Bongers-Schokking Jacoba J, de Muinck Keizer-Schrama Sabine M P F
Department of Endocrinology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
J Pediatr. 2005 Dec;147(6):768-74. doi: 10.1016/j.jpeds.2005.09.031.
To evaluate the influence of initial and postinitial treatment factors on cognitive, psychomotor, and psychological outcome in schoolchildren with congenital hypothyroidism (CH).
We studied 45 patients (19 with severe CH and 26 with mild CH) and 37 control children by correlating initial and postinitial treatment factors (free thyroxine and thyroid-stimulating hormone [TSH] concentrations, and the percentage of overtreatment and undertreatment periods) with the results of neuropsychological tests and behavior (as reported on the Teacher Report Form [TRF]).
The global IQ of the children with CH was comparable to that of the controls; visuomotor and verbal scores were lower, and total TRF scores were higher. Ethnic group, previous development, and overtreatment predicted IQ and verbal scores, with higher scores seen for the overtreated patients than for the control children and those patients who had not been overtreated. As initial treatment was less satisfactory, total TRF scores were higher.
Our study suggests that initial and postinitial suboptimal treatment of CH leads to abnormalities in IQ and specific fields. Overtreatment may advance cognitive development in 5-1/2- to 7-year-olds. Suboptimal initial treatment may lead to behavioral problems. We recommend that TSH concentrations be maintained within the normal range in patients with CH.
评估初始治疗和初始治疗后因素对先天性甲状腺功能减退症（CH）学龄儿童认知、心理运动和心理结局的影响。
我们通过将初始治疗和初始治疗后因素（游离甲状腺素和促甲状腺激素[TSH]浓度，以及过度治疗和治疗不足期的百分比）与神经心理学测试结果和行为（如教师报告表[TRF]所报告）相关联，对45例患者（19例重度CH和26例轻度CH）和37例对照儿童进行了研究。
CH患儿的总体智商与对照组相当；视觉运动和语言得分较低，TRF总分较高。种族、既往发育情况和过度治疗可预测智商和语言得分，过度治疗患者的得分高于对照儿童和未接受过度治疗的患者。由于初始治疗效果欠佳，TRF总分较高。
我们的研究表明，CH的初始治疗和初始治疗后治疗不充分会导致智商和特定领域出现异常。过度治疗可能会促进5岁半至7岁儿童的认知发展。初始治疗不充分可能会导致行为问题。我们建议将CH患者的TSH浓度维持在正常范围内。
