Hobbs Annabelle, Jack Michelle, Benitez-Aguirre Paul, Srinivasan Shubha, Wotton Tiffany, Cho Yoon Hi
The Children's Hospital Westmead, Sydney, New South Wales, Australia.
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
J Paediatr Child Health. 2025 Feb;61(2):185-190. doi: 10.1111/jpc.16733. Epub 2024 Dec 4.
Abnormal thyroid function tests (TFTs) are found in a wide range of settings in hospitalised infants. This retrospective descriptive study reviewed management decisions and outcomes of these infants, identifying factors influencing clinicians' decision to treat with thyroxine.
Data were collected for all infants referred to the on-call endocrinology service at a tertiary Australian centre for thyroid dysfunction between 1 July 2019 and 30 June 2021. Electronic medical records were reviewed for birth and neonatal factors, TFTs, relevant investigations, treatment and disposition.
Of 124 infants referred to the service over a 2-year period, 43% (52 out of 120) were premature, with a high rate of comorbidities, including jaundice, hypoglycaemia, respiratory distress and cardiac anomalies. About 57% (69 out of 121) of referrals to the service were from neonatal intensive care units. Investigations to evaluate hypothyroidism included nuclear thyroid scans in 40% (46 out of 114) and ultrasound in 37% (41 out of 112). Levothyroxine treatment was initiated in 66% (77 out of 117) of infants, with 63% (73 out of 117) assigned a presumptive diagnosis of transient congenital hypothyroidism. At the end of the study period, 70% (54 out of 77) remained on thyroid replacement.
Our study demonstrates the challenge clinicians face when deciding whether to treat premature and medically unwell infants with abnormal TFTs. Further prospective studies are required to determine predictors of permanent CH in this complex population.
住院婴儿在多种情况下会出现甲状腺功能检查（TFTs）异常。这项回顾性描述性研究回顾了这些婴儿的管理决策和结局，确定了影响临床医生使用甲状腺素治疗决策的因素。
收集了2019年7月1日至2021年6月30日期间转诊至澳大利亚一家三级甲状腺功能障碍中心随叫随到内分泌科的所有婴儿的数据。对电子病历进行了审查，以获取出生和新生儿因素、TFTs、相关检查、治疗和处置情况。
在两年期间转诊至该科室的124名婴儿中，43%（120名中的52名）为早产儿，合并症发生率高，包括黄疸、低血糖、呼吸窘迫和心脏异常。转诊至该科室的婴儿中约57%（121名中的69名）来自新生儿重症监护病房。评估甲状腺功能减退的检查包括40%（114名中的46名）进行了核甲状腺扫描，37%（112名中的41名）进行了超声检查。66%（117名中的77名）的婴儿开始使用左甲状腺素治疗，其中63%（117名中的73名）被推定诊断为暂时性先天性甲状腺功能减退。在研究期结束时，70%（77名中的54名）仍在接受甲状腺替代治疗。
我们的研究表明，临床医生在决定是否治疗TFTs异常的早产和身体不适婴儿时面临挑战。需要进一步的前瞻性研究来确定这一复杂人群中永久性先天性甲状腺功能减退的预测因素。
