Ann Pediatr Endocrinol Metab.  2023 Mar;28(1):42-48. 10.6065/apem.2244002.001.

Development of delayed thyroid stimulating hormone elevation in small-for-gestational-age infants: is a second screening needed?

• Lee G
• Park SY
• Park JH
• Kang S

• KMID: 2540786
• DOI: http://doi.org/10.6065/apem.2244002.001

Abstract

Purpose
Recent reports indicate that small for gestational age (SGA) could be a risk factor for delayed thyroid stimulating hormone (dTSH) elevation in preterm infants. The development of dTSH elevation in SGA late-preterm infants with a gestational age of 34–36 weeks has been investigated in only a few studies.
Methods
In the present retrospective study, 70 SGA infants and 86 sex- and gestational age-matched controls who presented with normal results on initial thyroid function testing were included.
Results
SGA infants had a significantly higher prevalence of dTSH elevation (15.7% vs. 3.5%, P=0.009) compared with appropriate-for-gestational age infants. In SGA infants, the mean age at the time of dTSH was 24 days. Development of dTSH was associated with SGA and medical treatment with dopamine or furosemide. After adjusting for confounding factors, multiple logistic regression analysis showed SGA was a significant risk factor for the development of dTSH elevation (odds ratio, 23.2; 95% confidence interval, 2.27–236.91; P=0.008).
Conclusion
SGA infants may be at risk for dTSH and clinicians could consider a second thyroid screening test around the age of 1 month.

Keyword

Congenital hypothyroidism; Delayed thyrotropin elevation; Levothy roxine; Newborn thyroid screening; Small for gestational age

Reference

References

1. Woo HC, Lizarda A, Tucker R, Mitchell ML, Vohr B, Oh W, et al. Congenital hypothyroidism with a delayed thyroid-stimulating hormone elevation in very premature infants: incidence and growth and developmental outcomes. J Pediatr. 2011; 158:538–42.

2. 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.

3. Hunter MK, Mandel SH, Sesser DE, Miyabira RS, Rien L, Skeels MR, et al. Follow-up of newborns with low thyroxine and nonelevated thyroid-stimulating hormone-screening concentrations: results of the 20-year experience in the Northwest Regional Newborn Screening Program. J Pediatr. 1998; 132:70–4.

4. Liu C, Wang K, Guo J, Chen J, Chen M, Xie Z, et al. Small for gestational age is a risk factor for thyroid dysfunction in preterm newborns. BMC Pediatr. 2020; 20:179.

5. Uchiyama A, Watanabe H, Nakanishi H, Totsu S. Small for gestational age is a risk factor for the development of delayed thyrotropin elevation in infants weighing less than 2000 g. Clin Endocrinol (Oxf). 2018; 89:431–6.

6. Lim JS, Lim SW, Ahn JH, Song BS, Shim KS, Hwang IT. New Korean reference for birth weight by gestational age and sex: data from the Korean Statistical Information Service (2008-2012). Ann Pediatr Endocrinol Metab. 2014; 19:146–53.

7. Clark SJ, Deming DD, Emery JR, Adams LM, Carlton EI, Nelson JC. Reference ranges for thyroid function tests in premature infants beyond the first week of life. J Perinatol. 2001; 21:531–6.

8. Rastogi MV, LaFranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis. 2010; 5:17.

9. Wang Y, Wu X, Hong K, Fu X, Chen T, Zhu M, et al. Establishment of reference intervals for thyroid hormones in premature infants beyond the first week of life using Beckman Coulter Unicel DxI 800. Clin Biochem. 2019; 74:19–23.

10. Lee JH, Kim SW, Jeon GW, Sin JB. Thyroid dysfunction in very low birth weight preterm infants. Korean J Pediatr. 2015; 58:224–9.

11. Ogilvy-Stuart AL. Neonatal thyroid disorders. Arch Dis Child Fetal Neonatal Ed. 2002; 87:F165–71.

12. Larson C, Hermos R, Delaney A, Daley D, Mitchell M. Risk factors associated with delayed thyrotropin elevations in congenital hypothyroidism. J Pediatr. 2003; 143:587–91.

13. Zung A, Bier Palmon R, Golan A, Troitzky M, Eventov-Friedman S, Marom R, et al. Risk factors for the development of delayed TSH elevation in neonatal intensive care unit newborns. J Clin Endocrinol Metab. 2017; 102:3050–5.

14. Kaluarachchi DC, Zhao Q, Colaizy TT. Antenatal steroids and thyroid hormone function in preterm infants. J Perinatol. 2018; 38:1466–70.

15. Bosch-Giménez VM, Palazón-Bru A, Blasco-Barbero Á, Juste-Ruiz M, Rizo-Baeza MM, Cortés-Castell E. Multivariate analysis of thyrotropin in preterm newborns based on adequacy of weight for gestational age. Thyroid. 2017; 27:120–4.

16. Franco B, Laura F, Sara N, Salvatore G. Thyroid function in small for gestational age newborns: a review. J Clin Res Pediatr Endocrinol. 2013; 5 Suppl 1(Suppl 1):2–7.

17. Lem AJ, de Rijke YB, van Toor H, de Ridder MA, Visser TJ, Hokken-Koelega AC. Serum thyroid hormone levels in healthy children from birth to adulthood and in short children born small for gestational age. J Clin Endocrinol Metab. 2012; 97:3170–8.

18. Cuestas E, Gaido MI, Capra RH. Transient neonatal hyperthyrotropinemia is a risk factor for developing persistent hyperthyrotropinemia in childhood with repercussion on developmental status. Eur J Endocrinol. 2015; 172:483–90.

19. Chung ML, Yoo HW, Kim KS, Lee BS, Pi SY, Lim G, et al. Thyroid dysfunction of prematurity and their impacts on neurodevelopmental outcome. J Pediatr Endocrinol Metab. 2013; 26:449–55.

20. Moon S, Kim J. Iodine content of human milk and dietary iodine intake of Korean lactating mothers. Int J Food Sci Nutr. 1999; 50:165–71.

21. Nicoletti A, Bal M, De Marco G, Baldazzi L, Agretti P, Menabò S, et al. Thyrotropin-stimulating hormone receptor gene analysis in pediatric patients with non-autoimmune subclinical hypothyroidism. J Clin Endocrinol Metab. 2009; 94:4187–94.

22. Turkkahraman D, Alper OM, Aydin F, Yildiz A, Pehlivanoglu S, Luleci G. Final diagnosis in children with subclinical hypothyroidism and mutation analysis of the thyroid peroxidase gene (TPO). J Pediatr Endocrinol Metab. 2009; 22:845–51.