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Shah AN, Li W, Zheng D, Lalani S, Kaluarachchi DC, Findley TO. A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants. J Perinatol 2024:10.1038/s41372-024-01985-5. [PMID: 38734804 DOI: 10.1038/s41372-024-01985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES To assess utility and accuracy of a gestational age-based screening targeting premature infants to detect congenital hypothyroidism. STUDY DESIGN A prospective cohort study was conducted in infants <35 weeks' gestational age with clinical outcomes at 2-3 years of age. Patients received newborn screenings at 24 hours and 10-14 days of life. Free T4 (FT4) and thyroid-stimulating hormone (TSH) levels were measured at one month of life and repeated based on algorithm by corrected gestational age. RESULTS Among infants <35 weeks gestation (n = 938), the incidence of hypothyroidism requiring treatment was 1:58. TSH levels at one month of age was predictive of treatment (AUC 0.96, 95% CI 0.88-1). The optimal TSH threshold of 8 mIU/L (8 µU/ml) increased the specificity to 0.97 and sensitivity to 0.88. Following initiation of treatment for hypothyroidism during NICU hospitalization, 43.8% (n = 7) were diagnosed with permanent congenital hypothyroidism. CONCLUSIONS Our study supports a gestational age-based screening algorithm for early detection of hypothyroidism in premature infants.
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Affiliation(s)
- Avni N Shah
- Division of Pediatric Endocrinology, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Denise Zheng
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Psychiatry, Case Western Reserve University - University Hospitals, Cleveland, OH, USA
| | - Sana Lalani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Tina O Findley
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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Chen LW, Chu CH, Lin YC, Huang CC. The Quartile Levels of Thyroid-Stimulating Hormone by Newborn Screening Stratified Risks of Neurodevelopmental Impairment in Extremely Preterm Infants - A Population Cohort Study. J Epidemiol 2024:JE20230253. [PMID: 38191177 DOI: 10.2188/jea.je20230253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND To evaluate whether thyroid-stimulating hormone (TSH) by newborn screening (NBS) at birth and at discharge can be surrogate markers for neurodevelopmental impairment (NDI) in extremely preterm infants. METHODS The population cohort enrolled infants born <29 weeks' gestation in 2008 - 2020 in southern Taiwan. Infants with a maternal history of thyroid disorders and infants who required thyroxine supplementation during hospitalization were excluded. TSH levels by NBS at birth and at term-equivalent age (TEA)/discharge were respectively categorized into the lowest quartile, the interquartile range, and the highest quartile, which were correlated to NDI outcomes. RESULTS Among 392 patients with paired TSH data, 358 (91%) were prospectively followed until corrected age 24 months. At birth, infants with lowest-quartile TSH had higher NDI risks (OR 2.3, 95% CI 1.3 - 4.1, P = 0.004) compared to infants with interquartile-range TSH. Conversely, by TEA/discharge, infants with highest-quartile TSH had increased NDI (OR 1.9, 1.0 - 3.4, P = 0.03). By paired TSH categories, infants persistently in the lowest TSH quartile (48%, aOR 4.4, 1.4 - 14.5, P = 0.01) and those with a shift from interquartile range to the highest quartile (32%, aOR 2.7, 1.0 - 7.4, P = 0.046) had increased NDI risks compared with the reference with consistent interquartile-range TSH. CONCLUSIONS Extremely preterm infants persistently in the lowest-quartile TSH level at birth and at discharge had the highest NDI risk. TSH quartile levels by NBS may serve as a population surrogate biomarker for assessing NDI risks in infants born extremely preterm.
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Affiliation(s)
- Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | | | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
- Department of Pediatrics, College of Medicine, Taipei Medical University
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YILDIZ D, ÇAKIR U, TUĞCU AU, TAYMAN C. Relationship between thyroid function tests and small for gestational age in preterm newborns. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1171931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: The aim of this study was to evaluate the relationship between thyroid hormone levels and clinical outcomes in preterm, small for gestational age (SGA) infants.
Materials and Methods: The premature newborns (gestational age of ≤30 weeks) were divided into two groups as SGA and non-SGA. Thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels, the frequency of congenital hypothyroidism (CH), demographic and clinical characteristics, morbidity and mortality rate were compared between the groups.
