Perinatology.  2019 Sep;30(3):160-170. 10.14734/PN.2019.30.3.160.

Levothyroxine Sodium Administration and Late Circulatory Collapse in Premature Infants with Thyroid Dysfunction

• Do HJ
• Cho JY
• Yeom JS
• Park JS
• Seo JH
• Lim JY
• Park CH
• Woo HO
• Youn HS

• KMID: 2460030
• DOI: http://doi.org/10.14734/PN.2019.30.3.160

Abstract

OBJECTIVE
Levothyroxine sodium (LT4) is considered safe, and widely administered to premature infants with thyroid dysfunction. Late circulatory collapse (LCC) has not been defined clearly, but it has been characterized as refractory hypotension in premature infants. Recently, LCC after LT4 administration was reported in Japan. However, there is controversy on the aspect of LT4 as a risk factor of LCC. The purpose of this study was to investigate relations between LT4 administration and LCC in premature infants.
METHODS
We retrospectively reviewed medical records of premature infants (≤32 weeks gestation) admitted in Gyeongsang National University Hospital between 2011 and 2018. To investigate the relation between LT4 supplementation and LCC, clinical and laboratory findings were reviewed and compared between premature infants with and without LCC.
RESULTS
Among 347 premature infants, LCC occurred in 21 (6.1%) on median 19.0th day. Sixteen (76.2%) of 21 infants with LCC were receiving LT4 and LCC was developed on median 3.0 days after LT4 initiation. Gestational age ≤28 weeks, birth weight <1.5 kg, hemodynamically significant patent ductus arteriosus, culture proven sepsis, necrotizing enterocolitis, congenital hypothyroidism, use of LT4 and diuretics, values of serum thyroid stimulating hormone, free thyroxine and sodium were significantly statistically different between LCC and no LCC group. Prematurity ≤28 weeks of gestation and LT4 replacement were risk factors of LCC on multivariate logistic regression analysis.
CONCLUSION
Supplementation of LT4 should be carefully considered in premature infants with thyroid dysfunction and serial monitoring of blood pressure should be warranted if LT4 was administered.

Keyword

Levothyroxine sodium; Circulatory collapse; Premature infant

MeSH Terms

Birth Weight
Blood Pressure
Congenital Hypothyroidism
Diuretics
Ductus Arteriosus, Patent
Enterocolitis, Necrotizing
Gestational Age
Humans
Hypotension
Infant
Infant, Newborn
Infant, Premature*
Japan
Logistic Models
Medical Records
Pregnancy
Retrospective Studies
Risk Factors
Sepsis
Shock*
Sodium
Thyroid Gland*
Thyrotropin
Thyroxine*
Diuretics
Sodium
Thyrotropin
Thyroxine

Figure

• 

  Fig. 1 Number of subjects in this study. Thyroid function was classified as normal (TSH <5 mIU/L and fT4 <0.9 ng/dL), hypothyroxinemia of prematurity (TSH <5 mIU/L and fT4 <0.9 ng/dL), hyperthyrotropinemia (TSH ≥5 mIU/L and fT4 ≥0.9 ng/dL), and hypothyroidism (TSH ≥5 mIU/L and fT4 <0.9 ng/dL), respectively. Thyroid function was defined with the last values of serum TSH and fT4 during hospital stays or prior to LT4 administration. LT4 was initiated when serum TSH was >20 mIU/L, TSH was 5 to 20 mIU/L or rising, and/or fT4 was <0.9 ng/dL on 2 or more consecutive tests with 1 or 2-week interval. LT4, levothyroxine sodium; LCC, late circulatory collapse; TFT, thyroid function test; TSH, thyroid stimulating hormone; fT4, free T4.

• 

  Fig. 2 Time interval (days) from initiation of LT4 and development of LCC, and number of patients with LCC in premature infants with ≤32 weeks of gestation. LCC, late circulatory collapse; LT4, levothyroxine sodium.

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