ESPE Abstracts

Background: Neurological outcomes in congenital hypothyroidism can be optimized by timely diagnosis and treatment. In this study, we compared the neurodevelopmental status of children with congenital hypothyroidism with healthy controls.

Methods: This cross-sectional study was performed in southern India between 2022 and 2024 after obtaining ethics approval. The neurodevelopmental outcome of 42 congenital hypothyroidism cases and 42 age-matched healthy controls were compared using Bayley scales of infant and toddler development (BSID) IV. The factors contributing to the presence of neurodevelopmental delay in children with congenital hypothyroidism were also assessed.

Results: The median age of assessment was 26.3 (23.7 - 32.7) months, and the age at diagnosis was 2(1.8 - 4.5) weeks. Overall, 2 (4.8%) children with congenital hypothyroidism had a major delay (BSID standard score <70), and 6 (14.3%) had mild impairment (BSID IV standard scores ≤84 and ≥70). The median standard score in the cognitive domain was 110 (98.7 – 120) in cases and 120 (110 - 121.2) in controls (p-value = 0.005). Similarly, the score in the language domain was 108 (98 – 120) in cases and 120 (108 – 124) in controls (p-value = 0.005). In the motor domain, it was 109 (98 - 119.7) in cases and 116 (108 - 123) in controls (p-value = 0.006). The median time of treatment initiation since birth was 4.5 (2 - 12) weeks. The median time taken for normalization of TSH was four weeks. A statistically significant negative correlation was observed between the time of treatment initiation and BSID IV standard scores for cognitive (r-value = -0.434, p-value = 0.004), language (r-value = -0.445, p value= 0.004) and motor domains (r-value = -0.523, p-value = 0.000). A statistically significant negative correlation was obtained between the time taken for normalization of TSH and BSID IV standard scores in cognitive (r-value = -0.437, p-value = 0.004), language (r-value = - 0.453, p-value = 0.003) and motor (r-value =-0.420, p-value = 0.006) domains. Parental education, occupation, income, socioeconomic status, initial severity of congenital hypothyroidism, presence of maternal hypothyroidism and compliance to medication did not have a significant association with neurodevelopmental outcome.

Conclusion: Children with congenital hypothyroidism had lower cognitive, language and motor standard scores compared to controls, as demonstrated by BSID IV standard scores. The developmental delay had a significant negative correlation with the time of treatment initiation and the time taken for normalization of TSH.