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The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism.
J Clin Endocrinol Metab 2000; 85(8):2722-7JC

Abstract

Measurements of serum concentrations of free T4, T3, TSH, and thyroglobulin (Tg) were conducted in 42 infants (2-9 months of age) detected and treated through the Northwest Newborn Regional Screening Program and 63 children and adolescents (1-18 yr of age) with congenital hypothyroidism (CH) detected and managed in the Northern California Kaiser Permanente Medical Care Program. Normal feedback control axis data were developed by Quest Diagnostics, Inc. - Nichols Institute Diagnostics and Loma Linda University, from free T4 and TSH measurements in 589 healthy subjects, 2 months to 54 yr of age; 83 untreated hypothyroid patients; and 116 untreated hyperthyroid patients. Twenty-four of the 42 CH infants and 57 of the 63 CH children manifested serum TSH concentrations appropriate for the measured free T4 level. In the remaining 18 infants and 6 children, serum free T4 values were increased 0.2-1.4 ng/dL (2.6-18.0 pmol/L) for the prevailing TSH level, suggesting a state of mild to moderate pituitary-thyroid hormone resistance. In the treated children, the mean T3 concentration was lower (by 32%, 102 vs. 150 ng/dL; 1.57 vs. 2.31 nmol/L) than in normal children, in agreement with earlier data in hypothyroid adults treated with exogenous T4. Serum Tg concentrations were normal or elevated in 90% of the 19 children with ectopic glands and 93% of 27 children with eutopic glands in whom measurements were available. There was a positive correlation between serum TSH and Tg concentrations (P < 0.001), suggesting significant endogenous thyroid hormone production in these children. Our results suggest that the majority of infants and children with CH have a normal hypothalamic-pituitary-thyroid negative feedback control axis during treatment and that the measurement of serum TSH is a useful marker complementing the free T4 measurement in the management of children with CH. A minority have variable pituitary-thyroid hormone resistance, with relatively elevated serum TSH levels for their prevailing serum free T4 concentration. The prevalence of resistance is greater (43%) in young infants (< 1 yr of age) than in older children (10%), indicating that, in most children, the resistance improves with age.

Authors+Show Affiliations

Quest Diagnostics, Inc - Nichols Institute, San Juan Capistrano, California 92690-6130, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

10946871

Citation

Fisher, D A., et al. "The Hypothalamic-pituitary-thyroid Negative Feedback Control Axis in Children With Treated Congenital Hypothyroidism." The Journal of Clinical Endocrinology and Metabolism, vol. 85, no. 8, 2000, pp. 2722-7.
Fisher DA, Schoen EJ, La Franchi S, et al. The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism. J Clin Endocrinol Metab. 2000;85(8):2722-7.
Fisher, D. A., Schoen, E. J., La Franchi, S., Mandel, S. H., Nelson, J. C., Carlton, E. I., & Goshi, J. H. (2000). The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism. The Journal of Clinical Endocrinology and Metabolism, 85(8), pp. 2722-7.
Fisher DA, et al. The Hypothalamic-pituitary-thyroid Negative Feedback Control Axis in Children With Treated Congenital Hypothyroidism. J Clin Endocrinol Metab. 2000;85(8):2722-7. PubMed PMID: 10946871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism. AU - Fisher,D A, AU - Schoen,E J, AU - La Franchi,S, AU - Mandel,S H, AU - Nelson,J C, AU - Carlton,E I, AU - Goshi,J H, PY - 2000/8/18/pubmed PY - 2000/9/2/medline PY - 2000/8/18/entrez SP - 2722 EP - 7 JF - The Journal of clinical endocrinology and metabolism JO - J. Clin. Endocrinol. Metab. VL - 85 IS - 8 N2 - Measurements of serum concentrations of free T4, T3, TSH, and thyroglobulin (Tg) were conducted in 42 infants (2-9 months of age) detected and treated through the Northwest Newborn Regional Screening Program and 63 children and adolescents (1-18 yr of age) with congenital hypothyroidism (CH) detected and managed in the Northern California Kaiser Permanente Medical Care Program. Normal feedback control axis data were developed by Quest Diagnostics, Inc. - Nichols Institute Diagnostics and Loma Linda University, from free T4 and TSH measurements in 589 healthy subjects, 2 months to 54 yr of age; 83 untreated hypothyroid patients; and 116 untreated hyperthyroid patients. Twenty-four of the 42 CH infants and 57 of the 63 CH children manifested serum TSH concentrations appropriate for the measured free T4 level. In the remaining 18 infants and 6 children, serum free T4 values were increased 0.2-1.4 ng/dL (2.6-18.0 pmol/L) for the prevailing TSH level, suggesting a state of mild to moderate pituitary-thyroid hormone resistance. In the treated children, the mean T3 concentration was lower (by 32%, 102 vs. 150 ng/dL; 1.57 vs. 2.31 nmol/L) than in normal children, in agreement with earlier data in hypothyroid adults treated with exogenous T4. Serum Tg concentrations were normal or elevated in 90% of the 19 children with ectopic glands and 93% of 27 children with eutopic glands in whom measurements were available. There was a positive correlation between serum TSH and Tg concentrations (P < 0.001), suggesting significant endogenous thyroid hormone production in these children. Our results suggest that the majority of infants and children with CH have a normal hypothalamic-pituitary-thyroid negative feedback control axis during treatment and that the measurement of serum TSH is a useful marker complementing the free T4 measurement in the management of children with CH. A minority have variable pituitary-thyroid hormone resistance, with relatively elevated serum TSH levels for their prevailing serum free T4 concentration. The prevalence of resistance is greater (43%) in young infants (< 1 yr of age) than in older children (10%), indicating that, in most children, the resistance improves with age. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/10946871/The_hypothalamic_pituitary_thyroid_negative_feedback_control_axis_in_children_with_treated_congenital_hypothyroidism_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jcem.85.8.6718 DB - PRIME DP - Unbound Medicine ER -