Details

Autor(en) / Beteiligte

• Bongers-Schokking, Jacoba J
• Resing, Wilma C M
• Oostdijk, Wilma
• de Rijke, Yolanda B
• de Muinck Keizer-Schrama, Sabine M P F

Titel

Individualized treatment to optimize eventual cognitive outcome in congenital hypothyroidism

Ist Teil von

• Pediatric research, 2016-12, Vol.80 (6), p.816-823

Ort / Verlag

United States: Nature Publishing Group

Erscheinungsjahr

2016

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• In congenital hypothyroidism (CH), age-specific reference ranges (asRR) for fT and thyrotropine (TSH) are usually used to signal over/under-treatment. We compared the consequences of individual fT steady-state concentrations (SSC's) and asRR regarding over-treatment signaling and intelligence quotient at 11 y (IQ ) and the effect of early over-treatment with high L-T dosages on IQ . Sixty-one patients (27 severe, 34 mild CH) were psychologically tested at 1.8, 6, and 11 y. Development scores were related to over-treatment in the period 0-24 mo, relative to either individual fT SSC's or asRR. Three groups were formed, based on severity of over/under-treatment 0-5 mo (severe, mild, and no over/under-treatment). FT and TSH asRR missed 41-50% of the over-treatment episodes and consequently 22% of the over-treated patients, classified as such by fT SSC's. Severe over-treatment 0-5 mo led to lowered IQ 's and to a 5.5-fold higher risk of IQ < 85 than other treatment regimes. Under-treatment had no effect on development scores. Initial L-T dosages >10 µg/kg resulted in a 3.7-fold higher risk of over-treatment than lower dosages. Data suggest that asRR, compared to fT SSC's, signal over-treatment insufficiently. Using fT SSC's and avoiding over-treatment may optimize cognitive outcome. Lowered IQ 's are usually a late complication of severe early over-treatment.