Ontiveros M Esperanza, González M Juan A, Rivera G Rolando, Sánchez P Carmen, Barragán M Gerardo
Instituto Nacional de Pediatría-UAM-X, Ciudad de México, México.
Universidad Autónoma Metropolitana Xochimilco, Ciudad de México, México.
Andes Pediatr. 2023 Jan;94(1):62-69. doi: 10.32641/andespediatr.v94i1.4356.
The age at treatment initiation is decisive for limiting the neurological sequelae of Congenital Hypothyroidism (CH). Incorporating children into follow-up programs could be very helpful.
To evaluate the cognitive performance of preschool children with CH incorporated into a follow- up program.
Prospective study of 93 patients with a confirmed diagnosis of CH. Intelligence quotient (IQ) was assessed using the Wechsler Preschool and Primary Intelligence Scale (WPPSI) at 4 and 5 years, and the WISC-R at 6 years of age. Full-Scale IQ (FSIQ), Verbal IQ (VIQ), and Performance IQ (PIQ) scores were analyzed.
The study sample was 80 children. The average age at starting hormonal treatment was 42 ± 18 days; treatment started early in 25 patients (24 ± 6 days) and late in 55 patients (50 ± 16 days). The mean initial dose of Levothyroxine was 13.5 ± 1.5µg/kg/day. Children with athyrosis and late initiation of treatment had lower scores on the VIQ (85 ± 14), the PIQ (89 ± 12), and the FSIQ (86 ± 13) scales at 4 years of age, in comparison with patients with early initiation of treatment. These patients scored within the cut-off point for the normal IQ classification (90-109 points). IQ comparison at 6 years of age revealed differences up to 14 points in the PIQ and 11 points in the FSIQ between children with athyrosis and early initiation of treatment, with and without regular attendance to the follow-up program.
These results support the importance of early initiation of treatment and the incorporation of children in follow-up programs and early stimulation. The etiology of hypothyroidism and the age at initiation of treatment were the most significant factors that affected cognitive performance.
开始治疗的年龄对于限制先天性甲状腺功能减退症（CH）的神经后遗症具有决定性作用。将儿童纳入随访计划可能会非常有帮助。
评估纳入随访计划的学龄前CH儿童的认知表现。
对93例确诊为CH的患者进行前瞻性研究。在4岁和5岁时使用韦氏学前和小学智力量表（WPPSI）评估智商（IQ），在6岁时使用韦氏儿童智力量表修订版（WISC-R）评估。分析全量表智商（FSIQ）、言语智商（VIQ）和操作智商（PIQ）得分。
研究样本为80名儿童。开始激素治疗的平均年龄为42±18天；25例患者（24±6天）治疗开始早，55例患者（50±16天）治疗开始晚。左甲状腺素的平均初始剂量为13.5±1.5μg/kg/天。与治疗开始早的患者相比，甲状腺发育不全且治疗开始晚的儿童在4岁时的VIQ（85±14）、PIQ（89±12）和FSIQ（86±13）量表得分较低。这些患者的得分在正常智商分类的临界值（90-109分）范围内。6岁时的智商比较显示，甲状腺发育不全且治疗开始早的儿童，无论是否定期参加随访计划，其PIQ差异高达14分，FSIQ差异高达11分。
这些结果支持早期开始治疗以及将儿童纳入随访计划和早期刺激的重要性。甲状腺功能减退症的病因和开始治疗的年龄是影响认知表现的最显著因素。