Results: A total of 430 premature newborns, 72 in the SGA group and 358 in the non-SGA group were included. The frequency of CH, morbidity, demographic and clinical characteristics were similar between two groups. The mortality rate was higher in SGA (36.1%) than in non-SGA group (13.6%). Serum fT4 level was lower in SGA group (1.04±0.30 ng/dl) compared to the non-SGA group (1.24±0.33 ng/dl). The serum TSH level was higher in SGA group (9.91 ± 5.6 uIU/L) than in non-SGA group (6.6 ± 5.2 uIU/L).
Conclusion: The frequency of thyroid dysfunction was higher in preterm SGA infants compared to non-SGA, which was due to transiently high TSH and low fT4 concentrations. Therefore, thyroid function tests should be monitored periodically in preterm and SGA infants.
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Affiliation(s)
- Duran YILDIZ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
| | - Ufuk ÇAKIR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
| | - Ali Ulaş TUĞCU
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
| | - Cüneyt TAYMAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
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4
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Grob F. Approaching the diagnosis of thyroid disorders in preterm infants. Pediatr Res 2022; 91:1021-1022. [PMID: 35079111 DOI: 10.1038/s41390-022-01951-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Francisca Grob
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Murdoch children's research institute (MCRI), Melbourne, Australia.
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Stawerska R, Nowak-Bednarek M, Talar T, Kolasa-Kicińska M, Łupińska A, Hilczer M, Gulczyńska E, Lewiński A. The prevalence of hypothyroxinemia in premature newborns. Front Endocrinol (Lausanne) 2022; 13:940152. [PMID: 36034431 PMCID: PMC9399394 DOI: 10.3389/fendo.2022.940152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022] Open
Abstract
Congenital hypothyroidism diagnosed by TSH assessment in bloodspot screening may be overlooked in preterm newborns due to immaturity of the hypothalamus-pituitary-thyroid axis in them. The purpose of the study was to determine the prevalence and causes of hypothyroxinemia in preterm newborns, determined by TSH and FT4 serum concentration measurement, performed on the 3-5th day of life. We assessed TSH, FT4 and FT3 serum concentration on the 3-5th day of life in preterm children born at our centre within three consecutive years. We assessed the incidence of hypothyroxinemia, and its cause: primary hypothyroidism, secondary hypothyroidism or low FT4 syndrome - with normal TSH concentration, its dependence - among others - on gestational age (GA), birth body weight (BBW) and being SGA. A total of 525 preterm children were examined. FT4 concentration was decreased in 14.9% of preterm newborns. The most frequent cause of hypothyroxinemia was low FT4 syndrome (79.5%). More than 92% cases of hypothyroxinemia occurred in children born before the 32nd week and/or with BBW below 1500 g. Thus, every fourth child in these groups had a reduced FT4 concentration. Neonates with hypothyroxinemia were significantly lighter than those with normal FT4. In older and heavier neonates with hypothyroxinemia, serious congenital defects were observed. Neither IVH nor SGA nor twin pregnancies predispose children to hypothyroxinemia. Among newborns with untreated hypothyroxinemia in whom TSH and FT4 assessment was repeated within 2-5 weeks, a decreased FT4 concentration was confirmed in 56.1% of cases. As hypothyroxinemia affects 25% of newborns born before the 32nd week of gestation and those in whom BBW is less than 1500g, it seems that in this group of children the newborn screening should be extended to measure serum TSH and FT4 concentration between the 3-5th day of life. In older and heavier neonates, additional serum TSH and FT4 assessment should be limited to children with severe congenital abnormalities but not to all SGA or twins. Despite the fact that the most common form of preterm hypothyroxinemia is low FT4 syndrome, it should be emphasized that FT4 remains lowered on subsequent testing in more them 50% of cases.
