Advertisement

Sign up for our daily newsletter

Advertisement

Levothyroxine dosage for congenital hypothyroidism – Initial treatment dose of L-thyroxine in congenital hypothyroidism

Email address. We sought any reports that examined the relationship between starting dose and behavior because behavioral problems have been reported to be an adverse effect of high-dose levothyroxine.

William Thompson
Saturday, August 31, 2019
Advertisement
  • Am Psychol 54 : 5—

  • Initial dose: The results of the between-study comparison should be interpreted with caution since an association between mean development scores and the starting dose of levothyroxine may have been masked by other center-specific characteristics.

  • Biondi B, Wartofsky L. Update of newborn screening and therapy for congenital hypothyroidism.

Publication types

The number of children lost to follow-up or refusing to participate increased with age at assessment. I accept the Terms and Privacy Policy. Cambridge, England Cambridge University Press.

Initially, HC was less affected than height and remained relatively larger, up to age 5 in for congenital groups. CH children were grouped into three etiological categories on the basis of scintigraphic and sonographic findings carried out during childhood: dysgenesis ectopy or hypoplasiaathyreosis, and dyshormonogenesis. Treatment for congenital hypothyroidism: thyroxine alone or thyroxine plus triiodothyronine? Characteristics of Studies. Save Preferences. All of these studies enrolled children whose hypothyroidism was identified by neonatal screening Table 1.

  • As mentioned in the evidence acquisition section, in this study we also evaluated risk of bias in articles that were entered in the review.

  • Hard copies of all potentially relevant articles were retrieved.

  • Italian Journal of Pediatrics

  • Fifty-seven percent of newborns with an initial dose of more than

  • A mean dosage of 7.

  • Initially, HC was less affected than height and remained relatively larger, up to age 5 in all groups.

Receiver operating characteristic curve analysis revealed the optimal cutoff values for levothyroxine dose to individually predict transient congenital hypothyroidism were 3. Horm Res 52 : 49— Acta Paediatr Scand. Griffiths R.

There were no language restrictions. Applies to the hypothtroidism strengths: 25 mcg 0. This important, potentially adverse congenital hypothyroidism of a high starting dose needs to be confirmed in other studies that adjust for possible confounding by severity of hypothyroidism at diagnosis and social factors. NEONATAL screening for congenital hypothyroidism was introduced in the early s in response to the finding that children who were diagnosed based on symptoms of congenital hypothyroidism had better developmental outcomes the earlier treatment was started. The age at final assessment ranged from 1 to 14 years.

We’re sorry, but an unexpected error has occurred.

Sign in to make a comment Sign in to your personal account. Since then, the standard therapy has been early high-dose substitution with L-T4. Adolescents with CH manifested IQ deficits when compared with their peers, despite early high-dose treatment and optimal substitution therapy throughout childhood. Median age at onset of treatment was 9 d range 5—18 d and median starting dose of levothyroxine L-T4 was Psychol Bull.

The changes seen in the doses were not statistically significant. Therefore, early detection of intellectual deficits is mandatory in children with CH. Starting dose was divided into 2 groups using a cutoff of 7. We did not find any randomized controlled trials related to the treatment of CH, and we found only one randomized, double-blind trial that compared a full starting levothyroxine dose of 1.

ALSO READ: Can Epstein Barr Virus Cause Hypothyroidism Causes

CH is the most common endocrine disease in newborns and levothyroxine dosage for biggest preventable cause of mental retardation. Please provide your email address to receive an email when new articles are posted on. Starting dose levothyroxine for the treatment of congenital hypothyroidism a systemic review. For the within-study comparison, inclusion criteria required that the study must 1 be a cohort study of children with congenital hypothyroidism identified by neonatal screening and 2 either include an analysis of the relationship between starting dose and any measure of global or cognitive development or growth, adjusted for severity of hypothyroidism at diagnosis based on serum T4 levels or bone age or include an analysis of the relationship between individual starting dose and any measure of behavior. Differences between the athyreosis group and the dysgenesis group were only significant for the PIQ. Neither study reported an association between starting dose and developmental outcome. This is in line with earlier studies 10 ,

High versus low dose of initial thyroid hormone replacement for congenital hypothyroidism. Touati et al. Arch Dis Child 62 : — Scintigraphic imaging of paediatric thyroid dysfunction. We stipulated that studies included in the within-study comparison had to address the potential confounding effects of severity of hypothyroidism at diagnosis. Rovet JF Long-term neuropsychological sequelae of early treated congenital hypothyroidism: effect in adolescence.

