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Clinical Endocrinology

Mild neonatal hyperthyrotrophinaemia: 10-year experience suggests the condition is increasingly common but often transient

Authors

  • Asaf Oren,

    1. Division of Pediatric Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
    2. Departments of Pediatrics and Physiology, University of Toronto, Toronto, ON, Canada
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  • Michael K. Wang,

    1. Division of Pediatric Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
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  • Lori Brnjac,

    1. Division of Pediatric Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
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  • Farid H. Mahmud,

    1. Division of Pediatric Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
    2. Departments of Pediatrics and Physiology, University of Toronto, Toronto, ON, Canada
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  • Mark R. Palmert

    Corresponding author
    1. Division of Pediatric Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
    2. Departments of Pediatrics and Physiology, University of Toronto, Toronto, ON, Canada
    • Correspondence: Mark R. Palmert, Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada. Tel.: +1 416 813 6217; Fax: +1 416 813 6304; E-mail: mark.palmert@sickkids.ca

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Summary

Objective

To examine a large population of infants with mild neonatal hyperthyrotrophinaemia (MNH) and determine prevalence, clinical characteristics and treatment history.

Methods

Retrospective study of infants with MNH followed at The Hospital for Sick Children between 2000 and 2011. MNH was defined by an abnormal newborn screen followed by thyroid-stimulating hormone (TSH) between 5 and 30 mU/l and normal free T4 (FT4) on confirmatory tests.

Results

Mild neonatal hyperthyrotrophinaemia represented 22·3% of patients (103/462; 60 boys, 43 girls) within our clinic. Incidence increased from two of 20 in 2000 to 31 of 74 cases in 2010. Seventy eight percent of patients started L-thyroxine (initial dose: 8·3 ± 2·5 mcg/kg). The treated group had higher confirmatory TSH levels (= 0·001) and had undergone thyroid scintigraphy more often (= 0·0001) compared with the nontreated group. Evidence of overtreatment was detected in 45% of thyroid function tests obtained during treatment. Among the treated infants who had reached 3 years of age, 45% (= 14) underwent a trial-off medication. Compared with those not trialled-off therapy, these infants were less likely to have had dose escalations during treatment (= 0·001). The trial-off treatment was successful in 50% of cases. In the subset of infants with confirmatory TSH >10 mU/l, trial-off therapy was successful in 40%. None of the assessed variables predicted success of trial-off therapy.

Conclusions

Mild neonatal hyperthyrotrophinaemia is an increasingly common diagnosis. It is more common in males and is often transient, but predictors of success of trial-off therapy were not identified. Further studies are needed to determine optimum L-thyroxine dosing and to determine whether treatment improves neurocognitive outcomes.

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