Neurodevelopmental and Body Composition Outcomes in Children With Congenital Hypothyroidism Treated With High-Dose Initial Replacement and Close Monitoring
Neurodevelopmental and Body Composition Outcomes in Children With Congenital Hypothyroidism Treated With High-Dose Initial Replacement and Close Monitoring
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DOI：
10.1210/jc.2013-1903
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发表时间：
2013-09-01
影响因子：
5.8
通讯作者：
Hofman, Paul L.
中科院分区：
文献类型：
--
作者：
Albert, Benjamin B.;Heather, Natasha;Hofman, Paul L.
背景：尽管进行了新生儿筛查和早期左旋甲状腺素替代，但仍有报道称先天性甲状腺功能减退症 (CHT) 儿童存在轻度神经认知障碍。在新西兰奥克兰，通过新生儿筛查计划发现病例，并快速进行大剂量左旋甲状腺素替代（10-15μg/kg.d），使甲状腺功能迅速恢复正常。随后，进行为期 2 年的频繁监测和剂量改变。我们的目的是评估奥克兰的治疗策略是否可以防止智力和运动发育受损。方法：这项研究涵盖了 1993-2006 年出生于奥克兰的所有患有 CHT 的儿童及其兄弟姐妹。神经认知评估包括以下内容：1）通过韦施勒学前班和小学智力量表 III 或韦施勒儿童智力量表 IV 进行的智商； 2）儿童运动评估电池； 3) Beery 视觉运动整合发育测试。通过双能 X 射线吸收测定法评估身体成分。结果：研究了 44 名 CHT 病例和 53 名年龄为 9.6 +/- 3.9 岁的兄弟姐妹对照。 CHT 病例和对照组的总体智商相似（95.2 vs 98.6；P = .20），并且运动功能也没有差异。 CHT 的严重程度并不影响结果，但游离 T-4 正常化所需的时间越长，运动平衡能力越差。各组之间的人体测量或身体成分没有差异。结论：这些发现表明，使用大剂量左旋甲状腺素替代品快速识别和治疗患有 CHT 的婴儿的策略与正常的智力和运动发育相关。与游离 T-4 水平正常化时间相关的对运动功能的微妙负面影响与快速初始校正的益处一致。 （临床内分泌代谢杂志 98：3663-3670，2013）
Background: Despite newborn screening and early levothyroxine replacement, there are continued reports of mild neurocognitive impairment in children with congenital hypothyroidism (CHT). In Auckland, New Zealand, cases are identified by a neonatal screening program with rapid institution of high-dose levothyroxine replacement (10-15 mu g/kg.d), producing prompt normalization of thyroid function. Subsequently, frequent monitoring and dose alterations are performed for 2 years. We aimed to assess whether the Auckland treatment strategy prevents impairment of intellectual and motor development.Methods: This study encompassed all children with CHT born in 1993-2006 in Auckland and their siblings. Neurocognitive assessments included the following: 1) intelligence quotient via Weschler Preschool and Primary Scale of Intelligence III or Weschler Intelligence Scale for Children IV; 2) Movement Assessment Battery for Children; and 3) Beery Developmental Test of Visual-Motor Integration. Body composition was assessed by dual-energy x-ray absorptiometry.Results: Forty-four CHT cases and 53 sibling controls aged 9.6 +/- 3.9 years were studied. Overall intelligence quotient was similar among CHT cases and controls (95.2 vs 98.6; P = .20), and there were also no differences in motor function. Severity of CHT did not influence outcome, but greater time to normalize free T-4 was associated with worse motor balance. There were no differences in anthropometry or body composition between groups.Conclusions: These findings suggest that a strategy of rapidly identifying and treating infants with CHT using high-dose levothyroxine replacement is associated with normal intellectual and motor development. The subtle negative impact on motor function associated with time to normalize free T-4 levels is consistent with benefit from rapid initial correction. (J Clin Endocrinol Metab 98: 3663-3670, 2013)