ESPE2014 Poster Category 2 Thyroid (1) (13 abstracts)
Levothyroxine Requirement in Congenital Hypothyroidism: 12-year Longitudinal Study
Maria Cristina Vigone a , Rosa Lapolla b , Maurizio Delvecchio c , Mariacarolina Salerno d , Malgorzata Wasniewska e , Pietro Pio Popolo b , Alessandro Mussa f , Giulia Maria Tronconi a , Raffaella Di Mase d , Ida D’Acunzo d , Rosa Maria Falcone g , Andrea Corrias f , Filippo De Luca e , Giovanna Weber a , Luciano Cavallo g & Maria Felicia Faienza g
aDepartment of Pediatrics Endocrinology, IRCCS Vita-Salute San Raffaele University, Milan, Italy; bDepartment of Pediatrics, University of Foggia, Foggia, Italy; cPaediatrics Unit IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy; dDepartment of Pediatrics, University of Naples Federico II,
Naples, Italy; eDepartment of Pediatrics, University of Messina, Messina, Italy; fDivision of Pediatric Endocrinology,
Department of Pediatrics, University of Turin, Turin, Italy;
gSection of Pediatrics, Department of Biomedical Sciences
and Human Oncology, University of Bari Aldo Moro,
Bari, Italy
Background: The replacement therapy with levo-thyroxine (LT4) in congenital hypothyroidism (CH) aims to ensure normal growth and neuropsychological development. Few data are available about the appropriate dose during childhood and early adolescence.
Objective and hypotheses: i) To evaluate LT4/kg per day requirement from diagnosis until 12 years of age; ii) to assess any differences in relation to the different etiology of CH as concerns the LT4/kg per day requirement.
Method: Multicentric observational study; 216 patients (142 females) with permanent CH classified as athyreosis, ectopia, in situ gland, on the basis of the thyroid imaging; LT4 dose was recorded from 6 months to 12 years of age and the LT4/kg per day calculated.
Results: The LT4/kg per day requirement statistically decreased year by year, irrespective of etiology. It was about 3–4 μg/kg per day from 1 to 5 and about 2–3 μg/kg per day from 6 to 12 years of age. It was significantly lower in patients with in situ gland than with athyreosis and with ectopic gland from the age of 1 year. Only at 1, 2, and 10 years the LT4/kg per day requirement was higher in athyreotic than in ectopic patients. The LT4/kg per day requirement at 6 months of age was correlated with the requirement at each later time point. The LT4/kg per day dose was modified less frequently in patients with in situ thyroid (40.5%) than in patients with ectopic gland (47.4%) or with athyreosis (48.9%).
Conclusion: Euthyroidism may be achieved by 3–4 and 2–3 μg/kg per day of LT4 in preschool and in school CH patients. The LT4/kg per day dose is affected by the etiology: patients with in situ gland require a lower dose than the other ones. The patients with ectopia or athyreosis require more frequently a change in the daily dose, and thus such patients have to be followed up more frequently. Since the age of 6 months, some patients require higher doses than other ones, irrespective of etiology.
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