Thyroid Dysfunction in Very-Low-Birth-Weight Premature Neonates: A Systematic Review of Published Evidence

Document Type : Review Article

Authors

1 Student of Medicine, Students Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Department of Pediatrics, School of Medicine AND Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

3 Center for Health Related Social and Behavioral Sciences Research AND Department of Epidemiology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran

4 Resident, Isfahan Endocrine and Metabolic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Congenital hypothyroidism is the most common preventable cause of mental retardation in children and should be diagnosed and treated at the earliest time. The prevalence of congenital hypothyroidism is high in preterm infants with low and very low birth weight.Methods: A systematic literature review was conducted using PubMed, Scopus and Google Scholar databases to 19 April 2014. We did not consider any time limitation; English-language papers were included. Irrelevant studies were set aside after studying their title, abstract, and full text. Two reviewers extracted the data; besides, the third reviewer checked their extracted data. In final, the data extracted from related studies.Findings: Normal serum thyroid-stimulating hormone (TSH) at third to sixth days of birth in low- and very-low-birth-weight preterm infants did not indicate normal thyroid function. In addition, TSH level of more than 10 mIu/l at the second week of the birth did not have a diagnostic value. A TSH level of 10-15 mIu/l, after a normal TSH value, posed the diagnosis of hypothyroidism with delayed TSH rise. Serum levels of free-T4 (FT4) and T4 would be normal at 2 to 8 weeks after the birth.Conclusion: It is recommended to repeat the screening of preterm newborns with low and very low birth weight by measuring TSH and FT4 levels simultaneously at two, six and ten weeks after the birth; the threshold of TSH = 10 mIu/l should be considered to select positive and suspected cases of the disease.

