Ann Pediatr Endocrinol Metab.  2017 Dec;22(4):253-258. 10.6065/apem.2017.22.4.253.

Clinical course of infants with congenital heart disease who developed thyroid dysfunction within 100 days

Affiliations
  • 1Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
  • 2Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. nina337@snu.ac.kr

Abstract

PURPOSE
We investigated the clinical course of infants with congenital heart disease (CHD) who experienced thyroid dysfunction within 100 days of birth.
METHODS
We performed retrospective medical reviews of 54 CHD patients (24 male patients) who underwent a thyroid function test (TFT) between January 2007 and July 2016. Data were collected on birth history, diagnosis of CHD, underlying chromosomal or genetic abnormalities, medication history, surgery, ventilator care, and exposure to iodine contrast media (ICM). Results of neonatal screening tests (NSTs) and TFTs were reviewed.
RESULTS
A total of 36 patients (29 transient, 7 permanent) showed thyroid dysfunction. Among the seven patients with permanent hypothyroidism, three had an underlying syndrome, three showed abnormal NST results, and one was admitted to the intensive care unit for macroglossia and feeding cyanosis. We found that infants with transient thyroid dysfunction had a lower birth weight and were more commonly exposed to thyroid disrupting medication and/or ICM. However, these risk factors were not significant. A total of 8 patients with a history of ICM exposure showed thyroid dysfunction. Excluding 3 patients with elevated thyroid stimulating hormone before ICM exposure, 5 patients recovered from transient thyroid dysfunction.
CONCLUSIONS
We observed thyroid dysfunction in two-thirds of CHD infants (53.7% transient, 13.0% permanent) who had risk factors and received TFT screening within 100 days, despite normal NSTs. Further studies with larger sample sizes are required to revise the criteria for TFT screening in CHD infants.

Keyword

Thyroid function tests; Congenital; Heart; Infant; Hypothyroidism

MeSH Terms

Birth Weight
Contrast Media
Cyanosis
Diagnosis
Heart
Heart Defects, Congenital*
Humans
Hypothyroidism
Infant*
Infant, Newborn
Intensive Care Units
Iodine
Macroglossia
Male
Mass Screening
Neonatal Screening
Parturition
Reproductive History
Retrospective Studies
Risk Factors
Sample Size
Thyroid Function Tests
Thyroid Gland*
Thyrotropin
Ventilators, Mechanical
Contrast Media
Iodine
Thyrotropin

Figure

  • Fig. 1. Clinical course of total subjects.