Sign in to make a comment Sign in to your personal account. The changes seen in the doses were not statistically significant. Global IQs at 5 years, 9 months, were similar: medians elvothyroxine were 87 to84 toand 88 to not significant for severe CH, moderate CH, and control children, respectively. Studies Analysis After critical appraisal of the studies selected for this review, we extracted the study design and main results for each study and classified its findings, the initial treatment dose and initiation time of treatment, separately. J Clin Endocrinol Metab 91 : —

Usual Adult Dose for TSH Suppression

Because PIQ is particularly affected in children with athyreosis, which may reflect a specific injury pattern, it is conceivable that also the interaction between SES and group is stronger within PIQ compared with VIQ. UK indicates United Kingdom. We did not attempt a quantitative analysis of the effect of starting dose on development due to the lack of consistency in the measures used for starting dose and other covariates and in the measures of association. Screening for congenital hypothyroidism: results of screening one million North American infants.

Purchase access Subscribe now. IQ was significantly lower than controls after adjustment for socioeconomic status and gender Dickerman Congenital hypothyroidism Vries L Prepubertal and pubertal growth, timing and duration of puberty and attained adult height in patients with congenital hypothyroidism CH detected by neonatal screening programme for CH—a longitudinal study. The changes between the presentation of the drug were not statistically significant, however, it is said that the use in the liquid formula of Levothyroxine is much more adequate in changes of TSH and its normalization as well as in its reflection at T4 and T3. Starting dose was divided into 2 groups using a cutoff of 7. Joint statement on the U. Thyroxine dose for congenital hypothyroidism.

ALSO READ: Bmi 30 Pregnancy Weight Gain

Early detection and treatment of CH facilitates normal pre-pubertal and pubertal growth and achievement of normal adult height, following normal puberty. Levothyroxine dosage for congenital hypothyroidism may be due to differential effects of prenatal thyroid hormone loss affecting selective brain regions at different times in development. Critical Assessment of Articles All selected studies were critically evaluated in terms of the probability of bias and confounding effects; for each article included in this systematic review, using the STROBE v4 Statement-Checklist 15risk of biases including probability of selection bias, loss during follow up bias, and confounders were assessed. Table 2 Treatment variables for specific age periods Full size table. Examiners were not involved in the endocrinological follow-up and thus were independent.

The relevance of the weak correlation, found in the Norwegian-Swedish study, between starting hypotuyroidism and the onset of childhood component of growth cow growth in later childhood and final adult height is uncertain. UK indicates United Kingdom. Publication types Review. Because the evidence for an association between severity of hypothyroidism at diagnosis and later behavior is inconsistent, 1824 we included reports regardless of whether they took account of severity of hypothyroidism. Evaluation of L-thyroxine replacement therapy in children with congenital hypothyroidism. Although neonatal screening for hypothyroidism has been in operation for more than 20 years, we found no randomized controlled trials comparing the effects of different starting doses on clinical outcomes.

Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. SPSS Clin Endocrinol Oxf. Results Two thousand three hundred and seventy-four articles excluding duplicates were retrieved from the primary search. Both parameters were not related to IQ at 14 y Table 4. Please review our privacy policy.

Publications

Neither study reported an association between starting dose and developmental outcome. Mean developmental score for cohorts at youngest age of assessment. Outcome was compared with an optimal control group.

Similarly, analysis of serum T4 level as a categorical variable reduces the power of the levothyroxine dosage for congenital hypothyroidism to control adequately for confounding. Pediatr Res. J Pediatr Endocrinol Metab. Derksen-Lubsen GVerkerk PH Neurological development in early treated congenital hypothyroidism: analysis of literature data. Two studies 1216 each reported a single episode of thyrotoxicosis. Continue Reading. Patients receiving lower doses of levothyroxine were found to have greater success in discontinuing therapy and may benefit from early discontinuation.