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Affiliation(s)
- Renata Stawerska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Paediatric Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Marzena Nowak-Bednarek
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Tomasz Talar
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Marzena Kolasa-Kicińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
| | - Anna Łupińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Paediatric Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Maciej Hilczer
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
| | - Ewa Gulczyńska
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- *Correspondence: Andrzej Lewiński,
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Subclinical hypothyroidism and Pelizaeus-Merzbacher Disease in same-sex twins: Case report. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.jecr.2021.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Thyroid Hormone Function in Small for Gestational Age Term Newborns. J Pediatr 2021; 238:181-186.e3. [PMID: 34214586 DOI: 10.1016/j.jpeds.2021.06.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To test the hypothesis that term-born small for gestational age (SGA) neonates have elevated thyroid-stimulating hormone (TSH) concentrations and an increased incidence of congenital hypothyroidism compared with non-SGA term neonates. STUDY DESIGN This retrospective cohort study included all term neonates screened in Wisconsin in 2015 and 2016. The cohort was divided based on SGA status, defined as birth weight <10th percentile as calculated from the World Health Organization's sex-specific growth charts for age 0-2 years. TSH concentration on first newborn screening performed between birth and 96 hours of life and incidence of congenital hypothyroidism were compared between the SGA and non-SGA groups. RESULTS A total of 115 466 term neonates, including 11 498 (9.96%) SGA neonates, were included in the study. TSH concentration and incidence of congenital hypothyroidism was significantly higher in the SGA group, but only TSH concentration remained significant when adjusted for potential confounding variables. CONCLUSIONS Our data do not support a higher incidence of congenital hypothyroidism in term SGA neonates after adjusting for potential confounders. However, TSH concentrations were higher in term SGA neonates compared with term non-SGA neonates. The effects of mild thyroid hormone dysfunction on neurodevelopmental outcomes and development of chronic medical conditions merit long-term study.
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Nagasaki K, Sato H, Sasaki S, Nyuzuki H, Shibata N, Sawano K, Hiroshima S, Asami T. Re-Evaluation of the Prevalence of Permanent Congenital Hypothyroidism in Niigata, Japan: A Retrospective Study. Int J Neonatal Screen 2021; 7:ijns7020027. [PMID: 34071177 PMCID: PMC8162320 DOI: 10.3390/ijns7020027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 01/21/2023] Open
Abstract
Although newborn screening (NBS) for congenital hypothyroidism (CH) in Japan started more than 40 years ago, the prevalence of CH remains unclear. Prevalence estimations among NBS-positive CH individuals include those with transient hypothyroidism and transient hyperthyrotropinemia, and re-evaluation with increasing age is necessary to clarify the actual incidence. Thus, we re-evaluated the incidence of permanent CH. Of the 106,114 patients who underwent NBS in the Niigata Prefecture, Japan, between April 2002 and March 2006, 116 were examined further due to high thyroid-stimulating hormone levels (>8 mIU/L) and were included in the study. We retrospectively evaluated their levothyroxine sodium (LT4) replacement therapy status from the first visit to 15 years of age. Of the 116 NBS-positive patients, 105 (91%) were initially examined in our department. Of these, 72 (69%) started LT4 replacement therapy on the first visit. Subsequently, 27 patients continued LT4 replacement until 15 years of age after multiple re-evaluations. The prevalence of permanent CH in the Niigata Prefecture during this period was 1 in 2500-3500 children. Ultimately, 62.5% of patients on LT4 replacement discontinued treatment by 15 years of age. This is the first study to clarify the true prevalence of permanent CH in Japan.
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Affiliation(s)
- Keisuke Nagasaki
- Department of Homeostatic Regulation and Development, Division of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (H.S.); (S.S.); (H.N.); (N.S.); (K.S.); (S.H.)
- Correspondence: ; Tel.: +81-25-227-2222
| | - Hidetoshi Sato
- Department of Homeostatic Regulation and Development, Division of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (H.S.); (S.S.); (H.N.); (N.S.); (K.S.); (S.H.)
| | - Sunao Sasaki
- Department of Homeostatic Regulation and Development, Division of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (H.S.); (S.S.); (H.N.); (N.S.); (K.S.); (S.H.)
| | - Hiromi Nyuzuki
- Department of Homeostatic Regulation and Development, Division of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (H.S.); (S.S.); (H.N.); (N.S.); (K.S.); (S.H.)
| | - Nao Shibata
- Department of Homeostatic Regulation and Development, Division of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (H.S.); (S.S.); (H.N.); (N.S.); (K.S.); (S.H.)
| | - Kentaro Sawano
- Department of Homeostatic Regulation and Development, Division of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (H.S.); (S.S.); (H.N.); (N.S.); (K.S.); (S.H.)
