Congenital hypothyroidism in children with eutopic gland or thyroid hemiagenesis: prognostic factors for transient vs. permanent hypothyroidism

Sylvie Hélène Bontemps; Carole Legagneur; Rosa-Maria Guéant-Rodriguez; Thomas Remen; Amandine Luc; Emeline Renard

doi:10.1515/jpem-2022-0101

Article

Congenital hypothyroidism in children with eutopic gland or thyroid hemiagenesis: prognostic factors for transient vs. permanent hypothyroidism

Sylvie Hélène Bontemps , Carole Legagneur , Rosa-Maria Guéant-Rodriguez , Thomas Remen , Amandine Luc and Emeline Renard

Published/Copyright: February 20, 2023

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 4

Abstract

Objectives

More than one third of children with congenital hypothyroidism (CH) and thyroid gland in situ (or eutopic gland) have transient hypothyroidism. It remains difficult to determine early on whether hypothyroidism will be transient which may cause overtreatment and its complications in these children. Our primary aim was to determine prognostic factors for transient hypothyroidism in children with congenital hypothyroidism and eutopic gland or thyroid hemiagenesis.

Methods

We retrospectively reviewed medical records of 111 children, born between 1996 and 2017, diagnosed with congenital hypothyroidism and eutopic gland or hemiagenesis and treated at the Nancy Regional and University Hospital.

Results

Fifty four infants (48.6%) had permanent congenital hypothyroidism (PCH) and 57 (51.4%) transient congenital hypothyroidism (TCH). Prognostic factors for TCH included prematurity, twin pregnancy, low birth weight and Apgar score <7, while low FT3 at diagnosis, maternal levothyroxine treatment, a family history of thyroid dysfunction and TSH ≥10 mUI/L while receiving treatment were associated with PCH. Knee epiphyses on X-ray at diagnosis were absent only in children with PCH. The median levothyroxine dose during follow-up was significantly lower in the TCH group compared to the PCH group. A levothyroxine dose of ≤3.95, ≤2.56, ≤2.19 and ≤2.12 μg/kg/day at 6 months, 1, 2 and 3 years of follow-up, respectively, had the best sensitivity-to-specificity ratio for predicting TCH.

Conclusions

Even though it remains difficult to predict the course of hypothyroidism at diagnosis, we were able to identify several prognostic factors for TCH including perinatal problems and lower levothyroxine requirements that can guide the physician on the evolution of hypothyroidism.

Clinical Trial Registration Number: NCT04712760.

Keywords: congenital hypothyroidism; drug therapy; neonatal screening; prognosis; thyroxine

Corresponding author: Sylvie Hélène Bontemps, Department of Pediatrics, University Hospital of Nancy, 54500 Vandoeuvre-Lès-Nancy, France, E-mail: s.bontemps123@gmail.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study design has been approved by the Review Board of the Nancy University Hospital. The research related to human use has complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration.

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Received: 2022-02-23

Accepted: 2023-01-29

Published Online: 2023-02-20

Published in Print: 2023-04-25

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Articles in the same Issue

https://doi.org/10.1515/jpem-2022-0101

Keywords for this article

congenital hypothyroidism; drug therapy; neonatal screening; prognosis; thyroxine