open access
The impact of subclinical hypothyroidism on growth and development in infants and young children aged 0 to 5 years
Affiliations- Department of Child Health Care, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, China
- Department of Neonatology, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, China
open access
Abstract
Introduction: The objective was to investigate the growth and development of infants and young children with mild subclinical hypothyroidism aged 0 to 5 years, especially those aged 0 to 2 years.
Material and methods: The study was a retrospective analysis of the birth status, physical growth, and neuromotor development of patients aged 0 to 5 years, who were diagnosed with subclinical hypothyroidism during newborn screening (NBS) in Zhongshan between 2016 and 2019. Based on preliminary results, we compared 3 groups: with thyroid-stimulating factor (TSH) value of 5–10 mIU/L (442 cases), TSH value of 10–20 mIU/L (208 cases), and TSH above 20 mIU/L (77 cases). Patients with TSH value above 5 mIU/L were called back for repeat testing and were divided into 4 groups as follows: mild subclinical hypothyroidism group 1 with a TSH value of 5–10 mIU/L in both initial screening and repeat testing; mild subclinical hypothyroidism group 2 with TSH value above 10 mIU/L in initial screening; and TSH value of 5–10 mIU/L in repeat testing; the severe subclinical hypothyroidism group with TSH value of 10–20 mIU/L in both the initial screening and repeat testing and the congenital hypothyroidism group.
Results: There were no significant differences in the maternal age, type of delivery, gender, length, and weight at birth between the preliminary groups; however, the gestational age at birth was significantly different (F = 5.268, p = 0.005). The z-score for length at birth was lower in the congenital hypothyroidism group compared to the other 3 groups but showed no difference at 6 months of age. The z-score for length in mild subclinical hypothyroidism group 2 was lower compared to the other 3 groups but showed no difference at 2–5 years of age. At 2 years of age there was no significant difference in the developmental quotient (DQ) of the Gesell Developmental Scale between the groups.
Conclusion: The gestational age at birth affected the neonatal TSH level. Intrauterine growth in infants with congenital hypothyroidism was retarded compared to that of infants with subclinical hypothyroidism. Neonates with a TSH value of 10–20 mIU/L in the initial screening and a TSH value of 5–10 mIU/L in the repeat testing showed developmental delay at 18 months but caught up at age 2 years. There was no difference in neuromotor development between the groups. Levothyroxine in patients with mild subclinical hypothyroidism is not required, but we recommend that the growth and development of such infants and young children continues to be monitored.
Abstract
Introduction: The objective was to investigate the growth and development of infants and young children with mild subclinical hypothyroidism aged 0 to 5 years, especially those aged 0 to 2 years.
Material and methods: The study was a retrospective analysis of the birth status, physical growth, and neuromotor development of patients aged 0 to 5 years, who were diagnosed with subclinical hypothyroidism during newborn screening (NBS) in Zhongshan between 2016 and 2019. Based on preliminary results, we compared 3 groups: with thyroid-stimulating factor (TSH) value of 5–10 mIU/L (442 cases), TSH value of 10–20 mIU/L (208 cases), and TSH above 20 mIU/L (77 cases). Patients with TSH value above 5 mIU/L were called back for repeat testing and were divided into 4 groups as follows: mild subclinical hypothyroidism group 1 with a TSH value of 5–10 mIU/L in both initial screening and repeat testing; mild subclinical hypothyroidism group 2 with TSH value above 10 mIU/L in initial screening; and TSH value of 5–10 mIU/L in repeat testing; the severe subclinical hypothyroidism group with TSH value of 10–20 mIU/L in both the initial screening and repeat testing and the congenital hypothyroidism group.
Results: There were no significant differences in the maternal age, type of delivery, gender, length, and weight at birth between the preliminary groups; however, the gestational age at birth was significantly different (F = 5.268, p = 0.005). The z-score for length at birth was lower in the congenital hypothyroidism group compared to the other 3 groups but showed no difference at 6 months of age. The z-score for length in mild subclinical hypothyroidism group 2 was lower compared to the other 3 groups but showed no difference at 2–5 years of age. At 2 years of age there was no significant difference in the developmental quotient (DQ) of the Gesell Developmental Scale between the groups.
Conclusion: The gestational age at birth affected the neonatal TSH level. Intrauterine growth in infants with congenital hypothyroidism was retarded compared to that of infants with subclinical hypothyroidism. Neonates with a TSH value of 10–20 mIU/L in the initial screening and a TSH value of 5–10 mIU/L in the repeat testing showed developmental delay at 18 months but caught up at age 2 years. There was no difference in neuromotor development between the groups. Levothyroxine in patients with mild subclinical hypothyroidism is not required, but we recommend that the growth and development of such infants and young children continues to be monitored.
Keywords
infant; neuromotor development; physical growth; subclinical hypothyroidism
About this articleTitle
The impact of subclinical hypothyroidism on growth and development in infants and young children aged 0 to 5 years
Journal
Issue
Article type
Original paper
Pages
254-259
Published online
2023-05-02
Page views
1463
Article views/downloads
465
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2023;74(3):254-259.
