Cognitive Outcomes for Congenital Hypothyroid and Healthy Children: A Comparative Study

How to Cite This Article: Ordooei M, MottaghiPisheh H, Fallah R, Rabiee A. Cognitive Outcomes for Congenital Hypothyroid andHealthy Children: A Comparative Study. Iran J Child Neurol. 2014 Autumn;8(4): 28-32.AbstractObjectiveEarly diagnosis and treatment of congenital hypothyroidism (CH) and the prevention of developmental retardation is the main goal of public health national screening programs. This study compares the cognitive ability of children with CH diagnosed by neonatal screening with a healthy control group (2007) in Yazd, Iran.Materials & MethodsIn a case-controlled study, the intelligent quotient (IQ) of 40 five-year-old children with early treated CH and good compliance were evaluated by the Wechsler preschool and primary scale of intelligent test and compared to 40 healthy age and gender matched children as controls.Results22 boys (55%) and 18 girls (45%) in both groups were evaluated. In children with CH, 19 (47.5%) and 21 (52.5%) persons had transient and permanent hypothyroidism, respectively.Range of TSH and T4 level at the onset of diagnosis were 11.41–81 mu/l and 1.50–14.20 μg/dl, respectively.The intelligence levels of all children with CH were within the average or normal range and IQs ranged from 91–108.Children with CH had lower full-scale IQs (107.25 ± 2. 9 versus 110.50 ± 2.66, p=0.001), verbal IQ (106.95 ± 3.5 versus 109.90 ± 3.44, P-value=0.001) and performance IQ (106.3 ± 3.68 versus 108.87 ± 3.70) than the control group.However, no statistically significant differences were observed for mean IQ scores in permanent and transient CH.ConclusionChildren with CH who had early treatment and good compliance had normal cognitive abilities, but may have a decreased IQ relative to the healthy control group.ReferencesLeFranchi S. Hypothyroidism. Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE. Nelson Textbook of Pediatrics. Philadelphia, Saunders 2011; 19th edition, Pp: 1895-1900.Nouri-Shadkam M, Jafarizadeh M, Mirzaei M, Motlagh M.E, Eslami Z, Afkhami-Ardekani M, et al. Prevalence of congenital hypothyroidism and transient increased levels of TSH in Yazd province. J Shahid Sadoughi Univ Med Sci 2008; 16:15-20. [Article in Persian]Hashemipour M, Hovsepian S, Kelishadi R, Iranpour R, Hadian R, Haghighi S, et al. Permanent and transient congenital hypothyroidism in Isfahan-Iran. J Med Screen 2009; 16:11-6.Dalili S, Rezvany SM, Dadashi A, Medghalchi A, Mohammadi H, Dalili H, et al. Congenital hypothyroidism: a review of the risk factors. Acta Med Iran 2012; 50:735-9.Zeinalzadeh AH, Talebi M. Neonatal screening for congenital hypothyroidism in East Azerbaijan, Iran: the first report. J Med Screen 2012; 19:123-6.Karamizadeh Z, Saneifard H, Amirhakimi G, Karamifar H, Alavi M. Evaluation of congenital hypothyroidism in Fars province, Iran. Iran J Pediatr 2012; 22:107-12.Bargagna S, Canepa G, Costagli C, Dinetti D, Marcheschi M, Millepiedi S, et al. Neuropsychological follow-up in early-treated congenital hypothyroidism: a problemoriented approach. Thyroid 2000; 10:243-9.van der Sluijs Veer L, Kempers MJ, Maurice-Stam H, Last BF, Vulsma T, Grootenhuis MA. Health- related quality of life and self-worth in 10-year old children with congenital hypothyroidism diagnosed by neonatal screening. Child Adolesc Psychiatry Ment Health 2012; 6:32.Soliman