ESPE2021 ePoster Category 2 Thyroid (46 abstracts)
Early reassessment in congenital hypothyroidism
Gema Grau 1 , María Laura Bertholt 2 , María Chueca 3 , Elena Artola 4 , María Concepción Fernández 5 , Ainhoa Sarasua 6 , Amaia Rodríguez 1 , Amaia Vela 7 , Sara Berrade 3 , Cristina Naranjo 2 , Laura Puges 4 , Ignacio Diez 6 , Mercedes Espada 8 , Nieves Ascunce 9 , Begoña Porras 10 & Itxaso Rica 7
1Hospital Universitario Cruces, BioCruces, Barakaldo, Vizcaya, Spain; 2Hospital Universitario Marqués de Valdecilla, Santander, Spain; 3Complejo Universitario de Navarra, Pamplona, Spain; 4Hospital Universitario Donostia, Donosti, Spain; 5Hospital de Basurto, Bilbao, Spain; 6Hospital Universitario Araba, Vitoria, Spain; 7Hospital Universitario Cruces, BioCruces, CIBERER, Barakaldo, Vizcaya, Spain; 8Programa de Cribado Neonatal, Salud Pública Gobierno del País Vasco, Zamudio, Vizcaya, Spain; 9Servicio de Epidemiología y Prevención Sanitaria, Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain; 9Dirección General de Salud Pública, Gobierno de Cantabria, Santander, Spain
Introduction: 2020 ESPE guidelines recommend early reevaluation in primary congenital hypothyroidism (PCH) with thyroid in situ (TIS) and with levothyroxine dose lower than 3 mg/kg/day.
Materials and Methods: Our Congenital Hypothyroidism screening program determine TSH and TT4 in dried blood spot (DBS) at 48 hours of life. A second DBS (DBS2) is indicated when the first is positive. Multicenter retrospective study (05/2016-05/2020; 105,858 screenings) of all newborns ≥33 weeks and/or ≥1500 grams with TSH≥10 mIU/l in DBS2. Serum TSH and FT4 were determined to make final diagnosis: PCH if TSH>20 mIU/l and hyperthyrotropinemia (HT) if TSH 10-20 mIU/l. Levothyroxine dose was assessed at diagnosis, at 6 and 12 months. Differences were related to phenotype.
| Values: median (range) | Dysgenesis/hypoplasias n =25 | TIS n =7 | Hyperthyrotropinemias n =5 | |
| Serum TSH (mIU/l) | 300 (73–779)a | 82.9 (76.3–89.5)a | 15.9 (9.5–1.6)a | |
| Serum FT4 (ng/dl) | 0.7 (0.2–1.2)a,c | 1.7 (1.6–1.8)c | 1.3 (1.2–1.5) | |
| Gestacional age (weeks) | 40 (37–42) | 39 (35–40) | 40 (35–41) | |
| SDS-newborn lenght | 0.2 (-2.0–1.9) | 0.0 (-1,1–2.5) | -0.5 (-3.4–1.3) | |
| SDS-newborn weight | 0.4 (-2.0–2.0) | 0.1 (-1.3–0.5) | -0.2 (-1.8–0.7) | |
| Levothyroxine start (days) | 7.0 (4.0–16.0)b | 7.0 (5.0–15.0) | 18.0 (10.0–44.0)b | |
| Starting dose (µg/kg/day) | 12.5 (2.9–17.0)b,e | 6.5 (3.5–13.0)e | 3.5 (3.0–6.0)b | |
| 6 month dose (µg/kg/day) | 4.5 (2.0–10.0)a,d | 3.0 (1.6–3.8)d | 1.6 (1.1–2.7)a | |
| 12 month dose (µg/kg/day) | 3.9 (1.3– 6.0)a | 2.5 (1.3–3.1)a | 2.0 (1.2–2.0)a | |
| U Mann-Whitney:a P:0.000;b P:0.001;c P:0.002;d P:0.003;eP:0.004 | ||||
Conclusions:
• DBS2 TSH and serum TSH had a good correlation
• Dysgenesis is the most common cause of PCH
• Early reassessment at 6 month of life could be consider in TIS and HT.
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