| | - Shota Hiroshima
- Department of Homeostatic Regulation and Development, Division of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (H.S.); (S.S.); (H.N.); (N.S.); (K.S.); (S.H.)
| | - Tadashi Asami
- Department of Pediatrics, Nagaoka Institute for Severely Handicapped Children, Nagaoka 940-2135, Japan;
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Chiesa AE, Tellechea ML. Update on Neonatal Isolated Hyperthyrotropinemia: A Systematic Review. Front Endocrinol (Lausanne) 2021; 12:643307. [PMID: 34484109 PMCID: PMC8416274 DOI: 10.3389/fendo.2021.643307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/26/2021] [Indexed: 01/17/2023] Open
Abstract
The purpose of this paper was to systematically summarize the published literature on neonatal isolated hyperthyrotropinemia (HTT), with a focus on prevalence, L-T4 management, re-evaluation of thyroid function during infancy or childhood, etiology including genetic variation, thyroid imaging tests, and developmental outcome. Electronic and manual searches were conducted for relevant publications, and a total of 46 articles were included in this systematic review. The overall prevalence of neonatal HTT was estimated at 0.06%. The occurrence of abnormal imaging tests was found to be higher in the persistent than in the transient condition. A continuous spectrum of thyroid impairment severity can occur because of genetic factors, environmental factors, or a combination of the two. Excessive or insufficient iodine levels were found in 46% and 16% of infants, respectively. Thirty-five different genetic variants have been found in three genes in 37 patients with neonatal HTT of different ethnic backgrounds extracted from studies with variable design. In general, genetic variants reported in the TSHR gene, the most auspicious candidate gene for HTT, may explain the phenotype of the patients. Many practitioners elect to treat infants with HTT to prevent any possible adverse developmental effects. Most patients with thyroid abnormalities and/or carrying monoallelic or biallelic genetic variants have received L-T4 treatment. For all those neonates on treatment with L-T4, it is essential to ensure follow-up until 2 or 3 years of age and to conduct medically supervised trial-off therapy when warranted. TSH levels were found to be elevated following cessation of therapy in 44% of children. Withdrawal of treatment was judged as unsuccessful, and medication was restarted, in 78% of cases. Finally, data extracted from nine studies showed that none of the 94 included patients proved to have a poor developmental outcome (0/94). Among subjects presenting with normal cognitive performance, 82% of cases have received L-T4 therapy. Until now, the precise neurodevelopmental risks posed by mild disease remain uncertain.
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Kollati Y, Akella RRD, Naushad SM, Borkar D, Thalla M, Nagalingam S, Lingappa L, Patel RK, Reddy GB, Dirisala VR. Newborn screening and single nucleotide variation profiling of TSHR, TPO, TG and DUOX2 candidate genes for congenital hypothyroidism. Mol Biol Rep 2020; 47:7467-7475. [PMID: 32930933 DOI: 10.1007/s11033-020-05803-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022]
Abstract
High prevalence of congenital hypothyroidism (CH) among Indian newborns prompted us to establish population-specific reference ranges of TSH and to explore the contribution of the common genetic variants in TSHR, TPO, TG and DUOX2 genes towards CH. A total of 1144 newborns (593 males and 551 females) were screened for CH. SNV profiling (n = 22) spanning three candidate genes, i.e. TSHR, TPO and TG was carried out in confirmed CH cases (n = 45). In screen negative cases (n = 700), ten TSHR variants were explored to establish association with CH. No mutation found in DUOX2. The 2.5th to 97.5th percentiles of TSH in these newborns were 0.5 to 12.2 mU/L. In newborns with optimal birth weight, the cut-off was 10 mU/L. Lower or higher birth weight resulted in slightly higher TSH. Two TSHR variants, i.e. rs7144481 and rs17630128 were associated with agenesis, hypoplasia and goiter. The rs2268477 was associated with agenesis and hypoplasia. The rs1991517, rs2075176 and rs2241119 were associated with agenesis only. The rs7144481, rs17630128, rs1991517 and rs2268477 were associated with 2.17, 4.62, 2.91 and 2.29-fold increased risk for CH, respectively. Among the TPO variants, rs867983 and rs2175977 were associated with agenesis and goiter, respectively. Among the TG variants, rs2076740 showed association with agenesis and goiter. Two rare variants i.e. TPO g.IVS14-19 G>C and TG c.1262 C>T were observed in CH cases. No genetic variant identified in the two exons of DUOX2. To conclude, the current study established Indian population-specific normative values for TSH and demonstrates specific genotype-phenotype correlations among three candidate genes.