AT, Azzam S, Elawwa A, Saleem W. Linear growth and neurodevelopmental outcome of children with congenital hypothyroidism detected by neonatal screening: A controlled study. Indian J Endocrinol Metab 2012; 16:565-8.Bongers-Schokking JJ. Influence of timing and dose of thyroid hormone replacement on mental, psychomotor, and behavioral development in children with congenital hypothyroidism. J Pediatr 2005; 147:768-74.Wechsler, D. The Wechsler Preschool and Primary Scale of Intelligence - Manual. New York: psychological Corporation, 1967.Romero JB, Palacios GC, Gómez N, Silva A, Fabela JH. Intelligence quotient related with congenital hypothyroidism etiology. Rev Med Inst Mex Seguro Soc 2011; 49:179-83. [Article in Spanish]Kik E, Noczyńska A. Evaluation of mental development of children with congenital hypothyroidism detected in screening test--personal observations. Pediatr Endocrinol Diabetes Metab 2010; 16:100-8. [Article in Polish]Arenz S, Nennstiel-Ratzel U, Wildner M, Dörr HG, Intellectual outcome, motor skills and BMI of children with congenital hypothyroidism: a population-based study. Acta Paediatr 2008; 97:447-50.Alvarez González MA, Carvajal Martínez F, Pérez Gesén C, Olivares Torres A, Fernández Yero JL, Robaina Alvarez R, et al. Prognosis of cognition in congenital hypothyroidism following early treatment. Double effect hypothesis. Rev Neurol 2004, 16-31; 38:513-7. [Article in Spanish]Boileau P, Bain P, Rives S, Toublanc JE. Earlier onset of treatment or increment in LT4 dose in screened congenital hypothyroidism: which as the more important factor for IQ at 7 years? Horm Res 2004; 61:228-33.Salerno M, Militerni R, Bravaccio C, Micillo M, Capalbo D, Di MS, Tenore A. Effect of different starting doses of levothyroxine on growth and intellectual outcome at four years of age in congenital hypothyroidism. Thyroid 2002; 12:45-52.Dimitropoulos A, Molinari L, Etter K, Torresani T, Lang- Muritano M, Jenni OG, Largo RH, Latal B. Children with congenital hypothyroidism: long-term intellectual outcome after early high-dose treatment. Pediatr Res 2009; 65:242-8.Joseph R. Neuro-developmental deficits in early-treated congenital hypothyroidism. Ann Acad Med Singapore 2008; 37(12 Suppl):42-3.Kempers MJ, van der Sluijs Veer L, Nijhuis-van der Sanden MW, Kooistra L, Wiedijk BM, Faber I, et al.Intellectual and motor development of young adults with congenital hypothyroidism diagnosed by neonatal screening. J Clin Endocrinol Metab2006; 91:418-24.Rovet JF. Children with congenital hypothyroidism and their siblings: do they really differ? Pediatrics 2005;115:e52-7.Kempers MJ, van der Sluijs Veer L, Nijhuis-van der Sanden RW, Lanting CI, Kooistra L, Wiedijk BM, et al. Neonatal screening for congenital hypothyroidism in the Netherlands: cognitive and motor outcome at 10 years of age. J Clin Endocrinol Metab2007; 92:919-24.Azizi F, Afkhami M, Sarshar A, Nafarabadi M. Effects of transient neonatal hyperthyrotropinemia on intellectual quotient and psychomotor performance. Int J Vitam Nutr Res 2001; 71:70-3.Salerno M, Militerni R, Di Maio S, Bravaccio C, Gasparini N, Tenore A. Intellectual outcome at 12 years of age in congenital hypothyroidism. Eur J Endocrinol 1999; 141:105-10.Hsiao PH, Chiu YN, Tsai WY, Su SC, Lee JS, Soong  WT. Intellectual outcome of patients with congenital hypothyroidism detected by neonatal screening. J Formos Med Assoc 2001; 100: 40-4