ALSO READ: Stewardess Diet Menu Plan

Italian Journal of Pediatrics Interestingly, we could not detect an association between median endocrinological levels throughout childhood or elvothyroxine undertreatment as well as over-treatment and intellectual impairment. Patients with transient congenital hypothyroidism were more likely to have smaller increases in serum TSH concentrations at diagnosis and were more likely to start levothyroxine treatment later during the first month of life compared with patients with permanent congenital hypothyroidism. A lower dose of levothyroxine treatment at age 6 months in infants with a normally located thyroid gland and a lower likelihood of having a first-degree family history of congenital hypothyroidism were associated with transient congenital hypothyroidism vs. Arch Fr Pediatr. Please review our privacy policy.

Because of potential biases due to loss to follow-up at older ages, we also plotted the mean scores for the youngest age of assessment Figure 2. One reviewer I. Please login or register first to view this content. Login Register.

Related Content. This view is supported by studies on early intervention programs for children at risk, demonstrating that intensive programs may be particularly effective in low-income families Arch Dis Child 62 : — In group 1, anthropometric measurements in the majority were in the 50th percentile or above. Six months experience with a reliable, efficient and inexpensive method. Received : 31 March The quality of the research and the methodology applied to the development of the reviewed clinical trials gave us as a result: 1 articles of low quality, 2 articles of medium quality and no article of high quality was obtained Table 2 3 articles were considered; 2 of medium quality and 1 of low quality, for purposes of the purpose of the work, the publication dates of the works ranged between andfocused on patients with HC treated with hormone replacement therapy.

Related Content

Neither study reported an association between starting dose and developmental outcome. Handbook and Test Instructions. Results Two thousand three hundred and seventy-four articles excluding duplicates were retrieved from the primary search.

Evidence Acquisition 2. Purchase access Subscribe now. In general, 22 studies met our aims, of which in, 17 and 13 studies initial dosage and initiation time of treatment was discussed, respectively. There was a trend toward stronger interaction in the athyreosis group slope 4.

They did not differ with respect to intelligence quotient IQ level, birth weight, pretreatment T4 levothyroxine dosage for congenital hypothyroidism TSH, age at onset of treatment, and initial dose of L-T4 compared with those who were followed until 14 y. Effect of high levothyrxoine low initial doses of L-thyroxine for congenital hypothyroidism on thyroid function and somatic growth. Following diagnosis, if tested positive for CH, what is important is the early treatment of children with CH, using an appropriate initiation dose of levothyroxine sodium. Abstract Context Appropriate management of neonates, tested positive for congenital hypothyroidism CHin particular, the initial dosage of levothyroxine and the time of initiation of treatment is a critical issue. Acta Paediatr Suppl 88 : 88—

The within-study comparison of 4 cohort studies based on patients that reported the effect of the starting dose of levothyroxine on cognitive hypothyroixism found no consistent effects. Acta Endocrinol. Thanks for visiting Endocrinology Advisor. There were, however, some studies that disagreed with increasing levothyroxine dose at initiation of treatment. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account. Myxedema Coma: Elderly and Patients with Cardiovascular Disease: IV use is associated with cardiac toxicity, therefore, doses at the lower end of the dose range should be used in these populations.

Want to read more?

No justifications were given for the cutoffs used and no other confounding factors were included in the analysis. There was weak evidence for an effect of starting hypothyroidism on growth 1 study and on behavior problems 1 study. New England Congenital Hypothyroidism Collaborative, Neonatal hypothyroidism screening: status of patients at 6 years of age. Our aim was to determine whether the mean IQ or DQ for the cohort was correlated with the mean starting dose of levothyroxine. Alternatively or in addition, unbiased estimates of the effect of starting dose of levothyroxine on development, growth, and behavior in the long term could be determined by undertaking a multicenter randomized controlled trial.

Yang et al. Conclusions Considering the results of this review, apparently there is no difference in opinion regarding the early initiation of treatment, whereas determining the optimal dose of levothyroxine for start of treatment in CH patients still remains a controversial issue, demonstrating the need for further studies, despite the fact that use of high doses can lead to rapid normalization of biochemical indices, although this may cause complications. Acta Endocrinol. Treatment and follow-up of children with transient congenital hypothyroidism. CCT Inadequate Inadequate yes not specified not specified not specified Table 2 Evaluation of quality in the recovered works. Overall, based on the results of our systematic review, we conclude that early detection is a fundamental key in dealing with congenital hypothyroidism; hence, there is no controversy or dispute regarding the issue of timing and initiation of treatment. J Pediatr Endocrinol.

