Neurodevelopmental outcomes in congenital hypothyroidism: comparison of initial T4 dose and time to reach target T4 and TSH.
OBJECTIVE
To compare neurodevelopmental outcomes in severe and moderate congenital hypothyroidism (CH) among 3 different initial L-thyroxine doses and to examine the effect of the time to thyroid function normalization on neurodevelopmental outcomes.


METHODS
Neurodevelopmental assessments of 31 subjects included the Mullen Scales of Early Learning, Wechsler Preschool and Primary Scale of Intelligence-Revised, Wechsler Intelligence Scale for Children, Wide-Range Achievement Test, and Child Behavioral Checklist.


RESULTS
Subjects started on higher initial L-thyroxine doses (50 mug) had full-scale IQ scores 11 points higher than those started on lower (37.5 mug) initial doses. However, verbal IQ, performance IQ, and achievement scores did not differ among the 3 treatment cohorts. Subjects with moderate CH had higher full-scale IQ scores than subjects with severe CH, regardless of the initial treatment dose. Subjects who took longer than 2 weeks to normalize thyroid function had significantly lower cognitive, attention, and achievement scores than those who achieved normal thyroid function at 1 or 2 weeks of therapy.


CONCLUSIONS
Initial L-thyroxine dose and faster time to normalization of thyroid function are important to optimal neurodevelopmental outcome. In severe CH, it is important to choose an initial dose at the higher end of the recommended range to achieve these goals.
Selva
Karin A
KA
Children's Diabetes & Endocrine Center, Legacy Emanuel Hospital, Portland, Oregon 97229, USA. kselva@lhs.org
Harper
A
A
Downs
A
A
Blasco
P A
PA
Lafranchi
S H
SH
D000704:Analysis of Variance; D002648:Child; D002652:Child Behavior; D002657:Child Development; D002675:Child, Preschool; D003409:Congenital Hypothyroidism / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D002658:Developmental Disabilities / Q000453:epidemiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004522:Educational Status; D005500:Follow-Up Studies; D006801:Humans; D007360:Intelligence; D012720:Severity of Illness Index; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood* / Q000494:pharmacology*
D013972:Thyrotropin; D013974:Thyroxine