Kugelman Amir, Riskin Arieh, Bader David, Koren Ilana
Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel.
Am J Perinatol. 2009 May;26(5):383-5. doi: 10.1055/s-0028-1110091. Epub 2008 Dec 11.
Sick premature infants may display transient hypothyroxinemia secondary to immaturity of the hypothalamic-pituitary axis. Therefore, early screening programs of such infants may be misleading. We present such a case report, with review of the literature and the following suggested recommendations. (1) Screening programs should report thyroid-stimulating hormone (TSH) as well as thyroxine (T(4)) levels in premature infants, which will allow the treating physicians to be aware of possible abnormality that needs to be followed. (2) Sick premature infants and other populations at risk should undergo a full serum thyroid function evaluation including free T(4) and TSH beyond the screening program at discharge or at 30 days of age, whichever comes first. (3) Physicians should use their clinical judgment and experience even in the face of normal newborn thyroid screening test and reevaluate for hypothyroidism when there is a clinical suspicion. Our case report is a reminder of the American Academy of Pediatrics guidelines with practical suggestions for extra caution to avoid missing primary hypothyroidism in sick premature infants.
患病早产儿可能因下丘脑 - 垂体轴不成熟而出现短暂性低甲状腺素血症。因此，对此类婴儿的早期筛查项目可能会产生误导。我们呈现这样一份病例报告，并回顾相关文献及给出以下建议。（1）筛查项目应报告早产儿的促甲状腺激素（TSH）以及甲状腺素（T4）水平，这将使治疗医生能够知晓可能需要追踪的异常情况。（2）患病早产儿及其他高危人群应在出院时或30日龄（以先到者为准）进行全面的血清甲状腺功能评估，包括游离T4和TSH，超出筛查项目范围。（3）即使面对新生儿甲状腺筛查结果正常，医生也应运用临床判断力和经验，当有临床怀疑时重新评估是否存在甲状腺功能减退。我们的病例报告提醒人们注意美国儿科学会的指南，并给出了实际建议，以格外谨慎避免漏诊患病早产儿的原发性甲状腺功能减退。
