Levothyroxine requirement in congenital hypothyroidism: a 12-year longitudinal study
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ORIGINAL ARTICLE
Levothyroxine requirement in congenital hypothyroidism: a 12-year longitudinal study Maurizio Delvecchio1 • Mariacarolina Salerno2 • Maria Cristina Vigone3 • Malgorzata Wasniewska4 • Pietro Pio Popolo5 • Rosa Lapolla5 • Alessandro Mussa6 • Giulia Maria Tronconi3 • Ida D’Acunzo2 • Raffaella Di Mase2 • Rosa Maria Falcone1 Andrea Corrias6 • Filippo De Luca4 • Giovanna Weber3 • Luciano Cavallo1 • Maria Felicia Faienza1
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Received: 28 December 2014 / Accepted: 4 March 2015 Ó Springer Science+Business Media New York 2015
Abstract The aim of the replacement therapy with levothyroxine in congenital hypothyroidism (CH) is to correct hypothyroidism and ensure normal growth and neuropsychological development. Few data are available about the appropriate dose during childhood and early adolescence; therefore, we performed a multicenter observational study in a large population of patients with CH to assess the required levothyroxine dose to obtain euthyroidism. We recruited 216 patients with permanent CH classified into three groups (agenesia, ectopia, and in situ gland) on the basis of the thyroid imaging. The levothyroxine dose was recorded at 6 and 12 months and then yearly until 12 years of age. The daily levothyroxine requirement progressively decreased during the follow-up, irrespective of etiology. It was significantly lower in patients with in situ gland than in patients with athyreosis during the entire study period and with ectopic gland from Electronic supplementary material The online version of this article (doi:10.1007/s12020-015-0574-1) contains supplementary material, which is available to authorized users. & Maurizio Delvecchio [email protected] 1
Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
2
Pediatric Section-Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
3
Department of Pediatrics Endocrinology, IRCCS Vita-Salute San Raffaele University, Milan, Italy
4
Department of Pediatrics, University of Messina, Messina, Italy
5
Department of Pediatrics, University of Foggia, Foggia, Italy
6
Division of Pediatric Endocrinology, Department of Pediatrics, University of Turin, Turin, Italy
the age of 1 year. The levothyroxine requirement at 6 months of age was correlated with the requirement at each later time-point. The daily dose was modified less frequently in patients with in situ thyroid (36 %) than in patients with ectopic gland (41.4 %) or with athyreosis (43.6 %). Patients with in situ gland required a lower dose than the other two subgroups. The dose at 6 months seems predictive of the requirement until 12 years of age. Euthyroidism may be achieved in pre-school and in-school patients by 3–4 and 2–3 lg/kg/day (70–90 and 60–80 lg/ m2/day) of levothyroxine, respectively. Keywords Congenital hypothyroidism Thyroxine requirement Replacement therapy Congenital hypothyroidism etiology Congenital hypothyroidism severity
Introduction Congenital hypothyroidism (CH) is usually sp
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