Reference

References

1. Grüters A, Krude H. Detection and treatment of congenital hypothyroidism. Nat Rev Endocrinol. 2011; 8:104–13.
Article
2. Rastogi MV, LaFranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis. 2010; 5:17.
Article
3. Oerbeck B, Sundet K, Kase BF, Heyerdahl S. Congenital hypothyroidism: influence of disease severity and L-thyroxine treatment on intellectual, motor, and school-associated outcomes in young adults. Pediatrics. 2003; 112:923–30.
4. Léger J, Larroque B, Norton J; Association Française pour le Dépistage et la Prévetion des Handicaps de l'Enfant. Influence of severity of congenital hypothyroidism and adequacy of treatment on school achievement in young adolescents: a population-based cohort study. Acta Paediatr. 2001; 90:1249–56.
Article
5. American Academy of Pediatrics, Rose SR; Section on Endocrinology and Committee on Genetics; American Thyroid Association, Brown RS; Public Health Committee; Lawson Wilkins Pediatric Endocrine Society, Foley T, et al. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics. 2006; 117:2290–303.
Article
6. Olivieri A, Stazi MA, Mastroiacovo P, Fazzini C, Medda E, Spagnolo A, et al. A population-based study on the frequency of additional congenital malformations in infants with congenital hypothyroidism: data from the Italian Registry for Congenital Hypothyroidism (1991-1998). J Clin Endocrinol Metab. 2002; 87:557–62.
Article
7. Passeri E, Frigerio M, De Filippis T, Valaperta R, Capelli P, Costa E, et al. Increased risk for non-autoimmune hypothyroidism in young patients with congenital heart defects. J Clin Endocrinol Metab. 2011; 96:E1115–9.
Article
8. Barr ML, Chiu HK, Li N, Yeh MW, Rhee CM, Casillas J, et al. Thyroid dysfunction in children exposed to iodinated contrast media. J Clin Endocrinol Metab. 2016; 101:2366–70.
Article
9. Ahmet A, Lawson ML, Babyn P, Tricco AC. Hypothyroidism in neonates post-iodinated contrast media: a systematic review. Acta Paediatr. 2009; 98:1568–74.
Article
10. Lee SY, Rhee CM, Leung AM, Braverman LE, Brent GA, Pearce EN. A review: radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab. 2015; 100:376–83.
Article
11. Rhee CM, Bhan I, Alexander EK, Brunelli SM. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Arch Intern Med. 2012; 172:153–9.
Article
12. Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G, et al. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab. 2014; 99:363–84.
Article
13. Soto-Rivera CL, Fichorova RN, Allred EN, Van Marter LJ, Shah B, Martin CR, et al. The relationship between TSH and systemic inflammation in extremely preterm newborns. Endocrine. 2015; 48:595–602.
Article
14. Mitchell ML, Hsu HW, Sahai I; Massachusetts Pediatric Endocrine Work Group. The increased incidence of congenital hypothyroidism: fact or fancy? Clin Endocrinol (Oxf). 2011; 75:806–10.
Article
15. Lee JH, Kim SW, Jeon GW, Sin JB. Thyroid dysfunction in very low birth weight preterm infants. Korean J Pediatr. 2015; 58:224–9.
Article
16. Haugen BR. Drugs that suppress TSH or cause central hypothyroidism. Best Pract Res Clin Endocrinol Metab. 2009; 23:793–800.
Article
17. Van den Berghe G, de Zegher F, Lauwers P. Dopamine suppresses pituitary function in infants and children. Crit Care Med. 1994; 22:1747–53.
Article
18. Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005; 118:706–14.
Article
19. Thaker VV, Leung AM, Braverman LE, Brown RS, Levine B. Iodine-induced hypothyroidism in full-term infants with congenital heart disease: more common than currently appreciated? J Clin Endocrinol Metab. 2014; 99:3521–6.
Article
20. Gartner W, Weissel M. Do iodine-containing contrast media induce clinically relevant changes in thyroid function parameters of euthyroid patients within the first week? Thyroid. 2004; 14:521–4.
Article
21. Linder N, Sela B, German B, Davidovitch N, Kuint J, Hegesh J, et al. Iodine and hypothyroidism in neonates with congenital heart disease. Arch Dis Child Fetal Neonatal Ed. 1997; 77:F239–40.
Article
22. del Cerro Marín M, Fernández Ruiz A, García-Guereta L, Benito Bartolomé F, Burgueros M, Ares Segura S, et al. Thyroid function alterations in children with congenital cardiac disease after catheterization with iodinated contrast agents. Rev Esp Cardiol. 2000; 53:517–24.
23. Radetti G, Renzullo L, Gottardi E, D'Addato G, Messner H. Altered thyroid and adrenal function in children born at term and preterm, small for gestational age. J Clin Endocrinol Metab. 2004; 89:6320–4.
Article
24. Kilby MD, Gittoes N, McCabe C, Verhaeg J, Franklyn JA. Expression of thyroid receptor isoforms in the human fetal central nervous system and the effects of intrauterine growth restriction. Clin Endocrinol (Oxf). 2000; 53:469–77.
Article
25. Dentice M, Cordeddu V, Rosica A, Ferrara AM, Santarpia L, Salvatore D, et al. Missense mutation in the transcription factor NKX2-5: a novel molecular event in the pathogenesis of thyroid dysgenesis. J Clin Endocrinol Metab. 2006; 91:1428–33.
Article
26. van Engelen K, Mommersteeg MT, Baars MJ, Lam J, Ilgun A, van Trotsenburg AS, et al. The ambiguous role of NKX2-5 mutations in thyroid dysgenesis. PLoS One. 2012; 7:e52685.
Article
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