Churesigaew Sunchai, Ratrisawasdi Vilai, Thaeramanophab Somchit
Endocrine Unit, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
J Med Assoc Thai. 2002 Jul;85(7):782-8.
To detect newborns with congenital hypothyroidism (CH) by TSH screening and to treat the affected infants as early as possible. To find the incidence of CH in neonates born at Rajavithi Hospital from 1995 to 2000. The effects of thyroid pathology, ages at the initiation of treatment, associated conditions, and severity of CH on the intellectual outcome of the patients were also analyzed.
Thyrotropin (TSH) screening for CH in Queen Sirikit National Institute of Child Health was done in neonates born at Rajavithi Hospital from 1995 to 2000. Infants with elevated TSH level of greater than 25 mU/L were recalled for tests including serum T4, TSH and roentgenogram of bone age. Infants with CH were treated with levothyroxine 10-12 Ug/Kg/day: growth and development, serum T4, TSH were followed-up every 3 months for at least 2 years to keep serum T4 between 10-14 Ug/dL and serum TSH below 6 mU/L. Levothyroxine was discontinued for 4 weeks when the infants were over 2 years old. Serum T4, TSH, thyroid scan, and uptake were then performed on these infants. The patients must be euthyroid at the time of the intelligence testing. The Stanford Binet or Vineland Social Maturity scale was used to evaluate the patient's intelligence between the ages of 2 and 5 years.
From 1995 to 2000, 62,681 neonates were screened for CH. The incidence of CH was 1:4,178 live births. The sex ratio female: male 2:1. Fifteen infants with CH were started on levothyroxine 10-12 Ug/Kg/day orally once a day. The age of initiation of treatment was between 2-8 weeks. There were 4 patients with lingual thyroid, 4 patients with thyroid hypoplasia, 2 patients with thyroid aplasia and one patient with organification defect. The average intelligence score was 93.8. The factor that significantly affected the intellectual outcome of the patients was associated with adverse conditions such as prematurity with complications, epilepsy and family disruption (p<0.05).
通过促甲状腺激素（TSH）筛查检测先天性甲状腺功能减退症（CH）新生儿，并尽早治疗患病婴儿。了解1995年至2000年在拉贾维提医院出生的新生儿中CH的发病率。还分析了甲状腺病理、开始治疗的年龄、相关病症以及CH的严重程度对患者智力发育结果的影响。
1995年至2000年在拉贾维提医院出生的新生儿在诗丽吉王后国家儿童健康研究所进行了CH的促甲状腺激素（TSH）筛查。TSH水平高于25 mU/L的婴儿被召回进行包括血清T4、TSH和骨龄X线检查在内的检测。CH婴儿接受左甲状腺素10 - 12μg/（kg·天）治疗：每天口服一次。每3个月随访生长发育情况、血清T4、TSH至少2年，使血清T4维持在10 - 14μg/dL之间，血清TSH低于6 mU/L。婴儿2岁以上时停用左甲状腺素4周。然后对这些婴儿进行血清T4、TSH、甲状腺扫描及摄取率检查。在进行智力测试时患者必须甲状腺功能正常。使用斯坦福 - 比奈智力量表或维兰德社会成熟度量表评估2至5岁患者的智力。
1995年至2000年，共筛查了62681例新生儿的CH。CH的发病率为1:4178活产。男女比例为2:1。15例CH婴儿开始口服左甲状腺素10 - 12μg/（kg·天），每天一次。开始治疗的年龄在2至8周之间。有4例患者为舌甲状腺，4例甲状腺发育不全，2例甲状腺缺如，1例有机化缺陷。平均智力得分为93.8。显著影响患者智力发育结果的因素与早产伴并发症、癫痫和家庭破裂等不良状况有关（p<0.05）。
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