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Severe Early Maternal Hypothyroidism Corrected Prior to the Third Trimester Associated with Normal Cognitive Outcome in the Offspring.
MedLine Citation:
PMID:  22397527     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background : Concern about potential harmful effects of early maternal hypothyroidism (MH) on fetal brain development has led to calls for universal screening early in, or even before, pregnancy. However, evidence in humans that adverse effects are irreversible if thyroid hormone replacement is initiated after the first trimester is limited. Severe MH due to thyrotropin (TSH) receptor blocking antibodies (Abs) is associated with profound cognitive delay in the offspring if MH is untreated or inadequately treated; here we sought to determine the outcome if treatment is given in early pregnancy. Methods: We identified three women who had TSH receptor blocking Ab-induced MH during pregnancy and were treated with L-thyroxine (L-T4), starting at 27 weeks, 5 weeks, and the first month of gestation. The corresponding pre-treatment serum TSH levels in the 2 women in whom data were available were 68 mU/L and 65 mU/L, falling to 6 mU/L at 25 weeks and 24 weeks gestation, respectively. The third woman with MH required 0.5 mg L-T4 to normalize her thyroid hormone levels by 4 months gestation. Their infants were also treated with L-T4 after neonatal screening identified congenital hypothyroidism (CH). Neuropsychological tests to assess intelligence, language, memory and visual-motor performance were administered to these 3 infants at 5.4 years of age (range 5.1 to 6.1) and to 3 sibling controls at 6.8 years (range 9.1 to 3.0). Results: Children born after MH had average or above average results on all parameters. Comparative scores of the neuropsychological tests in sibling pairs for full scale IQ and performance IQ were variable; some scores were higher and some lower in CH children. Conclusions: Although the findings do not exclude a subtle impact of MH during early gestation on intellectual function, the normal cognitive outcome despite overt MH should provide data with which to counsel mothers who have overt hypothyroidism early in pregnancy. Aggressive thyroid hormone replacement as soon as possible is important, but early termination of the pregnancy because of fear that the baby will have significant cognitive delay is not warranted.
Authors:
Susan D Downing; Leslie Halpern; Jeremi Carswell; Rosalind S Brown
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-7
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  -     ISSN:  1557-9077     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
UMass Medical Center, Pediatrics, Worcester, Massachusetts, United States; downingsd@hotmail.com.
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