Keywords

References

  1. Harris KB, Pass KA. Increase in congenital hypothyroidism in New York State and in the United States. Mol Genet Metab 2007; 91(3): 268-77.
  2. Rose SR, Brown RS, Foley T, Kaplowitz PB, Kaye CI, Sundararajan S, et al. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics 2006; 117(6): 2290-303.
  3. Maniatis AK, Taylor L, Letson GW, Bloch CA, Kappy MS, Zeitler P. Congenital hypothyroidism and the second newborn metabolic screening in Colorado, USA. J Pediatr Endocrinol Metab 2006; 19(1): 31-8.
  4. Olney RS, Grosse SD, Vogt RF, Jr. Prevalence of congenital hypothyroidism--current trends and future directions: workshop summary. Pediatrics 2010; 125(Suppl 2): S31-S36.
  5. Mandel SJ, Hermos RJ, Larson CA, Prigozhin AB, Rojas DA, Mitchell ML. Atypical hypothyroidism and the very low birthweight infant. Thyroid 2000; 10(8): 693-5.
  6. Effects of neonatal screening for hypothyroidism: prevention of mental retardation by treatment before clinical manifestations. Lancet 1981; 2(8255): 1095-8.
  7. Hyman SJ, Greig F, Holzman I, Patel A, Wallach E, Rapaport R. Late rise of thyroid stimulating hormone in ill newborns. J Pediatr Endocrinol Metab 2007; 20(4): 501-10.
  8. Elementary school performance of children with congenital hypothyroidism. New England Congenital Hypothyroidism Collaborative. J Pediatr 1990; 116(1): 27-32.
  9. Selva KA, Harper A, Downs A, Blasco PA, Lafranchi SH. Neurodevelopmental outcomes in congenital hypothyroidism: comparison of initial T4 dose and time to reach target T4 and TSH. J Pediatr 2005; 147(6): 775-80.
  10. Dubuis JM, Glorieux J, Richer F, Deal CL, Dussault JH, Van Vliet G. Outcome of severe congenital hypothyroidism: closing the developmental gap with early high dose levothyroxine treatment. J Clin Endocrinol Metab 1996; 81(1): 222-7.
  11. Bongers-Schokking JJ, de Muinck Keizer-Schrama SM. Influence of timing and dose of thyroid hormone replacement on mental, psychomotor, and behavioral development in children with congenital hypothyroidism. J Pediatr 2005; 147(6): 768-74.
  12. Hinton CF, Harris KB, Borgfeld L, Drummond-Borg M, Eaton R, Lorey F, et al. Trends in incidence rates of congenital hypothyroidism related to select demographic factors: data from the United States, California, Massachusetts, New York, and Texas. Pediatrics 2010; 125(Suppl 2): S37-S47.
  13. Parks JS, Lin M, Grosse SD, Hinton CF, Drummond-Borg M, Borgfeld L, et al. The impact of transient hypothyroidism on the increasing rate of congenital hypothyroidism in the United States. Pediatrics 2010; 125(Suppl 2): S54-S63.
  14. DeLong GR. Observations on the neurology of endemic cretinism. In: DeLong GR, Robbins J, Condliffe PG, editors. Iodine and the brain. Boston, MA: Springer; 1989. p. 231-8.
  15. Murphy N, Hume R, van Toor H, Matthews TG, Ogston SA, Wu SY, et al. The hypothalamic-pituitary-thyroid axis in preterm infants; changes in the first 24 hours of postnatal life. J Clin Endocrinol Metab 2004; 89(6): 2824-31.
  16. Kugelman A, Riskin A, Bader D, Koren I. Pitfalls in screening programs for congenital hypothyroidism in premature newborns. Am J Perinatol 2009; 26(5): 383-5.
  17. Frank JE, Faix JE, Hermos RJ, Mullaney DM, Rojan DA, Mitchell ML, et al. Thyroid function in very low birth weight infants: effects on neonatal hypothyroidism screening. J Pediatr 1996; 128(4): 548-54.
  18. Larson C, Hermos R, Delaney A, Daley D, Mitchell M. Risk factors associated with delayed thyrotropin elevations in congenital hypothyroidism. J Pediatr 2003; 143(5): 587-91.
  19. Hunter MK, Mandel SH, Sesser DE, Miyabira RS, Rien L, Skeels MR, et al. Follow-up of newborns with low thyroxine and nonelevated thyroid-stimulating hormone-screening concentrations: results of the 20-year experience in the Northwest Regional Newborn Screening Program. J Pediatr 1998; 132(1): 70-4.
  20. UK Newborn Screening Programme Centre (UKNSPC) [Online]. [cited 2008 Apr 14]; Available from: URL:
  21. http://www.ucl.ac.uk/ich/research/population-policy-practice/research/right-column-items/collaborations/UK-Newborn-Screening-Programme-Centre
  22. Minamitani K, Inomata H. Neonatal screening for congenital hypothyroidism in Japan. Pediatr Endocrinol Rev 2012; 10(Suppl 1): 79-88.
  23. Korada M, Pearce MS, Ward Platt MP, Avis E, Turner S, Wastell H, et al. Repeat testing for congenital hypothyroidism in preterm infants is unnecessary with an appropriate thyroid stimulating hormone threshold. Arch Dis Child Fetal Neonatal Ed 2008; 93(4): F286-F288.
  24. Vincent MA, Rodd C, Dussault JH, Van Vliet G. Very low birth weight newborns do not need repeat screening for congenital hypothyroidism. J Pediatr 2002; 140(3): 311-4.
  25. Rapaport R. Thyroid function in the very low birth weight newborn: rescreen or reevaluate? J Pediatr 2002; 140(3): 287-9.
  26. Reuss ML, Paneth N, Pinto-Martin JA, Lorenz JM, Susser M. The relation of transient hypothyroxinemia in preterm infants to neurologic development at two years of age. N Engl J Med 1996; 334(13): 821-7.
  27. Fisher DA. Thyroid function and dysfunction in premature infants. Pediatr Endocrinol Rev 2007; 4(4): 317-28.
  28. Sun X, Lemyre B, Nan X, Harrold J, Perkins SL, Lawrence SE, et al. Free thyroxine and thyroid-stimulating hormone reference intervals in very low birth weight infants at 3-6 weeks of life with the Beckman Coulter Unicel DxI 800. Clin Biochem 2014; 47(1-2): 16-8.
  29. Slaughter JL, Meinzen-Derr J, Rose SR, Leslie ND, Chandrasekar R, Linard SM, et al. The effects of gestational age and birth weight on false-positive newborn-screening rates. Pediatrics 2010; 126(5): 910-6.
  30. Chung HR, Shin CH, Yang SW, Choi CW, Kim BI, Kim EK, et al. High incidence of thyroid dysfunction in preterm infants. J Korean Med Sci 2009; 24(4): 627-31.
  31. Mengreli C, Kanaka-Gantenbein C, Girginoudis P, Magiakou MA, Christakopoulou I, Giannoulia-Karantana A, et al. Screening for congenital hypothyroidism: the significance of threshold limit in false-negative results. J Clin Endocrinol Metab 2010; 95(9): 4283-90.
  32. Srinivasan R, Harigopal S, Turner S, Cheetham T. Permanent and transient congenital hypothyroidism in preterm infants. Acta Paediatr 2012; 101(4): e179-e182.
  33. Chee YY, Wong KY, Low L. Review of primary hypothyroidism in very low birthweight infants in a perinatal centre in Hong Kong. J Paediatr Child Health 2011; 47(11): 824-31.
  34. Corbetta C, Weber G, Cortinovis F, Calebiro D, Passoni A, Vigone MC, et al. A 7-year experience with low blood TSH cutoff levels for neonatal screening reveals an unsuspected frequency of congenital hypothyroidism (CH). Clin Endocrinol (Oxf) 2009; 71(5): 739-45.
  35. Klein RZ, Carlton EL, Faix JD, Frank JE, Hermos RJ, Mullaney D, et al. Thyroid function in very low birth weight infants. Clin Endocrinol (Oxf) 1997; 47(4): 411-7.
  36. Tylek-Lemanska D, Kumorowicz-Kopiec M, Starzyk J. Screening for congenital hypothyroidism: the value of retesting after four weeks in neonates with low and very low birth weight. J Med Screen 2005; 12(4): 166-9.
  37. Gruneiro-Papendieck L, Prieto L, Chiesa A, Bengolea S, Bossi G, Bergada C. Usefulness of thyroxine and free thyroxine filter paper measurements in neonatal screening for congenital hypothyroidism of preterm babies. J Med Screen 2000; 7(2): 78-81.
  38. de Moraes SM, Espiridiao S, Fonseca FA, de Abreu LC, Valenti VE, do Souto RP. Collection time of Thyroid hormones and TSH in preterm newborns. Health Med 2011; 5(3): 627-32.
  39. Niwa F, Kawai M, Kanazawa H, Iwanaga K, Matsukura T, Hasegawa T, et al. Hyperthyrotropinemia at 2 weeks of age indicates thyroid dysfunction and predicts the occurrence of delayed elevation of thyrotropin in very low birth weight infants. Clin Endocrinol (Oxf) 2012; 77(2): 255-61.
  40. Bijarnia S, Wilcken B, Wiley VC. Newborn screening for congenital hypothyroidism in very-low-birth-weight babies: the need for a second test. J Inherit Metab Dis 2011; 34(3): 827-33.