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Affiliation(s)
- Yedukondalu Kollati
- Department of Biotechnology, Vignan's Foundation for Science, Technology & Research (Deemed to be University), Vadlamudi, Guntur, Andhra Pradesh, 522213, India
| | - Radha Rama Devi Akella
- Department of Genetics, Rainbow Children's Hospital, Banjara Hills, Hyderabad, Telangana, 500009, India
- Department of Biochemical Genetics and Pharmacogenomics, Sandor Speciality Diagnostics Pvt. Ltd, Banjara Hills, Hyderabad, Telangana, 500034, India
| | - Shaik Mohammad Naushad
- Department of Biochemical Genetics and Pharmacogenomics, Sandor Speciality Diagnostics Pvt. Ltd, Banjara Hills, Hyderabad, Telangana, 500034, India
| | - Divya Borkar
- Department of Biochemical Genetics and Pharmacogenomics, Sandor Speciality Diagnostics Pvt. Ltd, Banjara Hills, Hyderabad, Telangana, 500034, India
| | - Maunika Thalla
- Department of Biochemical Genetics and Pharmacogenomics, Sandor Speciality Diagnostics Pvt. Ltd, Banjara Hills, Hyderabad, Telangana, 500034, India
| | - Swapna Nagalingam
- Biochemistry Division, National Institute of Nutrition, Hyderabad, Telangana, 500007, India
| | - Lokesh Lingappa
- Department of Pediatric Neurology, Rainbow Children's Hospital, Banjara Hills, Hyderabad, Telangana, 500009, India
| | - Rajesh K Patel
- Department of Genetics, Genetic Group of Gujarat Diagnostic Centre, Mehsana, Gujarat, 384002, India
| | - G Bhanuprakash Reddy
- Biochemistry Division, National Institute of Nutrition, Hyderabad, Telangana, 500007, India.
| | - Vijaya R Dirisala
- Department of Biotechnology, Vignan's Foundation for Science, Technology & Research (Deemed to be University), Vadlamudi, Guntur, Andhra Pradesh, 522213, India.
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Shi R, Zhang M, Chen Y, Han M, Xu P, Li M, Ding Y, Zhang X, Kou Y, Xu H, Zong F, Liu X, Wang H, He H, Liu Q, Kong W, Niu S, Li X, Huang L, Lu Q, Wang X, Deng L, Yang Z, Zhang X, Sun R, Zhao R, Shi J, Peng F, Sun X, Zhao G, Zhao X, Ge Y, Zhang N, Zhu R, Li J, Li H, Hao H, Yu Y. Dynamic Change of Thyroid Hormones With Postmenstrual Age in Very Preterm Infants Born With Gestational Age <32 Weeks: A Multicenter Prospective Cohort Study. Front Endocrinol (Lausanne) 2020; 11:585956. [PMID: 33859613 PMCID: PMC8043151 DOI: 10.3389/fendo.2020.585956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND At present, the relationship between thyrotropin (TSH) and free thyroxine (FT4) in relation to postmenstrual age (PMA) in preterm infants is still unclear, and there is no reliable standard thyroid hormone reference ranges, resulting in different diagnostic criteria for congenital hypothyroidism been used by different newborn screening programs and different countries. OBJECTIVES To investigate the relationship between TSH/FT4 and PMA in very preterm infants (VPIs) born with gestational age (GA) <32 weeks and to derive thyroid function reference charts based on PMA. METHODS A prospective cohort study was performed on VPIs born with GA<32 weeks and born in or transferred to the 27 neonatal intensive care units from January 1, 2019 to December 31, 2019. Serial TSH and FT4 values were measured at the end of each week during the first month after birth and also at PMA36 weeks, PMA40 weeks and at discharge, respectively. The 2.5th, 5th, 50th, 95th, and 97.5th percentiles of TSH and FT4 of different PMA groups were calculated to draw the percentile charts based on PMA. RESULTS 1,093 preterm infants were included in this study. The percentile charts of TSH and FT4 levels based on PMA were drawn respectively, and the result indicated that the percentile charts of TSH values were gradually increased initially and then decreased with increasing PMA. The 97.5th percentile chart reached the peak at PMA30 weeks (17.38μIU/ml), and then decreased gradually, reaching the same level as full-term infants (9.07μIU/ml) at PMA38-40 weeks. The 2.5th percentile chart of FT4 was at its lowest point at PMA26-27 weeks (5.23pmol/L), then increased slowly with PMA and reached the same level as full-term infants at PMA38-40 weeks (10.87pmol/L). At PMA36 weeks, the reference intervals of the 2.5th to 97.5th percentiles of TSH and FT4 were 1.18-12.3μIU/ml and 8.59-25.98pmol/L, respectively. CONCLUSION The percentile charts of TSH and FT4 in VPIs showed characteristic change with PMA. The results prompt that age-related cutoffs, instead of a single reference range, might be more useful to explain the thyroid function of VPIs. And repeated screening is necessary for preterm infants.
