Comparison between transient and permanent congenital hypothyroidism on a thyroid function test after re-evaluation
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Congenital hypothyroidism (CH) is diagnosed with neonatal screening and is treated early in the neonatal period. Among these patients, transient CH (TCH) is included and requires re-evaluation. The purpose of this study was to find the best way to discontinue levothyroxine and to find trends in thyroid function tests (TFTs) after re-evaluation. Methods: We retrospectively reviewed 388 patients diagnosed with CH. They were classified as permanent CH (PCH) and TCH. The total number of the PCH and TCH groups was 83 (51 boys and 32 girls). We compared clinical parameters to predict TCH and to identify the trends of TFT. Results: The first thyroid-stimulating hormone (TSH) value after discontinuation and the average TSH value for 1, 2, and 3 years were all significantly higher in the PCH group (P<0.01). The first fT4 value after discontinuation and the average fT4 value for 1, 2, and 3 years were all significantly higher in the TCH group (P<0.01). The optimal cutoff value on the receiver operating characteristic curve for PCH prediction with an average of 3 years of TSH was greater than 9.05 μIU/mL, which was predicted with a sensitivity of 100% and a specificity of 100%. Conclusion: When the TSH value ranges from 10 μIU/mL to 20 μIU/mL, clinicians can discontinue levothyroxine if the next result is around 10 μIU/mL or shows a decreasing trend.
Abstract
Purpose: Congenital hypothyroidism (CH) is diagnosed with neonatal screening and is treated early in the neonatal period. Among these patients, transient CH (TCH) is included and requires re-evaluation. The purpose of this study was to find the best way to discontinue levothyroxine and to find trends in thyroid function tests (TFTs) after re-evaluation. Methods: We retrospectively reviewed 388 patients diagnosed with CH. They were classified as permanent CH (PCH) and TCH. The total number of the PCH and TCH groups was 83 (51 boys and 32 girls). We compared clinical parameters to predict TCH and to identify the trends of TFT. Results: The first thyroid-stimulating hormone (TSH) value after discontinuation and the average TSH value for 1, 2, and 3 years were all significantly higher in the PCH group (P<0.01). The first fT4 value after discontinuation and the average fT4 value for 1, 2, and 3 years were all significantly higher in the TCH group (P<0.01). The optimal cutoff value on the receiver operating characteristic curve for PCH prediction with an average of 3 years of TSH was greater than 9.05 μIU/mL, which was predicted with a sensitivity of 100% and a specificity of 100%. Conclusion: When the TSH value ranges from 10 μIU/mL to 20 μIU/mL, clinicians can discontinue levothyroxine if the next result is around 10 μIU/mL or shows a decreasing trend.
참고문헌 (30)
- 서민경, "Intellectual development in preschool children with early treated congenital hypothyroidism", Annals of Pediatric Endocrinology & Metabolism, 22(2), pp.102~107 (2017), 대한소아내분비학회
- Rose SR, "Update of newborn screening and therapy for congenital hypothyroidism", Pediatrics, 117, pp.2290~2303 (2006)
- Kara C, "Transient congenital hypothyroidism in Turkey : an analysis on frequency and natural course", J Clin Res Pediatr Endocrinol, 8, pp.170~179 (2016)
- Zung A, "Neonatal hyperthyrotropinemia : population characteristics, diagnosis, management and outcome after cessation of therapy", Clin Endocrinol(Oxf), 72, pp.264~271 (2010)
- Van Trotsenburg P, "Congenital hypothyroidism : a 2020-2021consensus guidelines update-an endo-european reference network initiative endorsed by the european society for pediatric endocrinology and the european society for endocrinology", Thyroid, 31, pp.387~419 (2021)
- Léger J, "European society for pediatric endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism", J Clin Endocrinol Metab, 99, pp.363~384 (2014)