Keywords
infant
neuromotor development
physical growth
subclinical hypothyroidism
Authors
Xueqin Yan
Guomei Jiang
Chunhui Yang
Yuming Chen
Jie Zeng
Lianhong Huang
Xia Chen
Jialuo Liao
References (23)- Léger J, Olivieri A, Donaldson M, et al. ESPE-PES-SLEP-JSPE-APEG-APPES-ISPAE, Congenital Hypothyroidism Consensus Conference Group. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab. 2014; 99(2): 363–384.
- Salerno M, Capalbo D, Cerbone M, et al. Subclinical hypothyroidism in childhood - current knowledge and open issues. Nat Rev Endocrinol. 2016; 12(12): 734–746.
- Endocrinology, Genetics and Metabolism Group, Pediatric Society, Chinese Medical Association. Consensus on the diagnosis and treatment of congenital hypothyroidism. Chin J Pediatrics. 2011; 49(6): 421–424.
- Biondi B, Cappola AR, Cooper DS. Subclinical Hypothyroidism: A Review. JAMA. 2019; 322(2): 153–160.
- Kanike N, Davis A, Shekhawat PS. Transient hypothyroidism in the newborn: to treat or not to treat. Transl Pediatr. 2017; 6(4): 349–358.
- Oren A, Wang MK, Brnjac L, et al. Mild neonatal hyperthyrotrophinaemia: 10-year experience suggests the condition is increasingly common but often transient. Clin Endocrinol (Oxf). 2013; 79(6): 832–837.
- Hashemipour M, Hovsepian S, Ansari A, et al. Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates: A systematic review. Pediatr Neonatol. 2018; 59(1): 3–14.
- Kilberg MJ, Rasooly IR, LaFranchi SH, et al. Newborn Screening in the US May Miss Mild Persistent Hypothyroidism. J Pediatr. 2018; 192: 204–208.
- Zung A, Tenenbaum-Rakover Y, Barkan S, et al. Neonatal hyperthyrotropinemia: population characteristics, diagnosis, management and outcome after cessation of therapy. Clin Endocrinol (Oxf). 2010; 72(2): 264–271.
- Aguiar L, Garb J, Reiter E, et al. Can One Predict Resolution of Neonatal Hyperthyrotropinemia? J Pediatr. 2016; 174: 71–77.e1.
- Unüvar T, Demir K, Abacı A, et al. The role of initial clinical and laboratory findings in infants with hyperthyrotropinemia to predict transient or permanent hypothyroidism. J Clin Res Pediatr Endocrinol. 2013; 5(3): 170–173.
- Korzeniewski SJ, Grigorescu V, Kleyn M, et al. Transient hypothyroidism at 3-year follow-up among cases of congenital hypothyroidism detected by newborn screening. J Pediatr. 2013; 162(1): 177–182.
- Wasniewska M, Corrias A, Aversa T, et al. Comparative evaluation of therapy with L-thyroxine versus no treatment in children with idiopathic and mild subclinical hypothyroidism. Horm Res Paediatr. 2012; 77(6): 376–381.
- Huang L, Shangguan Y, Fu S, et al. Screening and treatment of congenital hypothyroidism in Zhongshan city. J Clin Ped. 2014; 32(9): 876–880.
- Cerbone M, Bravaccio C, Capalbo D, et al. Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism. Eur J Endocrinol. 2011; 164(4): 591–597.
- Wasniewska M, Aversa T, Salerno M, et al. Five-year prospective evaluation of thyroid function in girls with subclinical mild hypothyroidism of different etiology. Eur J Endocrinol. 2015; 173(6): 801–808.
- Ergür AT, Taner Y, Ata E, et al. Neurocognitive functions in children and adolescents with subclinical hypothyroidism. J Clin Res Pediatr Endocrinol. 2012; 4(1): 21–24.
- van Trotsenburg P, Stoupa A, Léger J, et al. 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(3): 387–419.
- Wassner A. Pediatric Hypothyroidism: Diagnosis and Treatment. Pediatric Drugs. 2017; 19(4): 291–301.
- Vigone MC, Capalbo D, Weber G, et al. Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated? J Endocr Soc. 2018; 2(9): 1024–1039.
- Lain SJ, Bentley JP, Wiley V, et al. Association between borderline neonatal thyroid-stimulating hormone concentrations and educational and developmental outcomes: a population-based record-linkage study. Lancet Diabetes Endocrinol. 2016; 4(9): 756–765.
- Trumpff C, De Schepper J, Vanderfaeillie J, et al. Thyroid-Stimulating Hormone (TSH) Concentration at Birth in Belgian Neonates and Cognitive Development at Preschool Age. Nutrients. 2015; 7(11): 9018–9032.
- Trumpff C, De Schepper J, Vanderfaeillie J, et al. Neonatal thyroid-stimulating hormone concentration and psychomotor development at preschool age. Arch Dis Child. 2016; 101(12): 1100–1106.