Acta Endocrinol. The primary outcome was predictive factors of transient disease in infants with congenital hypothyroidism. If you wish to read unlimited content, please log in or register below. Replacement therapy for congenital hypothyroidism was initially determined empirically and was based on the use of desiccated thyroid.

The results were inconsistent. Research in Congenital Hypothyroidism. Characteristics of Studies. Thirty-three potentially relevant studies were evaluated against the inclusion criteria references available.

1. Context

For congenital the evidence for an association between severity of hypothyroidism at hypothyroidsm and later behavior is inconsistent, 1824 we included reports regardless of whether they took account of severity of hypothyroidism. This Issue. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Statacorp, Stata Statistical Software: Release 6. In preterm patients, patients with permanent congenital hypothyroidism needed higher levothyroxine doses at discontinuation compared with patients with transient congenital hypothyroidism 3.

We thank For congenital hypothyroidism Congehital. Adult height in CH is significantly correlated with parental height and the mean L-T4 daily dose administered over the first six months of treatment. IQ was significantly lower than in controls after adjustment for socioeconomic status and gender The data suggest that optimal treatment includes achievement of euthyroidism before the third week of life by initiation of therapy before 13 days. Fifty-seven percent of newborns with an initial dose of more than Acta Endocrinol.

Starting dose of levothyroxine for the treatment of congenital hypothyroidism: a systematic review. Horm Res 52 : 49— Thus, close surveillance, early detection of developmental delay, and intervention programs are particularly important for this specific subgroup of children with CH. Cambridge, England Cambridge University Press. Growth and bone age maturation are not affected by such a high dose.

  • Rovet JF Long-term neuropsychological sequelae of early-treated congenital hypothyroidism: effects in adolescence. Acta Paediatr Scand 78 : —

  • The report by Bongers-Schokking et al 51 of a weak association between a composite measure dose divided by log age at the start of treatment and developmental outcome up to 2.

  • Derksen-Lubsen GVerkerk PH Neurological development in early treated congenital hypothyroidism: analysis of literature data. In this study, all published research related to the initiation treatment dose and the onset time of treatment in congenital hypothyroidism were reviewed.

  • Poster Board FRI Eur J Endocrinol.

  • We found that initial disease severity was the only predictor of later intellectual outcome. However, we found several studies that contradict these results, e.

J Endocrinol Invest. The limitations of the evidence found do not support clinical recommendations of fof or standard starting doses of levothyroxine. Acta Paediatr Suppl. Cohorts are ranked according to mean starting dose of levothyroxine. Replacement therapy for congenital hypothyroidism was initially determined empirically and was based on the use of desiccated thyroid.

There was weak evidence for an effect of starting dose on growth 1 study hypothyroiddism on behavior problems 1 study. Get free access to newly published articles Create a personal account or sign in to: Register for email alerts with links to free full-text articles Access PDFs of free articles Manage your interests Save searches and receive search alerts. Psychol Bull. More reliable information, based on a randomized controlled trial of starting dose or a meta-analysis of the individual patient data currently available, is required to inform treatment policies.

Congenitql also recorded results from studies that cattle overeating disease in cow the relationship between starting dose and any measure of growth, after adjusting for severity of hypothyroidism at diagnosis. They concluded that the prompt restoration of clinical and biochemical euthyroidism during early infancy is a safe and effective method for treatment of children with CH. Replacement therapy for congenital hypothyroidism was initially determined empirically and was based on the use of desiccated thyroid. Similar results were observed at the oldest age assessed.

J Pediatr : — SPSS Because to our knowledge there have been no controlled trials comparing starting doses of levothyroxine treatment, we first compared mean population standardized developmental scores in cohorts with different mean starting doses of levothyroxine between-study comparison. Treating congenital hypothyroidism: maximum age limit up to which a socially compatible child is expected. SES is an additional risk factor for adverse outcome.

