with CH did not. Both groups produced weak repetition effects when viewing faces, although the amplitudes of children with CH were somewhat smaller. It is proposed that the dampened neurophysiological response to repeated verbal stimuli by children with CH may explain some of their clinically observed difficulties in short-term recognition memory.
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Siesser WB, Cheng SY, McDonald MP. Hyperactivity, impaired learning on a vigilance task, and a differential response to methylphenidate in the TRbetaPV knock-in mouse. Psychopharmacology (Berl) 2005; 181:653-63. [PMID: 15983791 DOI: 10.1007/s00213-005-0024-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2004] [Accepted: 04/05/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE The thyroid hormones (T3 and T4) play a critical role in brain development, and thyroid abnormalities have been linked to a variety of psychiatric and neuropsychological disorders. Among patients with the rare genetic syndrome resistance to thyroid hormone (RTH), 40-70% meet the diagnostic criteria for attention deficit-hyperactivity disorder (ADHD). RTH is caused by a mutation in the thyroid receptor beta (Thrb) gene that results in reduced binding of T3 to its receptor and elevated concentrations of T3, T4, and thyroid-stimulating hormone. OBJECTIVES We tested a knock-in (KI) mouse expressing a mutant TRbeta allele (TRbetaPV) for the behavioral features of ADHD and their response to methylphenidate (MPH). METHODS The locomotor activity of the TRbetaPV KI mice was measured in activity monitors over multiple sessions. Sustained attention and the effects of MPH on attention were assessed using a vigilance task. RESULTS The TRbetaPV KI mice are hyperactive and have learning deficits on a vigilance task. Doses of MPH that impair the vigilance performance of wild-type mice do not affect the performance of the TRbetaPV KI mice. CONCLUSIONS The TRbetaPV KI mice provide a tool for studying the underlying neural deficits that contribute to thyroid-related neurological disorders, hyperactivity, and altered responsiveness to MPH.
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Affiliation(s)
- William B Siesser
- Program in Neuroscience, Vanderbilt University, Nashville, TN 37232-0325, USA
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Ho J, Kendrick V, Dewey D, Pacaud D. New insight into the pathophysiology of severe hypothyroidism in an infant with multiple hepatic hemangiomas. J Pediatr Endocrinol Metab 2005; 18:511-4. [PMID: 15921182 DOI: 10.1515/jpem.2005.18.5.511] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report on an infant with severe acquired hypothyroidism resulting from both increased activity of type 3 iodothyronine deiodinase and increased production of TSH-like hormone from hepatic hemangiomas. The combination of these two mechanisms in a patient with hepatic hemangiomas has not been reported previously.
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Affiliation(s)
- Josephine Ho
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
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15
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Negishi T, Kawasaki K, Sekiguchi S, Ishii Y, Kyuwa S, Kuroda Y, Yoshikawa Y. Attention-deficit and hyperactive neurobehavioural characteristics induced by perinatal hypothyroidism in rats. Behav Brain Res 2005; 159:323-31. [PMID: 15817195 DOI: 10.1016/j.bbr.2004.11.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2004] [Revised: 11/05/2004] [Accepted: 11/11/2004] [Indexed: 11/17/2022]
Abstract
Thyroid hormone is essential for the proper development of the mammalian central nervous system (CNS). In the present study, we examined behavioural alterations caused by transient perinatal hypothyroidism induced by an anti-thyroid drug, propylthiouracil (PTU). This drug produces perinatal disruption of the thyroid system and subsequent behavioural changes, which we investigated using a series of behavioural tests and focusing particularly on attention-deficit/hyperactivity disorder (ADHD)-like behaviours. In the open field test, both male and female rats that had experienced perinatal hypothyroidism (HT rats) showed an increased percent of locomotion behaviour and reduced grooming behaviour, suggesting that HT rats may be hyperactive and show fewer anxiety characteristics. Neither male nor female HT rats showed retention in the passive avoidance test. Male HT rats showed a significantly lower rate of correct avoidance responses than control rats in earlier sessions in the active avoidance test. In addition, we observed significant increases in the number of times that rats crossed the partition during inter-trial intervals and the percent of failure of avoidance during 5 s electrical stimuli in HT rats, suggesting that HT rats are restless, have a shortened attention span and panic easily. In measuring spontaneous motor activity during a period of darkness, male HT rats appeared to plunge into active phase with short, quick steps, while male control rats showed only long active phases during a stress-free period of darkness. These abnormal behavioural characteristics in HT rats might coincide with those found in some cases of ADHD.
