Document Detail


Serum thyroid hormones in preterm infants: associations with postnatal illnesses and drug usage.
MedLine Citation:
PMID:  16105964     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Transient hypothyroxinemia is common in infants less than 30 wk gestation and is associated with neurodevelopmental deficits. Reductions in T4 and T3 levels with TSH unchanged are the key features of severe illness using surrogate indices of overall severity of illness, but these do not inform the impact of individual disease conditions or drug use. OBJECTIVE: Our objective was to investigate the contribution of postnatal factors to the variations in serum levels of iodothyronines, thyroid-binding globulin, and TSH. DESIGN: We recruited a cohort of infants (23-34 wk gestation; n = 780) between January 1998 and September 2001. SETTING AND PATIENTS: The study involved 11 level III Scottish neonatal intensive care units and included cohorts of infants delivered at 23-34 wk gestation. MAIN OUTCOME: We assessed serum levels of iodothyronines, thyroid-binding globulin, and TSH at 7, 14, and 28 d adjusted for the potentially significant postnatal influences (n = 31). RESULTS: Serum levels of TSH, free T4, T3, and T4 are variably but significantly associated with bacteremia, endotracheal bacterial cultures, persistent ductus arteriosus, necrotizing enterocolitis, cerebral ultrasonography changes, oxygen dependence at 28 d, and the use of aminophylline, caffeine, dexamethasone, diamorphine, and dopamine. CONCLUSIONS: There are many more associations of postnatal factors with transient hypothyroxinemia than had previously been considered in preterm infants. Alternative strategies should be considered for correction of hypothyroxinemia rather than sole reliance on the direct therapy of hormone replacement. A more oblique preventative approach may be necessary through reduction in the incidence or severity of individual illness(es). Similarly, alternatives to those drugs that interfere with the hypothalamic-pituitary-thyroid axis should be evaluated (e.g. other inotropics instead of dopamine).
Authors:
Fiona L R Williams; Simon A Ogston; Hans van Toor; Theo J Visser; Robert Hume
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-08-16
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  90     ISSN:  0021-972X     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-08     Completed Date:  2005-12-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  5954-63     Citation Subset:  AIM; IM    
Affiliation:
Community Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Aminophylline / therapeutic use
Bacterial Infections / etiology
Caffeine / therapeutic use
Dexamethasone / therapeutic use
Dopamine / therapeutic use
Heroin / therapeutic use
Humans
Infant, Newborn
Infant, Newborn, Diseases / etiology*
Infant, Premature / blood*
Thyroid Hormones / blood*
Thyroxine / blood
Chemical
Reg. No./Substance:
0/Thyroid Hormones; 317-34-0/Aminophylline; 50-02-2/Dexamethasone; 561-27-3/Heroin; 58-08-2/Caffeine; 7488-70-2/Thyroxine

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