  41. Uhrmann S, Marks KH, Maisels MJ, Kulin HE, Kaplan M, Utiger R. Frequency of transient hypothyroxinaemia in low birthweight infants. Potential pitfall for neonatal screening programmes. Arch Dis Child 1981; 56(3): 214-7.
  42. Kok JH, Hart G, Endert E, Koppe JG, de Vijlder JJ. Normal ranges of T4 screening values in low birthweight infants. Arch Dis Child 1983; 58(3): 190-4.
  43. Clark SJ, Deming DD, Emery JR, Adams LM, Carlton EI, Nelson JC. Reference ranges for thyroid function tests in premature infants beyond the first week of life. J Perinatol 2001; 21(8): 531-6.
  44. Mercado M, Yu VY, Francis I, Szymonowicz W, Gold H. Thyroid function in very preterm infants. Early Hum Dev 1988; 16(2-3): 131-41.
  45. Delange F, Dalhem A, Bourdoux P, Lagasse R, Glinoer D, Fisher DA, et al. Increased risk of primary hypothyroidism in preterm infants. J Pediatr 1984; 105(3): 462-9.
  46. Woo HC, Lizarda A, Tucker R, Mitchell ML, Vohr B, Oh W, et al. Congenital hypothyroidism with a delayed thyroid-stimulating hormone elevation in very premature infants: incidence and growth and developmental outcomes. J Pediatr 2011; 158(4): 538-42.
  47. Torkaman M, Ghasemi F, Amirsalari S, Abyazi M, Afsharpaiman S, Kavehmanesh Z, et al. Thyroid Function Test in Pre-term Neonates During the First Five Weeks of Life. Int J Prev Med 2013; 4(11): 1271-6.
  48. Jacobsen BB, Andersen HJ, Peitersen AB, Dige-Petersen H, Hummer L. Serum levels of thyrotropin, thyroxine and triiodothyronine in fullterm, small-for-gestational age and preterm newborn babies. Acta Paediatr Scand 1977; 66(6): 681-7.
  49. Rooman RP, Du Caju MV, De Beeck LO, Docx M, Van Reempts P, Van Acker KJ. Low thyroxinaemia occurs in the majority of very preterm newborns. Eur J Pediatr 1996; 155(3): 211-5.
  50. Korada SM, Pearce M, Ward Platt MP, Avis E, Turner S, Wastell H, et al. Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold. Arch Dis Child 2010; 95(3): 169-73.
  51. Frank JE, Faix JE, Hermos RJ, Mullaney DM, Rojan DA, Mitchell ML, et al. Thyroid function in very low birth weight infants: effects on neonatal hypothyroidism screening. J Pediatr 1996; 128(4): 548-54.
  52. Carrascosa A, Ruiz-Cuevas P, Potau N, Almar J, Salcedo S, Clemente M, et al. Thyroid function in seventy-five healthy preterm infants thirty to thirty-five weeks of gestational age: a prospective and longitudinal study during the first year of life. Thyroid 2004; 14(6): 435-42.
  53. Adams LM, Emery JR, Clark SJ, Carlton EI, Nelson JC. Reference ranges for newer thyroid function tests in premature infants. J Pediatr 1995; 126(1): 122-7.
  54. Langham S, Hindmarsh P, Krywawych S, Peters C. Screening for congenital hypothyroidism: comparison of borderline screening cut-off points and the effect on the number of children treated with levothyroxine. Eur Thyroid J 2013; 2(3): 180-6.
  55. Silva SA, Chagas AJ, Goulart EM, Silva GA, Marcal LV, Gomes MN, et al. Screening for congenital hypothyroidism in extreme premature and/or very low birth weight newborns: the importance of a specific protocol. J Pediatr Endocrinol Metab 2010; 23(1-2): 45-52.
  56. Muhammad Z, Irshad M. Comparison of serum TSH and T4 levels in preterm and term neonates for screening of congenital hypothyroidism. J Med Sci 2013; 21(4): 194-7.
  57. Chan DK, Tagamolila V, Ardhanari J, Lim XY, Wong J, Yeo CP. Reference range of thyroid hormones in very low birth weight infants at the time of discharge. Thyroid 2014; 24(1): 73-7.
  58. Zhu L, Zhang X, He X, Yang X, Wang Y, Wang C, et al. Reference intervals for serum thyroid hormones in preterm hospitalized infants. J Pediatr Endocrinol Metab 2013; 26(5-6): 463-7.
Journal of Isfahan Medical School
Volume 34, Issue 416 - Serial Number 416
November and December 2017
Pages 1706-1722

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History

  • Receive Date: 23 June 2014
  • Revise Date: 19 April 2024
  • Accept Date: 06 April 2022

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