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Mild Neonatal Hyperthyrotropinemia: 10 Years' Experience Suggests the Condition is Increasingly Common But Often Transient.
MedLine Citation:
PMID:  23611595     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To examine a large population of infants with mild neonatal hyperthhyrotropinemia (MNH) and determine prevalence, clinical characteristics and treatment history. METHODS: Retrospective study of infants with MNH followed at The Hospital for Sick Children between 2000-2011. MNH was defined by an abnormal newborn screen followed by TSH between 5-30 mU/L and normal FT4 on confirmatory tests. RESULTS: MNH represented 22.3% of patients (103/462; 60 boys, 43 girls) within our clinic. Incidence increased from 2/20 in 2000 to 31/74 cases in 2010. 78% of patients started L-thyroxine (initial dose: 8.3±2.5 mcg/kg). The treated group had higher confirmatory TSH levels (p=0.001) and had undergone thyroid scintigraphy more often (p=0.0001) compared to the non-treated group. Evidence of overtreatment was detected in 45% of thyroid function tests obtained during treatment. Among the treated infants who had reached 3 years of age, 45% (N=14) underwent a trial-off medication. Compared to those not trialed-off therapy, these infants were less likely to have had dose escalations during treatment (p=0.001). The trial-off treatment was successful in 50% of cases. In the subset of infants with confirmatory TSH >10 mU/L, trial-off therapy was successful in 40%. None of the assessed variables predicted success of trial-off therapy. CONCLUSIONS: MNH is an increasingly common diagnosis. It is more common in males and is often transient, but predictors of success of trial-off therapy were not identified. Further studies are needed to determine optimum L-thyroxine dosing and to determine if treatment improves neurocognitive outcomes. This article is protected by copyright. All rights reserved.
Authors:
Asaf Oren; Michael Ke Wang; Lori Brnjac; Farid H Mahmud; Mark R Palmert
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-24
Journal Detail:
Title:  Clinical endocrinology     Volume:  -     ISSN:  1365-2265     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
Affiliation:
Division of Pediatric Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada; Departments of Pediatrics and Physiology, University of Toronto.
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