Original articlesInfluence of timing and dose of thyroid hormone replacement on development in infants with congenital hypothyroidism☆,☆☆
Section snippets
Subjects
In the Netherlands, infants with positive CH screening results are referred by the general practitioner to a pediatrician. On confirmation of the diagnosis of CH, the patient data are reported to the national coordination office (Toegepast Natuurwetenschappelijk Onderzoek–Prevention and Health [TNO-PH], Leiden). This data bank was used to identify the subjects for this study. Ethical approval for the study was obtained from the Academic Hospital in Rotterdam and the privacy committee of the CH
Bayley Scores
Overall MDI and PDI scores did not differ from those of the reference population (113 ± 14 and 114 ± 12, respectively). Mean MDI in the severe CH group was 106 ± 19, significantly lower than that in the mild CH group (118 ± 11, P =.002) (Table II).Treatment group MDI PDI Severe CH Mild CH Severe CH Mild CH Early/high 124 ± 16 125 ± 10 123 ± 9 120 ± 13 Early/low 103 ± 10 124 ± 11* 109 ± 8 123 ± 12* Late/high 99 ± 23 122 ± 10*
DISCUSSION
The influence of timing and dosage of replacement therapy on intellectual outcome in infants with CH has been debated. American20 and European21 guidelines, which advise use of a high initial dose of levothyroxine, have been questioned,1, 2, 3, 4, 8, 9, 10, 11 and many clinicians do not follow them because of fear of overtreatment. In our study higher versus lower treatment was compared in infants with CH of the same age. The infants achieved development comparable to that of the reference
Acknowledgements
We thank Prof J. V. L. Van den Brande, PhD, for critically reviewing the manuscript and Mrs M. E. C. Damen-van de Ven for correcting the English.
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Cited by (0)
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Supported by a grant from the Sophia Fund for Scientific Research.
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Reprint requests: Jacoba J. Bongers-Schokking, MD, PhD, Academic Hospital Sophia Children’s Hospital, Department of Endocrinology, Sp 3429, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.