A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants

Avni N Shah; Wen Li; Denise Zheng; Sana Lalani; Dinushan C Kaluarachchi; Tina O Findley

doi:10.1038/s41372-024-01985-5

A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants

J Perinatol. 2024 May 11. doi: 10.1038/s41372-024-01985-5. Online ahead of print.

Authors

Avni N Shah¹, Wen Li^{2

3}, Denise Zheng^{4

5}, Sana Lalani⁴, Dinushan C Kaluarachchi⁶, Tina O Findley⁴

Affiliations

¹ Division of Pediatric Endocrinology, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA. Avni.R.Shah@uth.tmc.edu.
² Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
³ Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX, USA.
⁴ Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
⁵ Department of Psychiatry, Case Western Reserve University - University Hospitals, Cleveland, OH, USA.
⁶ Department of Pediatrics, University of Wisconsin - Madison, Madison, WI, USA.

PMID: 38734804
DOI: 10.1038/s41372-024-01985-5

Abstract

Objectives: To assess utility and accuracy of a gestational age-based screening targeting premature infants to detect congenital hypothyroidism.

Study design: A prospective cohort study was conducted in infants <35 weeks' gestational age with clinical outcomes at 2-3 years of age. Patients received newborn screenings at 24 hours and 10-14 days of life. Free T4 (FT4) and thyroid-stimulating hormone (TSH) levels were measured at one month of life and repeated based on algorithm by corrected gestational age.

Results: Among infants <35 weeks gestation (n = 938), the incidence of hypothyroidism requiring treatment was 1:58. TSH levels at one month of age was predictive of treatment (AUC 0.96, 95% CI 0.88-1). The optimal TSH threshold of 8 mIU/L (8 µU/ml) increased the specificity to 0.97 and sensitivity to 0.88. Following initiation of treatment for hypothyroidism during NICU hospitalization, 43.8% (n = 7) were diagnosed with permanent congenital hypothyroidism.

Conclusions: Our study supports a gestational age-based screening algorithm for early detection of hypothyroidism in premature infants.