Efficacy of Levothyroxine in Migraine Headaches in Children with Subclinical Hypothyroidism

How to Cite this article: Mirouliaie M, Fallah R, Partovee M, Ordooei M. Efficacy of Levothyroxine in Migraine Headaches in Children with Subclinical Hypothyroidism. Iran J Child Neurol Autumn 2012;6(4):23-26. AbstractObjectiveHypothyroidism may be an exacerbating factor for  primary headaches and migraine is one of the most common primary headaches in childhood. Thepurpose of this study was to evaluate the effect of treatment of subclinical hypothyroidism on children with migraine headache.Materials & MethodsIn a quasi-experimental study, the severity and monthly frequency of headache of 25 migraineur  children with subclinical hypothyroidism who were referred to the pediatric neurology clinic of Shahid Sadoughi University of Medical Sciences, Yazd, Iran between January 2010 and February 2011and were treated with levothyroxine for two months were evaluated.ResultsThirteen girls (52%) and 12 boys (48%) with the mean age of 10.2 ± 2.76years were evaluated.In children with hypothyroidism, the monthly frequency of headache (mean± SD: 17.64 ± 9.49 times vs. 1.2 ± 1.1 times) and the severity of headache(mean± SD: 6.24±1.8 scores vs. 1.33 ± 0.87 scores) were significantly decreased by treatment.ConclusionBased on the results of this study, treatment of subclinical hypothyroidism was effective in reducing migraine headaches. Therefore, it is logical to check thyroid function tests in migraineur  children. References:Jan MM. Updated overview of pediatric headache and migraine. Saudi Med J. 2007 Sep;28(9):1324-9.Hershey AD. Headaches. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 2039-42.Hershey AD. Current approaches to the diagnosis and management of paediatric migraine. Lancet Neurol. 2010 Feb;9(2):190-204.Bigal ME, Gladstone J. The metabolic headaches. Curr Pain Headache Rep. 2008 Aug;12(4):292-5.Tepper DE, Tepper SJ, Sheftell FD, Bigal ME. Headache attributed to hypothyroidism. Curr Pain Headache Rep. 2007 Aug;11(4):304-9.Toprak D, Demirkukan K, Ellidokuz H. Is it important to test thyroid function tests in migraineurs? TJFMPC. 2007;4:47-51.Hagen K, Bjøro T, Zwart JA, Vatten L, Stovner LJ, Bovim G. Low headache prevalence amongst women with high TSH values. Eur J Neurol. 2001 Nov;8(6):693-9.Oleson J. The International Classification of Headache Disorders: 2nd edition. Headache Classification Subcommittee of the International Headache Society. Cephalalgia 2004; 24 (Suppl) : 9-160.LaFranchi S. Disorders of the Thyroid Gland. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 1894-908.Mavromichalis I, Anagnostopoulos D, Metaxas N, Papanastassiou E. Prevalence of migraine in schoolchildren and some clinical comparisons between migraine with and without aura. Headache. 1999 Nov-Dec;39(10):728-36.Zwart JA, Dyb G, Holmen TL, Stovner LJ, Sand T. The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trøndelag Health Study (Head-HUNT-Youth), a large population-based epidemiological study. Cephalalgia. 2004 May;24(5):373-9.Bigal ME, Lipton RB, Winner P, Reed ML, Diamond S, Stewart WF. Migraine in adolescents: association with socioeconomic status and family history. Neurology. 2007 Jul;69(1):16-25.Singh SK. Prevalence of migraine in hypothyroidism. J Assoc Physicians India. 2002 Nov;50:1455-6.Moreau T, Manceau E, Giroud-Baleydier F, Dumas R, Giroud M. Headache in hypothyroidism. Prevalence and outcome under thyroid hormone therapy. Cephalalgia.1998 Dec;18(10):687-9.Iwasaki Y, Kinoshita M, Ikeda K, Takamiya K, Shiojima T. Thyroid function in patients with chronic headache. Int J Neurosci. 1991 Apr;57(3-4):263-7.Abend NS, Younkin D. Medical Causes of Headache in Children. Curr Pain Headache Rep. 2007 Oct;11(5):401-7.Abend NS, Younkin D, Lewis DW. Secondary headaches in children and adolescents. Semin Pediatr Neurol. 2010 Jun;17(2):123-33

Congenital Hypothyroidism in Yazd: Is It Really Prevalent?

Congenital hypothyroidism (CH) is the most frequent type of endocrine disorders which presents at birth. It plays a major role in developing the most common preventable type of mental retardation around the world. In this study, we aimed to investigate CH incidence and its predictive factors among newborns in Yazd province. This cohort study was conducted in 38 health centers of 10 cities in Yazd province which is located in the center of Iran, from March 2008 to February 2015. All neonates, as the audiences of this program, were evaluated using heel prick or Guthrie test according to the national protocol of CH screening. During 7 years of screening for CH from March 2008 to February 2015, 143190 neonates were screened. Among them, 434 neonates were diagnosed as affected cases by CH, and the 7-year incidence of this disease was 303/ 100,000 live births. First, cousin consanguinity, hospitalization, male sex and low birth weight had a significant relationship with congenital hypothyroidism. Logistic regression analysis revealed that aforementioned variables in addition to delivery type (cesarean section) were significant predictor of CH. CH is more prevalent in Yazd compared to the other provinces in Iran. It is recommended that the effects of probable risk factors are evaluated through additional longitudinal studies and effective preventive strategies are designed according to the results

Mutational and bioinformatics analysis of the NKX2.1 gene in a cohort of Iranian pediatric patients with congenital hypothyroidism (CH)

Abstract Congenital hypothyroidism (CH) occurs with a relatively alarming prevalence in infants, and if not diagnosed and treated in time, it can have devastating consequences for the development of the nervous system. CH is associated with genetic changes in several genes that encode transcription factors responsible for thyroid development, including mutations in the NK2 homeobox 1 (NKX2.1) gene, which encodes the thyroid transcription factor-1 (TTF-1). Although CH is frequently observed in pediatric populations, there is still a limited understanding of the genetic factors and molecular mechanisms contributing to this disease. The sequence of the NKX2.1 gene was investigated in 75 pediatric patients with CH by polymerase chain reaction (PCR), single-stranded conformation polymorphism (SSCP), and direct DNA sequencing. Four missense heterozygous variations were identified in exon 3 of the NKX2.1 gene, including three novel missense variations, namely c.708A>G, p.Gln202Arg; c.713T>G, p.Tyr204Asp; c.833T>G, p.Tyr244Asp, and a previously reported variant rs781133468 (c.772C>G, p.His223Gln). Importantly, these variations occur in highly conserved residues of the TTF-1 DNA-binding domain and were predicted by bioinformatics analysis to alter the protein structure, with a probable alteration in the protein function. These results indicate that nucleotide changes in the NKX2.1 gene may contribute to CH pathogenesis