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Affiliation(s)
- Takayuki Negishi
- Department of Biomedical Science, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.
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16
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Münte TF, Lill C, Otting G, Brabant G. Cognitive changes in short-term hypothyroidism assessed with event-related brain potentials. Psychoneuroendocrinology 2004; 29:1109-18. [PMID: 15219634 DOI: 10.1016/j.psyneuen.2003.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2003] [Revised: 12/02/2003] [Accepted: 12/06/2003] [Indexed: 10/26/2022]
Abstract
Hypothyroidism is a common clinical problem during (131)Iodine-therapy of thyroid cancer. In the present investigation, possible cognitive dysfunction during hypothyroid state was assessed by means of neuropsychological tests and the recording of event-related brain potentials (ERPs). Fifteen patients undergoing therapy for thyroid cancer were examined twice: (1) substituted with thyroid hormones, (2) during hypothyroid state immediately prior to treatment. Standard neuropsychological tests were applied during both sessions and subjects showed a mild-to-moderate impairment in their hypothyroid state. In addition, ERPs were recorded from 19 scalp sites while subjects performed two visual search tasks. The serial task required the effortful one-by-one scanning of several items within a visual array, while the parallel task allowed processing of all stimulus items in parallel and automatically. ERPs showed a marked amplitude decrement and delay of the P3 component known to index the speed of stimulus evaluation and the amount of available processing resources. This effect was present only for the serial search task, while no changes were seen in the parallel search task. These data show that hypothyroidism during (131)Iodine-therapy is associated with clinically relevant cognitive dysfunctions, especially with effortful attention demanding tasks.
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Affiliation(s)
- Thomas F Münte
- Department of Neuropsychology, Otto-von-Guericke Universität Magdeburg, Universitätsplatz 2, Gebäude 24, 39016 Magdeburg, Germany.
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17
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Heyerdahl S, Oerbeck B. Congenital hypothyroidism: developmental outcome in relation to levothyroxine treatment variables. Thyroid 2003; 13:1029-38. [PMID: 14651787 DOI: 10.1089/105072503770867200] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neonatal screening programs for congenital hypothyroidism (CH) were initiated in the 1970s to ensure early treatment in order to prevent mental retardation. With screening, developmental prognosis is considerably improved, but follow-up studies still report developmental delay compared to controls. To explain the delay, most studies have focused on effects of CH severity, supposedly caused by prenatal hypothyroidism. Nonoptimal treatment could also be an explanatory factor. Treatment guidelines have changed; now, a higher levothyroxine starting dose is recommended. In this review, we first summarize outcome studies in CH versus controls and in mild versus severe CH. Second, we report results on the association between levothyroxine treatment variables and developmental outcome. Six research groups have reported results on the association between levothyroxine starting dose and intelligence, and eight groups on the association between circulating thyroid hormones and intelligence. Most studies found a positive association between a high level of treatment, primarily treatment during the first year and later intelligence. However, negative associations between high-dose treatment and outcome have been reported, and the question of optimal treatment in relation to developmental outcome has not been answered. Effects of high levothyroxine dosage should be documented in samples that have been treated according to recent recommendations.
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Affiliation(s)
- Sonja Heyerdahl
- Regional Center for Child and Adolescent Psychiatry, Region East and South, Oslo, Norway.