- Kang MJ, "Three-year follow-up of children with abnormal newborn screening results for congenital hypothyroidism", Pediatr Neonatol, 58, pp.442~448 (2017)
- Razavi Z, "Permanent and transient congenital hypothyroidism in Hamadan west province of Iran", Int J Endocrinol Metab, 14, pp.e38256~ (2016)
- Unüvar T, "The role of initial clinical and laboratory findings in infants with hyperthyrotropinemia to predict transient or permanent hypothyroidism", J Clin Res Pediatr Endocrinol, 5, pp.170~173 (2013)
- Hong SY, "Factors distinguishing between transient and permanent hypothyroidism in patients diagnosed as congenital hypothyroidism by newborn screening", J Korean Soc Pediatr Endocrinol, 10, pp.154~160 (2005)
- Lim HK, "Predictors of transient hypothyroidism in neonatal screening test", J Korean Soc Pediatr Endocrinol, 11, pp.50~56 (2006)
- 박일순, "Predictors of transient congenital hypothyroidism in children with eutopic thyroid gland", Annals of Pediatric Endocrinology & Metabolism, 22(2), pp.115~118 (2017), 대한소아내분비학회
- Fu C, "The incidence of congenital hypothyroidism(CH)in Guangxi, China and the predictors of permanent and transient CH", Endocr Connect, 6, pp.926~934 (2017)
- Kemper AR, "Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism : findings from health insurance claims data", BMC Pediatr, 10, pp.9~ (2010)
- Akobeng AK, "Understanding diagnostic tests 3 : receiver operating characteristic curves", Acta Paediatr, 96, pp.644~647 (2007)
- Hanukoglu A, "Relationship of etiology to treatment in congenital hypothyroidism", J Clin Endocrinol Metab, 86, pp.186~191 (2001)
- Seung Heo, "Congenital hypothyroidism due to thyroglobulin deficiency: a case report with a novel mutation in TG gene", Annals of Pediatric Endocrinology & Metabolism, 24(3), pp.199~202 (2019), 대한소아내분비학회[DOI]
- 곽민정, "Clinical genetics of defects in thyroid hormone synthesis", Annals of Pediatric Endocrinology & Metabolism, 23(4), pp.169~175 (2018), 대한소아내분비학회
- 최진호, "선천성 갑상샘 저하증의 분자유전학적 측면", Annals of Pediatric Endocrinology & Metabolism, 14(2), pp.87~93 (2009), 대한소아내분비학회
- 조민선, "Earlier re-evaluation may be possible in pediatric patients with eutopic congenital hypothyroidism requiring lower L-thyroxine doses", Annals of Pediatric Endocrinology & Metabolism, 19(3), pp.141~145 (2014), 대한소아내분비학회
- Oron T, "Permanent vs transient congenital hypothyroidism : assessment of predictive variables", J Clin Endocrinol Metab, 103, pp.4428~4436 (2018)
- Rabbiosi S, "Congenital hypothyroidism with eutopic thyroid gland : analysis of clinical and biochemical features at diagnosis and after re-evaluation", J Clin Endocrinol Metab, 98, pp.1395~1402 (2013)
- Zdraveska N, "Diagnostic re-evaluation of congenital hypothyroidism in Macedonia : predictors for transient or permanent hypothyroidism", Endocr Connect, 7, pp.278~285 (2018)
- Messina MF, "Early discrimination between transient and permanent congenital hypothyroidism in children with eutopic gland", Horm Res Paediatr, 84, pp.159~164 (2015)
- Saba C, "Early determinants of thyroid function outcomes in children with congenital hypothyroidism and a normally located thyroid gland : a regional cohort study", Thyroid, 28, pp.959~967 (2018)
- Wong ET, "Elevations of thyroidstimulating hormone during acute nonthyroidal illness", Arch Intern Med, 141, pp.873~875 (1981)
- 정소윤, "Persistent goiter with congenital hypothyroidism due to mutation in DUOXA2 gene", Annals of Pediatric Endocrinology & Metabolism, 25(1), pp.57~62 (2020), 대한소아내분비학회
- Agretti P, "Papillary thyroid cancer in a patient with congenital goitrous hypothyroidism due to a novel deletion in NIS gene", Endocrine, 54, pp.256~258 (2016)
- Zhu H, "TPO gene mutations associated with thyroid carcinoma : case report and literature review", Cancer Biomark, 15, pp.909~913 (2015)
- Niedziela M, "Pathogenesis, diagnosis and management of thyroid nodules in children", Endocr Relat Cancer, 13, pp.427~453 (2006)