Abstract
Transient hypothyroxinaemia with normal thyroid stimulating hormone (TSH) levels is a well-known condition in preterm neonates and is generally assumed to be a harmless epiphenomenon of prematurity. This assumption is, however, based on studies that included very few neonates with a gestational age (GA) below 30 weeks. We therefore measured serum free thyroxine (FT4) and serum TSH on days 1 and 14 in 263 neonates with a GA between 26 and 41 weeks. In 13 infants (5%), transient hypothyroidism (low FT4 and TSH>20 mU/l on day 14) was found. In the remaining 250 patients FT4 on days 1 and 14 but not TSH correlated positively with GA. In neonates with a GA of 35–41 weeks, FT4 increased postnatally to levels within or above the normal adult range. In contrast, in the very preterm group (26–31 weeks) the already low FT4 levels declined to values significantly below the range observed in term neonates. A significant proportion of these neonates had FT4 levels within the hypothyroid range. There was no difference in thyroid function between neonates treated with povidone-iodine or chlorhexidine.
Conclusion
Very preterm neonates have FT4 levels on day 14 that are much lower than is generally assumed while TSH remains in the normal range. We therefore propose to measure FT4 in all preterms with a GA below 33 weeks, during the 2nd week of life.
Similar content being viewed by others
Abbreviations
- GA :
-
gestational age
- FT 4 :
-
free thyroxine
- NICU :
-
neonatal intensive care unit
- TBG :
-
thyroxine binding globulin
- TRH :
-
thyrotropin releasing hormone
- TSH :
-
thyroid stimulating hormone
- TT 4 :
-
total thyroxine
References
Ballabio NM, Nicolini V, Jowett T, Ruiz de Elvira MC, Ekins RP, Rodeck CH (1989) Maturation of thyroid function in normal human fetuses. Clin Endocrinol 31:565–571
Burrow GN, Fisher DA, Larsen PR (1994) Maternal and fetal thyroid function. N Engl J Med 331:1072–1078
Delange F, Bürgi H (1989) Iodine deficiency disorders in Europe. Bull WHO 67:317–325
Delange F, Dalhem A, Bourdoux P, Lagasse R, Glinoer D, Fisher DA, Walfish PG, Ermans AM (1984) Increased risk of primary hypothyroidism in premature infants. J Pediatr 105:462–468
De Vries LS, Heckmatt JZ, Burrin JM, Dubowitz LMS, Dubowitz V (1986) Low serum thyroxine concentrations and neural maturation in preterm infants. Arch Dis Child 61:862–866
Eggermont E, Vanderschueren-Lodeweyckx M, De Nayer P, Jaeken J, De Vlieger H, Eeckels R, Beckers C, Smeets E, Vanacker G, Cornette C (1984) The thyroid system function in preterm infants of postmenstrual age of 31 weeks or less: evidence for a “transient lazy thyroid system”. Helv Paediatr Acta 39:209–222
Erenberg A, Phelps DL, Lam R, Fisher DA (1974) Total and free thyroid hormone concentrations in the neonatal period. Pediatrics 53:211–216
Fisher DA (1990) Euthyroid low thyroxine (T4) and triiodothyronine (T3) state in prematures and sick neonates. Pediatr Clin North Am 37:1297–1312
Fisher DA, Hober CJ, Ganza R, Pierce CA (1970) Thyroid function in the preterm fetus. Pediatrics 46:208–216
Franklin RC, Carpenter LM, O'Grady CM (1985) Neonatal thyroid function: influence of perinatal factors. Arch Dis Child 60:141–144
Franklin RC, Purdie GL, O'Grady CM (1986) Neonatal thyroid function: prematurity, prenatal steroids and respiratory distress syndrome. Arch Dis Child 61:589–592
Georgieff MK, Sazanow SK, Mammel MC, Ophoven J, Pereira GR (1986) Cord prealbumin values in newborn infants: effect of prenatal steroids, pulmonary maturity and size for dates. J Pediatr 108:972–976
Greenberg AH, Czernichow P, Reba RC, Tyson J, Blizzard RM (1970) Observations on the maturation of thyroid function in early fetal life. J Clin Invest 49:1790–1803
Hadeed AJ, Asay LD, Klein AH, Fisher DA (1981) Significance of transient postnatal hypothyroxinemia in premature infants with and without respiratory distress syndrome. Pediatrics 68:494–498
Harkavy KI, Enecio CE (1991) Free thyroxine levels in hospitalized newborns: depressed levels in critical, nonthyroidal illness. J Perinatol 11:117–121
Hirano T, Singh J, Srinivasan G, Pildes R (1982) Postnatal thyroid function in low birth weight infants: a cross-sectional assessment of free thyroxine and thyroid hormone binding globulin. Eur J Pediatr 139:244–246
Klein AH, Oddie TH, Parslow M, Foley TP, Fisher DA (1982) Developmental changes in pituitary-thyroid function in the human fetus and newborn. Early Hum Dev 6:321–330
Meijer WJ, Verloove-Vanhorick SP, Brand R, Van den Brande JL (1992) Transient hypothyroxinaemia associated with developmental delay in very preterm infants. Arch Dis Child 67:941–947
Mercado M, Szymonowicz W, Yu VYH, Gold H (1987) Symptomatic hypothyroxinemia with normal TSH levels in preterm infants. Clin Pediatr 26:343–346
Mercado M, Yu VYH, Francis I, Szymonowicz W, Gold H (1988) Thyroid function in very preterm infants. Early Hum Dev 16:131–141
Niklasson A, Ericson A, Fryer JG, Karlberg J, Lawrence C, Karlberg P, (1991) An update of the Swedish reference standards for weight, length and head circumference at birth for given gestational age (1977–1981). Acta Paediatr Scand 80:756–762
Sakaguchi M, Suzuki S, Nagashima K, Shimano S, Uchida S, Kurame T (1983) Longitudinal study of free thyroxine in low birth weight infants by paper disk method. J Pediatr 103:793–795
Smerdely P, Boyages SC, Wu D, Leslie G, John E, Lim A, Waite K, Roberts V, Arnold J, Eastman CJ (1989) Topical-iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants. Lancet II:661–664
Thorpe-Beeston JG, Nicolaides KH, Felton CV, Butler J, McGregor AM (1991) Maturation of the secretion of thyroid hormone in the fetus. N Engl J Med 324:532–536
Travert G, Lemonnier F, Fernandez Y (1985) Free thyroxin measured in dried blood spots: results for 10.000 euthyroid and 29 hypothyroid newborns. Clin Chem 5:31:1829–1832
Vulsma T, Gons MH, De Vijlder JJM (1989) Maternal-fetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect or thyroid agenesis. N Engl J Med 321:13–16
Wilson DM, Hopper AO, