Department of Pediatrics, Erasmus MC - Sophia Children's Hospital , University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Developmental and Educational Psychology, Faculty of Social Sciences, University of Leiden, Leiden, The Netherlands.
Horm Res Paediatr. 2018;90(4):247-256. doi: 10.1159/000494056. Epub 2018 Nov 8.
Congenital hypothyroidism (CH) per se, when not treated or undertreated, may lead to severe behavioural problems (cretinism), whereas overtreatment of CH seems associated with attention problems.
For 55 CH patients, prospectively followed from birth until 11 years, parents rated the Child Behaviour Checklist and teachers the Teacher's Report Form at children's ages 6 and 11 years. We related scores regarding Attention, Delinquency, and Aggression (ADA scores, indicative for attention deficit hyperactivity syndrome, ADHD), and scores regarding Withdrawn, Anxious, Social, and Thought problems (WAST scores, indicative for autism) to the occurrence of over- and undertreatment in five age periods. Over- and undertreatment were defined as free thyroxine (fT4) concentrations above/below the range of the patient's individual fT4 steady state concentration.
ADA scores at 6 and 11 years for patients overtreated in the period 1-3 months postnatally were higher than those for patients who were not overtreated. Patients with severe CH undertreated in the period 3-6 months postnatally had higher WAST scores at 6 and 11 years than all other patients.
This is the first study suggesting that permanent ADHD as well as autism in CH patients at ages 6 and 11 years are the result of early overtreatment and undertreatment, respectively.
先天性甲状腺功能减退症（CH）本身，如果未经治疗或治疗不足，可能导致严重的行为问题（呆小病），而 CH 的过度治疗似乎与注意力问题有关。
对 55 名 CH 患者进行前瞻性随访，从出生到 11 岁，在儿童 6 岁和 11 岁时，父母分别对儿童行为检查表和教师报告表进行评分。我们将注意力、违法行为和攻击行为（ADA 评分，提示注意缺陷多动障碍，ADHD）以及退缩、焦虑、社交和思维问题（WAST 评分，提示自闭症）的评分与五个年龄阶段的过度和治疗不足相关联。过度和治疗不足的定义为游离甲状腺素（fT4）浓度高于/低于患者个体 fT4 稳态浓度的范围。
在出生后 1-3 个月期间接受过度治疗的患者在 6 岁和 11 岁时的 ADA 评分高于未接受过度治疗的患者。在出生后 3-6 个月期间严重 CH 治疗不足的患者在 6 岁和 11 岁时的 WAST 评分高于所有其他患者。
这是第一项表明 CH 患者在 6 岁和 11 岁时永久性 ADHD 以及自闭症分别是早期过度和治疗不足的结果的研究。
