Review shows that thyroid hormone substitution could benefit transient hypothyroxinaemia of prematurity but treatment strategies need to be clarified

Aim Thyroid hormones are crucial for foetal and neonatal brain development. This paper provides an overview of the normal role of thyroid hormones in foetal brain development and the pathophysiology of transient hypothyroxinaemia of prematurity (THOP). It also discusses the diagnostic and therapeuti...

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Bibliographic Details
Published in:Acta Paediatrica 2019-05, Vol.108 (5), p.792-805
Main Authors: Eerdekens, An, Langouche, Lies, Van den Berghe, Greet, Verhaeghe, Johan, Naulaers, Gunnar, Vanhole, Christine
Format: Article
Language:English
Subjects:
Brain
Brain development
Clinical trials
Gestational age
Health risk assessment
Heterogeneity
Hormones
Infants
Neonates
Neurodevelopment
Pituitary
Preterm birth
Thyroid gland
Thyroid hormones
Thyroxine
Transient hypothyroxinaemia of prematurity
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Summary:Aim Thyroid hormones are crucial for foetal and neonatal brain development. This paper provides an overview of the normal role of thyroid hormones in foetal brain development and the pathophysiology of transient hypothyroxinaemia of prematurity (THOP). It also discusses the diagnostic and therapeutic controversies around THOP and looks at directions for future research. Methods We used the PubMed and Embase databases to identify papers published in English from 1969 to June 2018. This identified 20 papers about the impact of THOP on neurodevelopment and seven randomised controlled trials about therapeutic approaches from 1981–2016. Results THOP has been researched for more than three decades. The impact of temporarily low thyroxine levels, without any increase in pituitary‐secreted thyroid‐stimulating hormone at a critical timeframe in an infant's brain development, is still debated. Heterogeneity in THOP definitions, difficulties with thyroid hormone assessment, identifying patients at risk and a clear lack of sufficiently powered studies add to the current controversy. There are indications that thyroid hormone substitution might be useful in extremely low gestational age neonates with THOP. Conclusion Some preterm infants could benefit from THOP treatment, but more studies are needed to clarify further treatment strategies, including the optimal timing of initiation and duration.
ISSN:0803-5253
1651-2227
DOI:10.1111/apa.14685