早期接受大剂量左甲状腺素治疗的先天性甲状腺功能减退症患儿入学时的认知与行为

Cognition and behavior at school entry in children with congenital hypothyroidism treated early with high-dose levothyroxine.

作者信息

Simoneau-Roy J, Marti S, Deal C, Huot C, Robaey P, Van Vliet Guy

机构信息

Endocrinology Service, Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada.

出版信息

J Pediatr. 2004 Jun;144(6):747-52. doi: 10.1016/j.jpeds.2004.02.021.

DOI:10.1016/j.jpeds.2004.02.021

PMID:15192621

Abstract

OBJECTIVE

To document cognition and behavior at school entry in these patients. Study design Eighteen children with congenital hypothyroidism (CH; 9 severe and 9 moderate, based on a surface of the knee epiphyses at diagnosisor=0.05 cm(2)) treated from a median of 14 days with a median of 12.0 microg/kg per day of levothyroxine were evaluated at 5 years, 9 months, with the McCarthy Scale and the Questionnaire for Evaluation of Social Behavior, as were 40 control children.

RESULTS

The global IQs at 5 years, 9 months, were similar: medians (range) were 102 (87 to 133), 102 (84 to 135), and 115 (88 to 136) (not significant) for severe CH, moderate CH, and control children, respectively. The behavioral scores of CH children were within the normal range. However, the number of times when plasma TSH was >6.0 mIU/L during treatment was correlated positively with anxiety (P=.02) and inattention (P=.05), whereas the number of times TSH was <0.8 mIU/L was correlated with lower verbal scores (P=.05).

CONCLUSIONS

Children with severe CH treated early with a high dose of levothyroxine have normal global development and behavior at school entry.

摘要

目的

记录这些患者入学时的认知和行为情况。研究设计：对18名先天性甲状腺功能减退症（CH；根据诊断时膝关节骨骺面积分为9例重度和9例中度，<或>或=0.05平方厘米）患儿进行评估，这些患儿从第14天开始接受治疗，左甲状腺素的中位剂量为每天12.0微克/千克，在5岁9个月时使用麦卡锡量表和社会行为评估问卷进行评估，同时对40名对照儿童进行评估。

结果

在5岁9个月时，重度CH患儿、中度CH患儿和对照儿童的总体智商相似：中位数（范围）分别为102（87至133）、102（84至135）和115（88至136）（无显著差异）。CH患儿的行为评分在正常范围内。然而，治疗期间血浆促甲状腺激素（TSH）>6.0 mIU/L的次数与焦虑（P = 0.02）和注意力不集中（P = 0.05）呈正相关，而TSH<0.8 mIU/L的次数与较低的语言评分相关（P = 0.05）。