Can One Predict Resolution of Neonatal Hyperthyrotropinemia?

J Pediatr. 2016 Jul:174:71-77.e1. doi: 10.1016/j.jpeds.2016.04.011. Epub 2016 May 14.

Abstract

Objective: To identify predictors of transience vs permanence of neonatal hyperthyrotropinemia. We hypothesized that infants with greater severity of perinatal stress are more likely to have transient thyrotropin elevations.

Study design: We retrospectively studied infants diagnosed with hyperthyrotropinemia between 2002 and 2014, following them for up to 12 years after diagnosis. Patients were divided into 3 groups: transient hyperthyrotropinemia (treatment was never prescribed), transient congenital hypothyroidism (treatment started but discontinued), and permanent congenital hypothyroidism (withdrawal unsuccessful or not attempted). We performed univariate and multiple logistic regression analyses, including and excluding infants with maternal thyroid disease.

Results: We included 76 infants, gestational age mean (±SD) 34.2 (±5.7) weeks, evaluated for hyperthyrotropinemia. Thirty-five (46%) were never treated, and 41 (54%) received levothyroxine. Of the treated patients, 16 successfully discontinued levothyroxine, and for 25 withdrawal either failed or was not attempted. We found that male patients were almost 5 times more likely than female patients to have transient neonatal hyperthyrotropinemia (OR 4.85; 95% CI 1.53-15.37). We documented greater maternal age (31.5 ± 5.48 years vs 26 ± 6.76 years, mean ± SD, P = .02), greater rate of cesarean delivery (86.7% vs 54.2%; P = .036), and retinopathy of prematurity (37.5% vs 8%; P = .02) in the group with transient congenital hypothyroidism vs the group with permanent congenital hypothyroidism.

Conclusion: The results show transience of neonatal thyrotropin elevations in a majority of patients and suggest a possible association of hyperthyrotropinemia with maternal and perinatal risk factors.

Keywords: congenital hypothyroidism; neonatal hyperthyrotropinemia; perinatal stress.

MeSH terms

  • Congenital Hypothyroidism / blood
  • Congenital Hypothyroidism / etiology
  • Congenital Hypothyroidism / therapy*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / blood*
  • Male
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Thyrotropin / blood*
  • Treatment Outcome

Substances

  • Thyrotropin