Get free access to newly published articles. There was weak evidence for an effect of starting dose on growth 1 study and on behavior congenital hypothyroidism 1 study. This change probably reflects the start of the influence of growth hormone on linear growth. They concluded that discontinuation of levothyroxine at a dose of 2. Dussault JH Follow-up at ages 5 and 7 years on mental development in children with congenital hypothyroidism detected by Quebec Screening Program. We also recorded results from studies that examined the relationship between starting dose and any measure of growth, after adjusting for severity of hypothyroidism at diagnosis. Acta Paediatr.

Update of newborn screening and therapy for congenital hypothyroidism. Williams textbook of endocrinology. Defined age periods were formed 2 mo to 1 y, 1—4, 4—7, and 7—14 y. The limitations of the evidence found do not support clinical recommendations of high or standard starting doses of levothyroxine. New England Congenital Hypothyroidism Collaborative, Elementary school performance of children with congenital hypothyroidism.

Publication types

Critical Assessment of Articles All selected studies levothyroine critically congenital hypothyroidism in terms of the probability of bias and confounding effects; for each article included in this systematic review, using the STROBE v4 Statement-Checklist 15risk of biases including probability of selection bias, loss during follow up bias, and confounders were assessed. Clin Pediatr Phila. We are aware that VIQ and PIQ are summary scores of multiple abilities in two major functional domains and that subtest results are not presented here. Try out PMC Labs and tell us what you think.

Conclusions Congenitap this study, we reviewed studies assessing the effects of initial dosage of levothyroxine and the for congenital initiation of treatment in children with congenital hypothyroidism. Table 2 Treatment variables for specific age periods Full size table. Received: June 11, Published: June 27, Author information Article notes Copyright and License information Disclaimer. View Large Download. Two reviewers independently reviewed and scanned the titles and abstracts of all studies generated by the search.

Get free access to newly published articles Create a personal account or sign in to: Register for email alerts with links to free full-text articles Access PDFs of free articles Manage your interests Save searches and receive search alerts. These criteria can be seen below:. There were no language restrictions. Selva et al. Another one was excluded because of pseudohypoparathyroidism and dysmorphic features suspecting fetal alcohol syndrome. Purchase access Subscribe to the journal. Finally, the Dutch study 51 involved 61 children and found no direct association between starting dose and MDI or Psychomotor Developmental Index PDI measured between age 10 months and 2.

Six more cohort studies identified by the searches failed congneital meet all of the inclusion criteria because mean development scores were not given 1352 or there levothyroxine dosage for congenital hypothyroidism no information on the starting dose. New England Congenital Hypothyroidism Collaborative, Correlation of cognitive test scores and adequacy of treatment in adolescents with congenital hypothyroidism. Between-Study Comparison. Following diagnosis, if tested positive for CH, what is important is the early treatment of children with CH, using an appropriate initiation dose of levothyroxine sodium. Several recent studies have examined the long-term intellectual outcome after CH.

Publications

Prev Med. Although the extensive search of databases worldwide and close examination of the available evidence are considered the strong point for this study, there were some potential limitations in this review. Considering the results of this levothyroxine dosage for congenital hypothyroidism, apparently there is no difference in opinion regarding the early initiation of treatment, whereas determining the optimal dose of levothyroxine for start of treatment in CH patients still remains a controversial issue, demonstrating the need for further studies, despite the fact that use of high doses can lead to rapid normalization of biochemical indices, although this may cause complications. We did not find any randomized controlled trials. Try out PMC Labs and tell us what you think.

  • Literature search.

  • Studies were weighted by the inverse of the variance, and the model included terms for the proportion of children congenial and age at assessment. The relevance of the weak correlation, found in the Norwegian-Swedish study, between starting dose and the onset of childhood component of growth for growth in later childhood and final adult height is uncertain.

  • Sixty-three prospectively followed children with CH were assessed at age of 14 y with the Wechsler Intelligence Scale for Children-Revised and compared with healthy controls. In group 2, anthropometric measurements in the majority were below the 50th percentile.

  • Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

May Compared with patients with transient congenital hypothyroidism, patients with permanent disease were on a higher levothyroxine dose at discontinuation 4. Levothyroxine discontinuation failed in Study selection.

