Valoración del crecimiento y maduración de los casos de hipotiroidismo congénito detectados por el programa de cribado neonatal en Catalunya (1986 - 1997)
Clinical diagnosis of congenital hypothyroidism (CH) at the time of birth is difficult. The serious neurological, sensory and developmental effects that result from delayed treatment, linked to the fact that early treatment can prevent CH, have led many countries to develop screening programs for CH. In Catalonia, the screening program for CH began in 1982 and in year 1983 a commission for the definitive diagnosis and follow-up of these patients was set up in 1983 in the Maternal-infantile Vall d´Hebron Hospital in Barcelona.
HYPOTHESIS OF THE THESIS: The establishment of early treatment in children diagnosed with CH by means of the screening program can bring about a somatic development similar to that in the normal population, although alterations in neurological and psychological development could not be ruled out.
OBJECTIVES: To evaluate the hypothesis, a study has been made of the cases of CH that have been diagnosed by the screening program in Catalonia from 1986 to 1997 and that have been checked in the Maternal-infantile Vall d´Hebron Hospital in Barcelona, with the following objectives:
1. To find out the intensity and duration of hypothyroidism during the neonatal period.
2. To evaluate the dose of L-thyroxine administered and the serum levels of T4 and TSH according to age.
3. To evaluate the evolution of growth (height, weight and BMI) and bone maturation.
4. To evaluate pubertal development.
5. To evaluate neurological evolution.
6. To evaluate psychological evolution.
7. To correlate the intensity and duration of hypothyroidism with growth, pubertal development and neurological and psychological development.
PATIENTS AND METHODS: The study is descriptive, longitudinal and retrospective, of a series of 136 cases of CH detected by the screening program in Catalonia from 1986 to 1997.
The following data have been collected from the clinical history of the 136 cases in this study:
DATA FROM THE FIRST VISIT:
An evaluation is made of the parameters that indicate the intensity and duration of pre- and postnatal hypothyroidism: Dussaults clinical index, initial T4 and TSH, surface of the nuclei of ossification of the knee, days of life at the beginning of treatment, days of life when the values of T4 are normalized.
1) Follow-up is carried out for growth (height, weight, BMI, GV), for bone maturation, for treatment received (dose of L-thyroxine per kilogram in weight) and for biochemical control (serum levels of T4 and TSH) at three months of age, at six months of age, at one year of age and every subsequent six months.
2) Psychological exploration: This has been carried out in the infant psychiatry service. The results of these tests are considered:
- McCarthy Scales of Children´s Abilities.
- The Wechsler Intelligence Scale for Children (Revised) (WISC-R).
RESULTS: Males (30 cases, 22.1%) and females (106 cases, 77.9%) with congenital hypothyroidism who were detected and followed by the screening program in Catalonia have a height, weight and BMI that are no different from those of the current population of Barcelona. Height, both for the group of females and of males, is 0.5 SD above the Tanner reference values of 1966. BMI, also for both groups, is one SD above the Roland-Cachera reference values of 1982. This secular acceleration of growth has been observed in all developed countries.
In a sample of 37.5% of the cases, psychological development does not differ from that of the reference population. However, a greater intensity of neonatal hypothyroidism and the most delayed normalization of this correlate negatively with the score in the psychological tests.
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Advisor:Carrascosa Lezcano, Antonio; Vicens-Calvet, Enric
School:Universitat Autónoma de Barcelona
Source Type:Master's Thesis
Keywords:418 departament de pediatria obstetricia i ginecologia
Date of Publication:11/28/2006