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18
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Oerbeck B, Sundet K, Kase BF, Heyerdahl S. Congenital hypothyroidism: influence of disease severity and L-thyroxine treatment on intellectual, motor, and school-associated outcomes in young adults. Pediatrics 2003; 112:923-30. [PMID: 14523187 DOI: 10.1542/peds.112.4.923] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe intellectual, motor, and school-associated outcome in young adults with early treated congenital hypothyroidism (CH) and to study the association between long-term outcome and CH variables acting at different points in time during early development (CH severity and early L-thyroxine treatment levels [0-6 years]). METHODS Neuropsychological tests were administered to all 49 subjects with CH identified during the first 3 years of the Norwegian neonatal screening program (1979-1981) at a mean age of 20 years and to 41 sibling control subjects (mean age: 21 years). RESULTS The CH group attained significantly lower scores than control subjects on intellectual, motor, and school-associated tests (total IQ: 102.4 [standard deviation: 13] vs 111.4 [standard deviation: 13]). Twelve (24%) of the 49 CH subjects had not completed senior high school, in contrast to 6% of the control subjects. CH severity (pretreatment serum thyroxine [T4]) correlated primarily with motor tests, whereas early L-thyroxine treatment levels were related to verbal IQ and school-associated tests. In multiple regression analysis, initial L-thyroxine dose (beta = 0.32) and mean serum T4 level during the second year (beta = 0.48) predicted Verbal IQ, whereas mean serum T4 level during the second year (beta = 0.44) predicted Arithmetic. CONCLUSIONS Long-term outcome revealed enduring cognitive and motor deficits in young adults with CH relative to control subjects. Verbal functions and Arithmetic were associated with L-thyroxine treatment variables, suggesting that more optimal treatment might be possible. Motor outcome was associated with CH severity, indicating a prenatal effect.
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Affiliation(s)
- Beate Oerbeck
- Regional Center for Child and Adolescent Psychiatry, Region East and South, Oslo, Norway.
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19
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Stein MA, Weiss RE. Thyroid function tests and neurocognitive functioning in children referred for attention deficit/hyperactivity disorder. Psychoneuroendocrinology 2003; 28:304-16. [PMID: 12573298 DOI: 10.1016/s0306-4530(02)00024-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Thyroid abnormalities have been associated with attention deficit/hyperactivity disorder (ADHD) and with other childhood psychiatric disorders. The goal of this study was to determine the relationships between thyroid hormone concentrations, neurocognitive functioning, and psychiatric diagnosis in children. METHODS Free thyroxine index (FT4I) and thyroid stimulating hormone (TSH) were obtained, along with diagnostic and descriptive information for 338 children referred to a clinic specializing in learning and behavior problems. RESULTS Thyroid abnormalities were uncommon in children referred for ADHD. After excluding children with thyroid disease, there was a greater proportion with low concentrations of normal FT4I for ADHD-Predominantly Inattentive type (ratio=7.0), but not for ADHD-Combined Type. High concentrations of normal FT4I were associated with mood lability, preoccupations, and lower ratings of attention problems. Thyroxine concentrations within the normal range were differentially associated with ADHD-Combined Type compared to ADHD-Predominantly Inattentive, mood disorders, and pervasive developmental disorders. CONCLUSION Thyroxine concentrations were associated with mood symptoms and unusual behaviors, and were less strongly related to attentional functioning. Thyroxine concentrations were not related to hyperactivity.
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Affiliation(s)
- Mark A Stein
- Neuroscience and Behavioral Medicine Research Center, Children's National Medical Center and George Washington University Medical School, 111 Michigan Ave, NW, DC 20010, USA.
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Soldin OP, Lai S, Lamm SH, Mosee S. Lack of a relation between human neonatal thyroxine and pediatric neurobehavioral disorders. Thyroid 2003; 13:193-8. [PMID: 12699594 PMCID: PMC3641764 DOI: 10.1089/105072503321319503] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The growth and differentiation of the central nervous system are closely related to the presence of iodine and thyroid hormones. It has been hypothesized that neurobehavioral disabilities of childhood, such as attention deficit hyperactivity disorder (ADHD), learning disorders, and autism can be attributed to fetal thyroidal endocrine disruption in utero. To determine whether there is an association between neonatal thyroid status and a subsequent diagnosis of a neurobehavioral disability, neonatal thyroxine (T(4)) levels have been used as the indicator of the presence of intrauterine thyroidal dysfunction. Neonatal T(4) levels were obtained from the neonatal hypothyroidism screening program. All cases were diagnosed at medical school diagnostic clinics, the diagnostic categories being ADHD, autism spectrum disorder, behavioral disorder, cognitive disorder, developmental delay, emotional disorder, learning disability, and speech/language disorder. Conditional logistic regression analysis was performed for each clinical condition. Odds ratios for the conditions ranged from 0.92 to 1.13 with p values ranging between 0.19 and 0.84. No significant differences were detected between neonatal T(4) values of the cases and the controls for any of the neurobehavioral conditions. All neonatal T(4) values were within normal ranges. The data provide no evidence to suggest that intrauterine thyroid status as reflected by the neonatal T(4) values had an impact on the neurologic disorders diagnosed in childhood.
