Sze May Ng

Children with congenital hypothyroidism are at risk of adult obesity due to early adiposity rebound

objective  There is some evidence that children with congenital hypothyroidism (CH) are heavier than their reference population. There are few data on adults with CH. The timing of adiposity rebound (AR) in childhood has been shown to have strong correlations with adult obesity. Our aims were to study the timing of AR and factors affecting AR in children with CH.

Head circumference and linear growth during the first 3 years in treated congenital hypothyroidism in relation to aetiology and initial biochemical severity

aims  To determine the head circumference and linear growth in children with congenital hypothyroidism (CH) during the first 3 years of life in relation to the aetiology of CH and initial biochemical severity of thyroid function.

Multivariate analyses of factors that affect neonatal screening thyroid stimulating hormone

Abstract Aims: All screening programmes in the UK use a primary thyroid stimulating hormone (TSH) screen for congenital hypothyroidism. Recent attention has been paid to aspects of screening, such as the relation between blood spot TSH levels and birth weight or gestational age. The aim of our study was to determine the factors affecting screening neonatal TSH levels. Methods: We conducted a retrospective analysis of blood spot screening TSH levels of all infants screened at a single regional screening laboratory. Results: There were 6498 infants screened during a 12-week period. Screening TSH level showed negative correlation with gestational age and birth weight. Multiple linear regression analysis revealed low birth weight as the only independent factor affecting screening TSH level. Conclusions: Low birth weight infants appear to be at risk of thyroidal dysfunction. Our study showed that there were clinically significant but weak correlation between higher screening TSH levels and low birth weight. The clinical importance of these findings requires larger prospective studies to further elucidate the relevance of these factors affecting TSH screening levels.

The gonadotrophins response to GnRH test is not a predictor of neurological lesion in girls with central precocious puberty.

OBJECTIVES To assess the value of gonadotrophin releasing hormone (GnRH) stimulation test in identifying intracranial abnormality in girls with central precocious puberty (CPP). PATIENTS AND METHODS A study of 67 girls diagnosed with CPP who underwent cranial MRI scans. Patients were not receiving any therapy and there were no neurological signs or symptoms at presentation. Patients underwent evaluation of GnRH stimulation test and plasma oestradiol levels at presentation. RESULTS Mean age at onset of puberty was 6.2 years (range 2.0 to 8.0 years). Intracranial abnormalities were present in 10 (15%) patients, while 57 girls (85%) had no abnormalities. No significant difference was shown between girls with intracranial abnormality and girls without intracranial abnormality in basal LH or FSH values, peak LH or FSH values, LH/FSH peak ratios, peak LH/basal LH ratios, peak FSH/ basal FSH ratios at presentation. CONCLUSION GnRH stimulation test does not identify those with underlying intracranial abnormality at presentation. MRI imaging remains necessary in all cases of central precocious puberty in girls.

Multivariate analysis on factors affecting suppression of thyroid-stimulating hormone in treated congenital hypothyroidism.

Aims: To determine the factors which influence the suppression of thyroid-stimulating hormone (TSH) in infants with congenital hypothyroidism (CH) following treatment. Methods: We examined retrospectively the patterns of thyroid function tests from diagnosis to 3 years of age in 140 infants diagnosed with CH from screening. Patients were classified into 3 groups: athyreosis, ectopia and presumed dyshormonogenesis on the basis of thyroid scans. Adequate TSH suppression was defined as plasma TSH concentration <6 mU/l. The factors affecting the suppression of TSH at 6 months and 1 year of age which were evaluated were: initial confirmatory plasma TSH, initial plasma thyroxine (T4), mean age of starting treatment with L-T4, dose of L-T4 at diagnosis, 6 weeks, 3 months and 6 months, and aetiology of the congenital hypothyroidism. Variables were then entered in a stepwise logistic regression model for TSH suppression at 6 months and 1 year of age. Results: All infants had radionuclide scans prior to treatment: athyreosis (n = 39), ectopia (n = 78) and dyshormonogenesis (n = 23). 58% of patients had persistently raised TSH at 6 months of age while 31% of patients had a persistently raised TSH at 1 year of age. There was a significant delay in the normalisation of plasma TSH in athyreosis and ectopia groups compared with dyshormonogenesis. Multiple regression analysis for TSH suppression at 6 months of age found plasma T4 levels and aetiology of CH as independent factors affecting the timing of TSH suppression. Aetiology of CH was the only independent factor affecting TSH suppression at 1 year of age. Conclusion: At 6 months of age, plasma T4 levels at 6 weeks and 3 months, and aetiology of CH were independent factors affecting timing of TSH suppression. However, by 1 year of age, the aetiology of CH was the only independent factor affecting suppression of TSH.

Delay in screening premature infants for congenital hypothyroidism.

Optimal management of congenital hypothyroidism (CHT) includes early diagnosis and prompt treatment.1–3 We conducted an audit over a 12-week period in 2002 to determine whether time of screening for CHT was in adherence to standards published by the UK Newborn Screening Programme. The minimum standards recommended for time of screening for …

Neonatal Pituitary-Thyroid Axis Dysregulation with Combined Thyroid Hormone and Thyrotropin Resistance in Infant with Trisomy 21 and Maternal Subclinical Hypothyroidism

Trisomy 21 is commonly associated with thyroid problems. Although autoimmune hypothyroidism is the commonest thyroid problem in Trisomy 21, infants with this chromosomal disorder are also known to have dysregulated pituitary thyroid axis. This results in elevated thyrotropin (TSH) levels in absence of autoimmunity and structurally normal thyroid gland. The mechanism for this phenomenon is not clearly understood and it is possible that this may be due to genomic imbalance from trisomy of chromosome 21. Some authors have proposed that thyroid hormone resistance (RTH) might be a contributing factor to this. However, the genes coding for TSH receptor and the two proteins known to be implicated in TSH resistance are normal in patients with Trisomy 21. In newborns, transient hyperthyrotropinaemia is considered to be associated with maternal thyroperoxidase (TPO) antibody positivity. We describe a case of term infant with Trisomy 21, who was identified on newborn congenital hypothyroidism screening. The infant had high TSH and raised plasma free T4 (FT4) with clinical signs and symptoms of congenital hypothyroidism. We discuss the management of this case and possible mechanisms contributing to the uncommon presentation.

Continuous glucose monitoring: effects on metabolic control, fear and frequency of hypoglycaemic episodes

Self-monitoring of blood glucose (SMBG) is an important part of diabetes management.1 Continuous glucose monitoring (CGM) provides real-time measurement of users’ glucose levels. The advantage of CGM is the availability of constant information about glucose levels which helps to predict hyper and hypoglycaemia and to adjust the insulin doses accordingly. ! NICE guidelines recommend that children and young people with type 1 diabetes and persistent problems with hypoglycaemia unawareness or repeated hyper or hypoglycaemia should be offered CGM. 2 ! In UK there is limited funding for CGM due to lack of evidence for benefits of use over SMBG in improving control. In our service within a large DGH, we have a cohort of 12 children who were funded for CGM use over a minimum of 12 months. ! Aim To assess the effects of CGM on metabolic control, fear and frequency of hypoglycaemic episodes and assess the overall compliance over a period of 12 months. ! Method Data collected for 12 patients on HBA1C and frequency of hypoglycaemic episodes. Patients aged over 12 years and parents were asked to complete fear of hypoglycaemia questionnaires for before and after CGM use.

Intravaginal foreign body should be excluded in prepubertal cyclical vaginal bleeding without other evidence of precocious puberty

2. Aikaterini A.Nella, Paul B.Kaplowitz, Mary Scott Ramnitz, Radha Nandagopal. Journal of Pediatric Endocrinology and metabolism 2014; 27(9-10): 821-825 • Baseline LH, FSH, oestradiol, adrenal androgens, GnRH stimulation test, pelvic ultrasound for endometrial echo and bone age following clinical evaluation should be performed in prepubertal girls presenting with persistent and cyclical vaginal bleeding, in order to exclude precocious puberty.