Mean High-Dose l-Thyroxine Treatment Is Efficient and Safe to Achieve a Normal IQ in Young Adult Patients With Congenital Hypothyroidism
PE Aleksander, M Brückner-Spieler… - The Journal of …, 2018 - academic.oup.com
PE Aleksander, M Brückner-Spieler, AM Stoehr, E Lankes, P Kühnen, D Schnabel, A Ernert…
The Journal of Clinical Endocrinology & Metabolism, 2018•academic.oup.comContext The optimal levothyroxine (LT4) dose to treat congenital hypothyroidism (CH)
remains unclear, with debate over whether higher starting doses (> 10 µg/kg) are necessary
and safe for a normal intelligence quotient (IQ). Objective To examine psychomotor,
metabolic, and quality of life (QoL) outcomes in patients with CH treated with a mean high
initial LT4 dose. Design, settings, participants A cross-sectional cohort study of patients with
CH identified in the Berlin newborn screening program from 1979 to 2003; 76 patients with …
remains unclear, with debate over whether higher starting doses (> 10 µg/kg) are necessary
and safe for a normal intelligence quotient (IQ). Objective To examine psychomotor,
metabolic, and quality of life (QoL) outcomes in patients with CH treated with a mean high
initial LT4 dose. Design, settings, participants A cross-sectional cohort study of patients with
CH identified in the Berlin newborn screening program from 1979 to 2003; 76 patients with …
Context
The optimal levothyroxine (LT4) dose to treat congenital hypothyroidism (CH) remains unclear, with debate over whether higher starting doses (>10 µg/kg) are necessary and safe for a normal intelligence quotient (IQ).
Objective
To examine psychomotor, metabolic, and quality of life (QoL) outcomes in patients with CH treated with a mean high initial LT4 dose.
Design, settings, participants
A cross-sectional cohort study of patients with CH identified in the Berlin newborn screening program from 1979 to 2003; 76 patients with CH (mean age, 18 years; mean initial LT4 dose, 13.5 µg/kg) and 40 siblings completed the study.
Main outcome measures
Psychomotor (Wechsler Intelligence Test, CNS Vital Signs), QoL (short form-36 Health Survey), anthropometric (body mass index, height), and metabolic (intima media thickness, laboratory parameters) outcomes were compared with those of healthy siblings. Mean values and percentage of episodes of elevated thyroxine (T4) and tri-jod-thyronin (T3) and suppressed thyrotropin (TSH) before age 2 years were analyzed. A meta-analysis of CH treatment studies was performed.
Results
There were no significant differences in IQ, QoL, or other outcome measures in patients with CH compared with controls. Most T4 levels were high before age 2 years and during subsequent testing, but mean T3 and TSH levels remained normal. The meta-analysis showed a significant IQ difference in severe vs mild CH cases only when treatment started with an LT4 dose <10 µg/kg.
Conclusions
High initial LT4 dosing was effective and safely achieved optimal cognitive development in patients with CH, including those severely affected. Supranormal T4 values during infancy were not associated with impaired IQ in adolescence.
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