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Affiliation(s)
- Offie Porat Soldin
- Consultants in Epidemiology and Occupational Health, Inc, Washington, DC 20007, USA.
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21
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Soldin OP, Nandedkar AKN, Japal KM, Stein M, Mosee S, Magrab P, Lai S, Lamm SH. Newborn thyroxine levels and childhood ADHD. Clin Biochem 2002; 35:131-6. [PMID: 11983348 PMCID: PMC3635835 DOI: 10.1016/s0009-9120(02)00284-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Normal brain development is highly dependent on adequate levels of iodine and thyroid hormone. It has been suggested that Attention Deficit Hyperactivity Disorder (ADHD) is the consequence of prenatal thyroidal endocrine disruption. The hypothesis was examined using neonatal thyroxine levels as a bio-marker of prenatal thyroid status and comparing it to subsequent development of ADHD. DESIGN AND METHODS In a matched case-control study, cases were defined as children diagnosed with ADHD, while children born in the same hospital and tested on the same day served as matched controls. Conditional logistic regression analysis with unequal numbers of controls was performed. RESULTS The neonatal thyroxine levels were within normal limits for each of the children who were subsequently diagnosed as having ADHD, and their distribution was no different from that of their controls. CONCLUSIONS Children diagnosed with ADHD do not demonstrate prenatal thyroidal dysfunction as reflected in the newborn thyroxine levels, therefore neonatal thyroxine levels are not a bio-marker for the subsequent development of ADHD.
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Affiliation(s)
- Offie Porat Soldin
- Consultants in Epidemiology and Occupational Health, Inc., 2428 Wisconsin Avenue, N.W., Washington, DC 20007, USA.
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Song SI, Daneman D, Rovet J. The influence of etiology and treatment factors on intellectual outcome in congenital hypothyroidism. J Dev Behav Pediatr 2001; 22:376-84. [PMID: 11773802 DOI: 10.1097/00004703-200112000-00005] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To determine the effects of hypothyroidism and hormonal patterns on outcome, we tested 65 7- to 12-year-old children with congenital hypothyroidism using standardized tests of intelligence, neuropsychological functioning, memory, and achievement. Results were analyzed by etiology, time to thyrotropin normalization, and hormone levels at testing. Children with athyreosis scored below other etiologies on visuospatial, attention, and arithmetic indices. Children whose thyroid-stimulating hormone levels normalized by 1 to 2 months of age scored higher than later normalizers on indices of visual memory, attention, and arithmetic. Normalization of thyroid-stimulating hormone by 3 months of age was associated with better memory and learning abilities than later normalization. Thyroid hormone levels at testing were correlated with indices of sensorimotor, spatial, and language abilities. Two children with persistently elevated thyrotropin levels were not adversely affected. Present findings signify the need to establish etiology, normalize thyrotropin early, and maintain hormone levels in the normal range throughout childhood in children with congenital hypothyroidism.
