Earlier re-evaluation may be possible in pediatric patients with eutopic congenital hypothyroidism requiring lower L-thyroxine doses

PURPOSE: The incidence of congenital hypothyroidism (CH) has increased in several countries. Lower cut-off in screening programs have led to an increase in the proportion of transient hypothyroidism (TH) cases diagnosed, leading to debate on the associated clinical and economic impact. This study aimed to identify factors that would allow discrimination between TH and permanent CH (PH) in patients with a eutopic thyroid gland. METHODS: Sixty-six patients with CH from 3 different hospitals were studied: 26 cases of TH, and 40 cases of PH. Laboratory findings and clinical parameters were analysed in 56 patients with eutopic thyroid gland. RESULTS: Initial serum thyroid stimulating hormone levels and L-thyroxine dose at 12 and 24 months of age were significantly higher in PH than TH patients with a eutopic thyroid gland. The area under the curve for the 12-month and 24-month dose for the prediction of TH in eutopic CH was 0.799 (95% confidence interval [CI], 0.678-0.919; P<0.001) and 0.925 (95% CI, 0.837-1.000; P<0.001), respectively. The optimum 12-month and 24-month dose in predicting TH is 3.25 microg/kg (12-month: sensitivity, 87.1%; specificity, 68.0%; 24-month: sensitivity 93.5%, specificity 88%). CONCLUSION: Infants with CH requiring lower L-thyroxine doses (<3.25 microg/kg) are likely to have TH, and thus might be re-evaluated at 12 months or 24 months rather than 3 years of age.

Analysis for Spontaneous Remission of Chronic Immune Thrombocytopenic Purpura in Children / 임상소아혈액종양

BACKGROUND: Chronic immune thrombocytopenic purpura (chronic ITP) is the most common autoimmune disease for blood elements. Some patients recovered spontaneously during follow up of disease. We investigated the difference of related clinical parameters between spontaneous remission and no remission.METHODS: We reviewed retrospectively medical records from January 1994 to December 2010. We analyzed clinical parameters such as age, sex, initial platelet count, response to initial treatment, maintenance therapy, and platelet counts at post-diagnosis with regular period in children with or without spontaneous remission.RESULTS: This study was enrolled for 49 children with chronic ITP. Median age was 3.5 years (0.1-17.3). Male to female ratio was 1:1.9. Initial treatment with intravenous immunoglobulin was received in 36 children (73.3%). Spontaneous remission was shown in 23 children (46.9%) during study period with 4.4 year of median follow up. The relevant factors of remission were observed in younger age at diagnosis, maintenance therapy, and platelet counts at post-diagnosis 1 year, 2 years, 3 years (P<0.05). The most significant parameter for spontaneous remission was platelet count at post-diagnosis 6 months in Kaplan-Meier estimate (P=0.047, RR: 3.47, 95% CI: 1.03-24.04).CONCLUSION: Spontaneous remission was shown in about half of patients with chronic ITP. This remission was related with younger age, maintenance therapy, and platelet count at post-diagnosis 6 months. These results suggest that regular follow up with maintenance therapy may be required for management of chronic ITP in children.

Analysis for Spontaneous Remission of Chronic Immune Thrombocytopenic Purpura in Children / 임상소아혈액종양

BACKGROUND: Chronic immune thrombocytopenic purpura (chronic ITP) is the most common autoimmune disease for blood elements. Some patients recovered spontaneously during follow up of disease. We investigated the difference of related clinical parameters between spontaneous remission and no remission. METHODS: We reviewed retrospectively medical records from January 1994 to December 2010. We analyzed clinical parameters such as age, sex, initial platelet count, response to initial treatment, maintenance therapy, and platelet counts at post-diagnosis with regular period in children with or without spontaneous remission. RESULTS: This study was enrolled for 49 children with chronic ITP. Median age was 3.5 years (0.1-17.3). Male to female ratio was 1:1.9. Initial treatment with intravenous immunoglobulin was received in 36 children (73.3%). Spontaneous remission was shown in 23 children (46.9%) during study period with 4.4 year of median follow up. The relevant factors of remission were observed in younger age at diagnosis, maintenance therapy, and platelet counts at post-diagnosis 1 year, 2 years, 3 years (P<0.05). The most significant parameter for spontaneous remission was platelet count at post-diagnosis 6 months in Kaplan-Meier estimate (P=0.047, RR: 3.47, 95% CI: 1.03-24.04). CONCLUSION: Spontaneous remission was shown in about half of patients with chronic ITP. This remission was related with younger age, maintenance therapy, and platelet count at post-diagnosis 6 months. These results suggest that regular follow up with maintenance therapy may be required for management of chronic ITP in children.