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Affiliation(s)
- Ranran Shi
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ming Zhang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yao Chen
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Meiying Han
- Department of Neonatology, Liaocheng People’s Hospital, Liaocheng, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People’s Hospital, Liaocheng, China
| | - Min Li
- Department of Neonatology, Linyi Maternal and Child Health Hospital, Linyi, China
| | - Yanjie Ding
- Department of Neonatology, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiaohui Zhang
- Department of Neonatology, Yantai Yuhuangding Hospital, Yantai, China
| | - Yan Kou
- Department of Neonatology, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haiyan Xu
- Department of Neonatology, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fangru Zong
- Department of Neonatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinjian Liu
- Department of Neonatology, Hebei PetroChina Central Hospital, Langfang, China
| | - Hui Wang
- Department of Neonatology, Hebei PetroChina Central Hospital, Langfang, China
| | - Haiying He
- Department of Neonatology, Baogang Third Hospital of Hongci Group, Baotou, China
| | - Qiang Liu
- Department of Neonatology, Linyi People’s Hospital, Linyi, China
| | - Weikang Kong
- Department of Neonatology, Linyi People’s Hospital, Linyi, China
| | - Shiping Niu
- Department of Neonatology, Zibo Maternal and Child Care Hospital, Zibo, China
| | - Xia Li
- Department of Neonatal Intensive Care Unit, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Lei Huang
- Department of Neonatology, Shandong Maternal and Child Health Hospital, Jinan, China
| | - Qinghua Lu
- Department of Neonatology, Shandong Maternal and Child Health Hospital, Jinan, China
| | - Xiaofang Wang
- Department of Neonatology, Heze Municipal Hospital, Heze, China
| | - Liping Deng
- Department of Neonatology, Heze Municipal Hospital, Heze, China
| | - Zhenying Yang
- Department of Neonatology, Taian Maternal and Child Health Care Hospital, Tai’an, China
| | - Xiao Zhang
- Department of Neonatology, Taian Maternal and Child Health Care Hospital, Tai’an, China
| | - Rongrong Sun
- Department of Neonatology, Dongying People’s Hospital, Dongying, China
| | - Riming Zhao
- Department of Neonatology, Juxian People’s Hospital, Rizhao, China
| | - Jing Shi
- Department of Neonatology, Second People’s Hospital of Liaocheng, Liaocheng, China
| | - Fudong Peng
- Department of Neonatology, Second People’s Hospital of Liaocheng, Liaocheng, China
| | - Xueming Sun
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, China
| | - Guoying Zhao
- Department of Neonatology, Binzhou Medical University Hospital, Binzhou, China
| | - Xinfeng Zhao
- Department of Neonatology, Maternal and Child Health Care Hospital of Zaozhuang, Zaozhuang, China
| | - Yonghong Ge
- Department of Neonatology, Liaocheng Dongchangfu Maternal and Child Health Care Hospital, Liaocheng, China
| | - Nan Zhang
- Department of Neonatology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Renxia Zhu
- Department of Neonatology, Linzi District People’s Hospital, Zibo, China
| | - Jing Li
- Department of Neonatology, The Second Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Li
- Department of Neonatology, Yantaishan Hospital, Yantai, China
| | - Huijuan Hao
- Department of Neonatology, Jinan Second Maternal and Child Health Hospital, Jinan, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Yonghui Yu,
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