Weak evidence for an association between high starting dose and adverse behavior at 8 years indicates that further study is necessary. Hypotbyroidism of potential biases due to loss to follow-up at older ages, we also plotted the mean scores for the youngest age of assessment Figure 2. The report by Bongers-Schokking et al 51 of a weak association between a composite measure dose divided by log age at the start of treatment and developmental outcome up to 2. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major thyroid and pediatrics journals published within the past 35 years. Last updated on April 9, Literature search. Dose and age explained only 7.

Usual Adult Dose for Hypothyroidism

The researchers called for further prospective studies to levothyroxine dosage for congenital hypothyroidism the levothyroxine dose requirement with these cutoffs during routine monitoring or reevaluation of thyroid function in patients with no history of familial congenital hypothyroidism. The articles demonstrated medical evidence of improvement in somatometric and cognitive status in patients, causing an impact on symptom relief. DOI: We conclude that despite early high initial treatment and optimal substitution during childhood, a significant proportion of children with CH manifest intellectual deficits in adolescence, in particular those with an athyreosis. Replacement therapy for congenital hypothyroidism was initially determined empirically and was based on the use of desiccated thyroid.

One thousand one hundred sixty-six articles excluding duplicates were retrieved from the electronic congejital and from additional search methods, including hand-searches of textbooks, committee reports, and the forward citation search. Purchase access Subscribe to JN Learning for one year. Dussault JHMorrissette J Higher sensitivity of primary thyrotropin in screening for congenital hypothyroidism: a myth? Ilicki ALarsson A Psychological development at 7 years of age in children with congenital hypothyroidism. Adverse Effects Other Than Behavior. Pregnancy: New Onset Hypothyroidism: -Patients with moderate to severe signs and symptoms of hypothyroidism: 1.

ALSO READ: Hypothyroidism Test Kit

Overall, the majority of these studies emphasized the initial high dose of levothyroxine and early treatment of newborns with hypothyroidism. Acta Paediatr. Hulse JA Outcome for congenital hypothyroidism. One thousand one hundred sixty-six articles excluding duplicates were retrieved from the electronic databases and from additional search methods, including hand-searches of textbooks, committee reports, and the forward citation search. Cohorts are ranked according to mean starting dose of levothyroxine.

Treatment with thyroid hormone. The therapeutic regimen was regularly monitored by hypothytoidism in private practice, initially every 2—4 wk, then every 3—6 mo, by capillary blood on filter paper. The study initially included 89 prospectively enrolled children with CH, detected by neonatal screening. In conclusion, despite early high initial treatment according to the guidelines issued in the early s, intellectual deficits compared with controls persist. Patients with transient congenital hypothyroidism were more likely to have smaller increases in serum TSH concentrations at diagnosis and were more likely to start levothyroxine treatment later during the first month of life compared with patients with permanent congenital hypothyroidism. Evidence Acquisition 2. The changes seen in the doses were not statistically significant.

Purchase access Subscribe to JN Learning for one year. Although higher-dose regimens lead to more rapid normalization of biochemical indices, we found forr clear evidence for an effect on cognitive or global development. We analyzed the available cohort data using 2 approaches and found no clear evidence for an effect of starting dose of levothyroxine on cognitive or global development, growth, or behavior. Forward citation searches were conducted for all studies that met the inclusion criteria up to March Medically reviewed by Drugs. There were no language restrictions. Sign in to access your subscriptions Sign in to your personal account.

J Pediatr. We aimed to systematically evaluate the evidence of an effect of levothyroxine starting dose on development, growth, and behavior. Two studies 1216 each reported a single episode of thyrotoxicosis.

New England Congenital Hypothyroidism Collaborative, Correlation of cognitive test scores and adequacy of treatment in adolescents with congenital hypothyroidism. View Metrics. Compared with standard dosage regimens, a higher starting dose of levothyroxine for treatment of congenital hypothyroidism results in more rapid normalization of biochemical indices but the effect on development or growth is uncertain. Login Register. More reliable information, based on a randomized controlled trial of starting dose or a meta-analysis of the individual patient data currently available, is required to inform treatment policies. Dickerman ZDe Vries L Prepubertal and pubertal growth, timing and duration of puberty and attained adult height in patients with congenital hypothyroidism CH detected by neonatal screening programme for CH—a longitudinal study. Create a free personal account to make a comment, download free article PDFs, sign up for alerts and more.

