ESPE Abstracts (2022) 95 P2-283

ESPE2022 Poster Category 2 Thyroid (22 abstracts)

Identification of Predictors of Transient and Permanent Congenital Hypothyroidism

Constanza Navarro-Moreno & Ana-Lucía Gómez-Gila

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Pediatric Endocrinology Unit. Hospital Infantil Universitario Virgen del Rocío, Sevilla, Spain


Introduction: Congenital hypothyroidism (CH) is classified as permanent CH (PCH) if levothyroxine (LT4) is life-long required, or as transient CH (TCH) if after LT4 discontinuation thyroid function remains normal. Early detection of TCH allows early discontinuation of LT4.

Purposes: To identify predictors of TCH and PCH, and their cut-off value.

Subjects and Methods: Retrospective study of patients aged >3 years diagnosed of CH from 1993. Exclusion criteria: ≤32 weeks of gestation and birth weight ≤1500g. Patients are classified as PCH in case of high TSH after LT4 discontinuation, or compatible thyroid imaging (athyreotic or ectopic gland).

Results:

N=114 PCH
(n=92, 80.7%)
N TCH
(n=22, 19.3%)
N P -Cut-off value (ROC area)
-Cut-off value with specificity >95% for PCH/TCH
Screening TSH (mIU/l)b 101 (23.7-180) 61 15.3 (12.7–18.7) 13 <0.001 ≥18.8 (0.83)
≥54.8/<4.61
Diagnosis TSH (mIU/l)b 151 (52.28–425) 87 39 (13.86–59.3) 21 <0.001 ≥59.3 (0.85)
≥99.5/<23.6
Diagnosis fT4 (ng/dl)b 0.495 (0.25–1.06) 84 1.14 (0.75–1.61) 20 <0.001 ≥ 0.95 (0.76)
<0.36/≥1.77
Thyroid imaginga
- Apparent aplastic or hypoplastic
- Ectopic
- In situ
- Enlarged
24 (27.59%)
41 (47.13%)
16 (18.39%)
6 (6.9%)
87
2 (12.5%)
11 (68.75%)
3 (18.75%)
16 <0.001  
Starting LT4 dose (µg/kg)c 12.91 (3.74) 79 9.81 (3.44) 21 <0.001 ≥10.72 (0.74)
≥13.81 / <7.81
6 months LT4 dose (µg/kg/day)b
- <3 µg/kg/daya
4.47 (3.75–5.33)
3 (4%)
75
3.11 (2.36 – 3.73)
6 (42.86%)
14
<0.001
<0.001
≥3.74 (0.83)
≥5.12/<3.1
12 months LT4 dose (µg/kg/day)b
- <3µg/kg/daya
4.3 (3.7–5.19)
12 (15.19%)
79 2.4 (1.5–2.88)
13 (76.47%)
17 <0.001
<0.001
≥3.15 (0.92)
≥3.87/<2.25
3 years LT4 dose (µg/kg/day)b
- <3µg/kg/daya
3.73 (3–4.44)
8 (25.8%)
37 1.7 (1–2.08)
18 (94.7%)
19 <0.001
<0.001
≥2.42 (0.91)
≥2.5/<1.4
aFrequency
bMedian (interquartile range)
cMean (SD)
Gestational age, birth weight, TSH and fT4 at age 6 and 12 months do not show significant differences between TCH and PCH groups.

Conclusions: The strongest predictors of PCH are LT4 dose ≥3.15 µg/kg/day at age 12 months, and LT4 dose ≥2.42 µg/kg/day at age 3 years.
While screening TSH <4.61 mIU/l, diagnosis TSH <23.6 mIU/l, diagnosis fT4 ≥1.77 ng/dl, starting LT4 dose <7.81 µg/kg/day, LT4 dose <3.1 µg/kg/day at age 6 months, LT4 dose <2.25 µg/kg/day at age 12 months and LT4 dose <1.4 µg/kg/day at age 3 years individually predict TCH.
These predictors allow to identificate which patients may benefit for an ealy LT4 discontinuation.

Volume 95

60th Annual ESPE (ESPE 2022)

Rome, Italy
15 Sep 2022 - 17 Sep 2022

European Society for Paediatric Endocrinology 

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