Association of elevated neonatal thyroid-stimulating hormone levels with school performance and stimulant prescription for attention deficit hyperactivity disorder in childhood

Samantha J Lain; Veronica Wiley; Michelle Jack; Andrew J Martin; Bridget Wilcken; Natasha Nassar

doi:10.1007/s00431-020-03828-9

Association of elevated neonatal thyroid-stimulating hormone levels with school performance and stimulant prescription for attention deficit hyperactivity disorder in childhood

Eur J Pediatr. 2021 Apr;180(4):1073-1080. doi: 10.1007/s00431-020-03828-9. Epub 2020 Oct 14.

Authors

Samantha J Lain¹, Veronica Wiley^{2

3}, Michelle Jack^{4

5}, Andrew J Martin⁶, Bridget Wilcken^{2

3}, Natasha Nassar⁷

Affiliations

¹ The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia. Samantha.lain@sydney.edu.au.
² NSW Newborn Screening Programme, The Children's Hospital at Westmead, Sydney, Australia.
³ Disciplines of Genetic Medicine and Paediatrics and Child Health, University of Sydney, Sydney, Australia.
⁴ Department of Paediatric Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia.
⁵ Northern Clinical School, University of Sydney, Sydney, Australia.
⁶ School of Education, University of New South Wales, Sydney, Australia.
⁷ The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia.

PMID: 33057816
DOI: 10.1007/s00431-020-03828-9

Abstract

Untreated severe newborn thyroid deficiency causes neurocognitive impairment; however, the impact of mild thyroid deficiency is not known. This study aimed to examine whether mildly elevated neonatal thyroid-stimulating hormone (TSH) levels are associated with poor school performance or stimulant prescription for attention deficit hyperactivity disorder (ADHD). This record-linkage study included 232,790 term-born infants in Australia with a TSH level below newborn screening threshold (< 15 mIU/L). Among our cohort, as TSH levels increased, the proportion of infants born low birthweight via caesarean section and with disadvantaged socioeconomic status increased. Multivariable logistic regression analysis showed that, compared with infants with 'normal' neonatal TSH level (< 5 mIU/L), those with neonatal TSH 10-15 mIU/L had an increased risk of being exempt from school testing (aOR 1.63 (95% CI 1.06-2.69)) or prescribed a stimulant for ADHD (aOR 1.57 (95% CI 1.10-2.24)), adjusted for perinatal and sociodemographic factors. Among a nested analysis of 460 sibling pairs, siblings with 'mildly elevated' TSH levels were more likely to be exempt from school tests compared with siblings with normal TSH levels (aOR 2.53, 95% CI 1.01-6.33).Conclusion: In this population cohort and sibling analysis, mildly elevated neonatal TSH levels were associated with being exempt from school testing due to significant or complex disability. What is Known: • Newborn screening for severe thyroid hormone deficiency has virtually eliminated congenital hypothyroidism-associated intellectual disability in developed countries. • The impact of mild thyroid hormone deficiency in infants is unclear. What is New: • Children with a mildly elevated neonatal TSH level below current newborn screening cut-offs have an increased likelihood of being exempt from school testing due to significant or complex disability compared with siblings and peers. This study includes a population-based and nested sibling analysis.

Keywords: Congenital hypothyroidism; Newborn screening; TSH; Thyroid hormone.

MeSH terms

Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / epidemiology
Australia
Cesarean Section
Child
Congenital Hypothyroidism*
Female
Humans
Infant, Newborn
Neonatal Screening
Pregnancy
Prescriptions
Schools
Thyrotropin / metabolism*

Substances

Thyrotropin

Grants and funding

APP105068/Australian National Health and Medical Research Counci