ALSO READ: Hypothyroid Weight Loss Blog Titles

Select one or more newsletters to continue. Evidence acquisition: In this study, all hypothyrlidism research related to the initiation treatment dose and the onset time of treatment in congenital hypothyroidism were reviewed. The relevance of the weak correlation, found in the Norwegian-Swedish study, between starting odsage and the onset of childhood component of growth for growth in later childhood and final adult height is uncertain. The results of the between-study comparison should be interpreted with caution since an association between mean development scores and the starting dose of levothyroxine may have been masked by other center-specific characteristics. The researchers excluded patients who had aplastic, hypoplastic, or ectopic glands on thyroid ultrasonography or scan. Get free access to newly published articles Create a personal account or sign in to: Register for email alerts with links to free full-text articles Access PDFs of free articles Manage your interests Save searches and receive search alerts.

In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. The limitations of the evidence found do not support clinical recommendations of high or standard starting doses of levothyroxine. The inclusion criteria for the between-study comparison required that participants were children with congenital hypothyroidism identified by neonatal screening whose global development or cognitive development had been assessed using a population-standardized measure. The researchers excluded patients who had aplastic, hypoplastic, or ectopic glands on thyroid ultrasonography or scan. Conclusions The evidence for an effect of starting dose of levothyroxine on cognitive development, growth, or behavior is too weak to justify recommendations in favor of high- or standard-dose regimens. UK indicates United Kingdom. These include differential loss to follow-up, the spectrum of severity of hypothyroidism, the types of children refusing or excluded from participation, the performance of the IQ or DQ assessment, and secular trends in IQ score.

Blinding in the measurements: 1 point. They found no evidence for an effect of mean starting dose on mean IQ score. Treating congenital hypothyroidism: maximum age limit up to which a socially compatible child is expected.

Please try again later. Another one was excluded because of pseudohypoparathyroidism and dysmorphic features suspecting fetal alcohol syndrome. For the between-study comparison, we recorded the mean starting dose of levothyroxine, the number of patients identified with congenital hypothyroidism, the number of patients excluded from the developmental assessment and reasons for this, the number undergoing testing for IQ or developmental quotient DQand the mean IQ or DQ score at each age of assessment. Evidence Acquisition 2. Compared with standard dosage regimens, a higher starting dose of levothyroxine for treatment of congenital hypothyroidism results in more rapid normalization of biochemical indices but the effect on development or growth is uncertain. Similarly, analysis of serum T4 level as a categorical variable reduces the power of the study to control adequately for confounding. Table 2 Treatment variables for specific age periods Full size table.

Full size image. Pediatrics 83 : — Dimitropoulos, et al. NEONATAL screening for congenital hypothyroidism was introduced in the early s in response to the finding that children who were diagnosed based on symptoms of congenital hypothyroidism had better developmental outcomes the earlier treatment was started. Pediatr Res.

Create a free personal account to download free article PDFs, sign up for alerts, and more. Pediatrics : — Their mental age was deficient on average by 14 months with IQ ranging between 50 and

The analysis adjusted for serum T 4 level at diagnosis measured as a continuous variable and socioeconomic status measurement not specified. Derksen-Lubsen GVerkerk PH Neurological development in early treated congenital hypothyroidism: analysis of literature data. Open Next post in Thyroid Close. FDA Safety Alerts for all medications. Follow EndoAdvisor. Thirty-three potentially relevant studies were evaluated against the inclusion criteria references available. Acta Paediatr Suppl.

Congenital hypothyroidism found weak evidence for increased behavior problems in children given a high starting dose of levothyroxine. Wien: Hans Huber Bern Stuttgart. Meghan Elizabeth Craven. August 29, Rovet JF Long-term neuropsychological sequelae of early treated congenital hypothyroidism: effect in adolescence. However, the results of the above-mentioned study were not compared with a control group. We could show that early high-dose treatment and optimal substitution treatment throughout childhood cannot fully normalize intellectual performance in children with CH.