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Affiliation(s)
- S I Song
- Brain and Behaviour Program, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
A previous review of alternative treatments (Tx) of ADHD--those other than psychoactive medication and behavioral/psychosocial Tx--was supplemented with an additional literature search focused on adults with ADHD. Twenty-four alternative Tx were identified, ranging in scientific documentation from discrediting controlled studies through mere hypotheses to positive controlled double-blind clinical trials. Many of them are applicable only to a specific subgroup. Although oligoantigenic (few-foods) diets have convincing double-blind evidence of efficacy for a properly selected subgroup of children, they do not appear promising for adults. Enzyme-potentiated desensitization, relaxation/EMG biofeedback, and deleading also have controlled evidence of efficacy. Iron supplementation, magnesium supplementation, Chinese herbals, EEG biofeedback, massage, meditation, mirror feedback, channel-specific perceptual training, and vestibular stimulation all have promising prospective pilot data, many of these tests reasonably controlled. Single-vitamin megadosage has some intriguing pilot trial data. Zinc supplementation is hypothetically supported by systematic case-control data, but no systematic clinical trial. Laser acupuncture has promising unpublished pilot data and may be more applicable to adults than children. Essential fatty acid supplementation has promising systematic case-control data, but clinical trials are equivocal. RDA vitamin supplementation, non-Chinese herbals, homeopathic remedies, and antifungal therapy have no systematic data in ADHD. Megadose multivitamin combinations are probably ineffective for most patients and are possibly dangerous. Simple sugar restriction seems ineffective. Amino acid supplementation is mildly effective in the short term, but not beyond 2-3 months. Thyroid treatment is effective in the presence of documented thyroid abnormality. Some alternative Tx of ADHD are effective or probably effective, but mainly for certain patients. In some cases, they are the Tx of choice, and initial evaluation should consider the relevant etiologies. A few have failed to prove effective in controlled trials. Most need research to determine whether they are effective and/or to define the applicable subgroup. Some of them, although not safer than standard Tx, may be preferable for an etiologic subgroup.
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Affiliation(s)
- L E Arnold
- Department of Psychiatry, Ohio State University, Columbus, Ohio 43210, USA.
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Affiliation(s)
- V J Pop
- Department of Clinical Health Psychology, University of Tilburg, The Netherlands
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25
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26
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Millichap JG. Attention Deficits and Thyroid Function. Pediatr Neurol Briefs 1996. [DOI: 10.15844/pedneurbriefs-10-9-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rovet J, Walker W, Bliss B, Buchanan L, Ehrlich R. Long-term sequelae of hearing impairment in congenital hypothyroidism. J Pediatr 1996; 128:776-83. [PMID: 8648536 DOI: 10.1016/s0022-3476(96)70329-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hearing loss and its functional consequences were evaluated retrospectively in children with congenital hypothyroidism. From a cohort of 101 children followed longitudinally to evaluate newborn screening, 75 with previous hearing tests were studied. Fifteen (20%) were found to have hearing problems. Of these, nine had unilateral or sensorineural loss mostly at high frequencies, five had a conductive loss, and one had both problems. Hearing impaired children differed from children with normal hearing in age of treatment onset (22 vs 14 days) but not disease severity or duration. A comparison of language and auditory processing skills at ages 3, 5, and 7 years revealed that early speech was delayed in hearing impaired children, whereas deficits persisted in later receptive language and auditory discrimination skills. Comparing hearing impaired children and children with normal hearing with matched control subjects at grade 3 showed that hearing impaired children were poorer readers because of less adequate phonologic processing skills.
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MESH Headings
- Child
- Child, Preschool
- Cohort Studies
- Congenital Hypothyroidism
- Female
- Follow-Up Studies
- Hearing Disorders/congenital
- Hearing Disorders/diagnosis
- Hearing Disorders/prevention & control
- Hearing Loss, Conductive/congenital
- Hearing Loss, Conductive/diagnosis
- Hearing Loss, Conductive/prevention & control
- Hearing Loss, High-Frequency/congenital
- Hearing Loss, High-Frequency/diagnosis
- Hearing Loss, High-Frequency/prevention & control
- Hearing Loss, Sensorineural/congenital
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/prevention & control
- Humans
- Hypothyroidism/complications
- Hypothyroidism/prevention & control
- Infant
- Infant, Newborn
- Language Development Disorders/diagnosis
- Language Development Disorders/etiology
- Language Development Disorders/prevention & control
- Longitudinal Studies
- Male
- Neonatal Screening
- Ontario/epidemiology
- Reading
- Retrospective Studies
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Affiliation(s)
- J Rovet
- Department of Psychology and Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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