ABSTRACT
Introdução: no exame sérico os valores de TSH acima de 10 ?Ul/mL e de T4 livre (T4L) baixo confirmam o diagnóstico do hipotireoidismo congênito, e as crianças deverão ser tratadas. Contudo, se houver elevação discreta do TSH (5,6 a 10 µUI/mL) e T4L normal, o recém-nascido (RN) apresenta quadro de hipertireotropinemia (HT) neonatal, que pode ser transitório ou permanente, e deve permanecer em acompanhamento clínico rigoroso. Objetivos: verificar a evolução de crianças triadas pelo Programa de Triagem Neonatal de Minas Gerais (PTN-MG) com HT. Métodos: estudo do tipo coorte retrospectivo. Analisaram-se os dados obtidos pelo ?teste do pezinho?, disponibilizados pelo banco de dados do Núcleo deAções e Pesquisa em Apoio Diagnóstico (NUPAD). Resultados: no período de 2000 a 2010,125 RNs apresentaram HT. Desses, 48% normalizaram os níveis de TSH no período médio de 20 meses. Já os outros 52% não normalizaram o TSH no período estudado e por isso foram mantidos em acompanhamento. Conclusões: mesmo que os níveis de TSH tenham se normalizado em 48% dos casos, concedendo alta a esses RNs, o tempo para esse desfecho foi significativo (cerca de 20 meses). Nesse período, pode haver alterações nos exames, muitas vezes com necessidade de tratamento com reposição hormonal, sendo, portanto, fundamentalo seguimento por meio de consultas e dosagens hormonais periódicas.
Introduction: in the serum exam TSH values above 10 ?Ul / mL and free T4 (FT4) low confirm the diagnosis of congenital hypothyroidism, and children should be treated. However, if mild elevation of TSH (5.6 to 10 ?UI / mL), normal FT4, the newborn (NB) has a hyperthyrotropinemia (HT) frame neonatal, which can be temporary or permanent, and should remain in rigorous clinical monitoring. Objects: to check the progress of children screened by the Newborn Screening Program of Minas Gerais (LWA-MG) withHT. Methods: this is a retrospective cohort study. We analyzed the data obtained by ? heel prick test ? provided by the Core Database Action and Research in Support Diagnostics (NUPAD). Results: from 2000 to 2010, 125 newborns had HT. Of these, 48% had a normal TSH levels in an average period of 20 months. As for the other 52% did not normalizeTSH during the study period and were therefore kept in accompaniment. Conclusions: Even though TSH levels have become normal in 48% of cases providing high for these RNs, this time to endpoint was significantly (about 20 months). During this period there may be changes in the exams, often requiring treatment with hormone replacement, and is therefore essential to follow through periodic consultations and hormone levels.
Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant , Thyroid Gland , Neonatal Screening , Hyperthyroidism/epidemiology , Hypothyroidism/diagnosis , Thyroid Hormones , Infant, Newborn/growth & developmentABSTRACT
Objective To study the prognosis of neonatal hyperthyrotropinemia (HT). Methods Children with HT were followed up regularly to evaluate the growth index, thyroid function and effectiveness of treatment. Results One hundred and ninety-one neonates with serum TSH level of 5.6~10 mU/L at the screening were followed up until 24 months old. Serum TSH gradually returned to normal range in 182 cases. Serum TSH increased to be>10 mU/L in 5 cases who were treated with levothy-roxine sodium. Serum TSH lfuctuated between 5.6 and 10 mU/L in 4 cases who were continually followed up. Among 44 cases of serum TSH at 10~20mU/L, serum TSH gradually returned to normal range after levothyroxine sodium treatment in 38 cases;se-rum TSH increased to>20 mU/L in 7 cases for whom continuous treatment with levothyroxine sodium was required. In 242 cases of HT neonates, 18 cases had received continuous levothyroxine sodium replacement treatment for 2 years and were followed-up continuously. Conclusions Most of the newborns with HT recover within 2 years, while a few develop thyroid dysfunction and require follow-ups.
ABSTRACT
PURPOSE: In this study, we aimed to find useful methods for diagnosis and treatment of hyperthyrotropinemia in neonates showing normal T4 and elevated TSH levels in neonatal screening test. METHODS: We retrospectively reviewed the medical records of 16 male and 26 female neonates whose T4 were normal and TSH were elevated in the neonatal screening test from 1994 to 2006. The clinical data, including perinatal history, thyroid function test and radionuclide scannig was analysed. RESULTS: Of the forty-two patients, male was 38.1% and female was 61.9%. Mean T4 and TSH level were 8.61+/-1.55 ug/dL, 49.66+/-36.56 uU/mL respectively. At the recheck, when recalled, TSH were normalized in 8 patients (19.1%), still elevated in 34 patients (80.9%). (99m)TC thyroid scan was performed in 36 cases. The results were normal in 18 cases (50.0%), diffuse enlargement in 11 cases (30.5%), ectopic thyroid, poor visualization, hypoplasia respectly in 11.2%, 5.5%, 2.8%. Fourteen patients (33.3%) had histories of povidone use for umbilical care. Of the 42 patients, 27 (64.0%) cases were treated by thyroid hormone, 15 cases (36.0%) were followed up without treatment. Among 15 cases without treatment, 8 patients showed TSH normalization at 1.5 months, 5 patients at 3 months, one patient at 6 months and one patient at 9 months. Among 27 cases with treatment, 18 cases (66.7%) are being treated, 5 cases (18.6%) are being treated more than 3 years, the 3-years treatment was ended in 6 cases (22.2%), follow up loss was 3 cases (11.1%). CONCLUSION: At long term follow up, TSH was normalized in many patients who showed normal T4 and elevated TSH levels in neonatal screening test. Imaging study such as (99m)TC thyroid scanning was helpful to decide whether to treat with thyroid hormone replacement. To predict longer term prognosis of cases without thyroid hormone replacement, long term follow up of large number of patients is needed.
Subject(s)
Female , Humans , Infant, Newborn , Male , Diagnosis , Follow-Up Studies , Medical Records , Neonatal Screening , Povidone , Prognosis , Retrospective Studies , Thyroid Dysgenesis , Thyroid Function Tests , Thyroid GlandABSTRACT
PURPOSE: To understand natural course of transient hyperthyrotropinemia, so that the unnecessary treatment could be avoided. METHODS: Total 182 healthy newborns whose TSH levels in newborn screening test had been higher than 20 microIU/mL were recalled. Their serum levels of TSH, T4, free T4 were checked. RESULTS: Among 182 newborns, 10 newborns had congenital hypothyroidism. 68.1 % of healthy newborns who had high TSH levels were normalized within 2 months and all of the rests were normalized within 5 months. CONCLUSION: Transient hyperthyrotropinemia in newborns improves spontaneously. The unnecessary treatment of transient hyperthyrotropinemia should be avoided.