Conclusion: The articles demonstrated medical evidence of improvement in somatometric and cognitive status in patients, causing an impact on symptom relief. Treatment with thyroid hormone. You've successfully added to your alerts.

Five studies 20384251 levothyroxine dosage for congenital hypothyroidism, 58 met the inclusion criteria. Clause M. One child had an athyreosis, but substitution therapy started only at 90 d because the child's blood sample was mistaken for that of a healthy child. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially. An underlying assumption in this ecologic analysis was that the spectrum of patients identified by screening would be similar, and population differences in mean developmental scores might therefore be attributable to differences in the starting dose. Intellectual outcomes in children with CH are affected by bone age, initial serum T4, hypothyroidism etiology, and age at which treatment is started.

Forward citation searches were conducted for all studies that met the inclusion criteria and were levothyroxine dosage for congenital hypothyroidism before the mentioned date. Their mental age was deficient on average ldvothyroxine 14 months with IQ ranging between 50 and Rovet JF Long-term neuropsychological sequelae of early treated congenital hypothyroidism: effect in adolescence. An underlying assumption in this ecologic analysis was that the spectrum of patients identified by screening would be similar, and population differences in mean developmental scores might therefore be attributable to differences in the starting dose.

Yang et al. No significant differences for IQ were observed with various initial LT4. After applying the primary screening, based on the date of publication of the article, main topic, and type of study. Dickerman ZDe Vries L Prepubertal and pubertal growth, timing and duration of puberty and attained adult height in patients with congenital hypothyroidism CH detected by neonatal screening programme for CH—a longitudinal study.

Exp Clin Endocrinol Diabetes : 28— Eur J Pediatr. August 29, You are using a browser version with limited support for CSS. IQ at 14 y was the dependent variable, SES and gender were covariates for which each analysis was corrected.

Jones et al. Growth follow-up in children with congenital hypothyroidism before and during treatment. Click Here to Manage Email Alerts. Episodes of overtreatment during the first six months in children with congenital hypothyroidism and their relationships with sustained attention and inhibitory control at school age.

These were assessed by 2 independent reviewers R. The relevance of dosaye weak correlation, found in the Norwegian-Swedish study, between starting dose and the onset of childhood component of growth for growth in later childhood and final adult height is uncertain. Administration advice : -Take orally once a day on an empty stomach, preferably one-half to 1 hour before breakfast -Drugs that can decrease the absorption of levothyroxine should not be taken within 4 hours e. Our website uses cookies to enhance your experience. Replacement therapy for congenital hypothyroidism was initially determined empirically and was based on the use of desiccated thyroid.

Pediatrics 83 : — End results in treatment of congenital hypothyroidism; follow-up study of physical, mental and behavioral development. View author publications.

  • Eur J Endocrinol : —

  • The analysis adjusted for serum T 4 level at diagnosis measured as a continuous variable and fo status measurement not specified. Only 2 studies, UK II 42 and the Netherlands, 51 analyzed the starting dose of levothyroxine and serum T 4 level a measure of the severity of hypothyroidism as continuous variables.

  • Treatment and follow-up of children with transient congenital hypothyroidism.

  • Hence further studies providing stronger evidence regarding this issue are required to reach a definitive decision. Bongers-Schokking JJ, de Muinck Keizer-Schrama SM Influence of timing and dose of thyroid hormone replacement on mental, psychomotor, and behavioral development in children with congenital hypothyroidism.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Pediatric Endocrinol. New Dosaeg Congenital Hypothyroidism Collaborative, Congenital hypothyroidism of infantile hypothyroidism discovered on neonatal screening. The report by Bongers-Schokking et al 51 of a weak association between a composite measure dose divided by log age at the start of treatment and developmental outcome up to 2. Twitter Facebook Email. In addition, there are possible adverse effects of high-dose regimens and elevated T 4 levels on temperament and behavior in later childhood.

Eur J Endocrinol : — Twitter Facebook Email. In addition, among all neonatal variables, only pretreatment T4 levels were associated with outcome. Adolescents with athyreosis and lower SES were at particular risk for adverse outcomes. Pediatr Res 24 : 6—8.

Read more about:

Sidebar1?
Sidebar2?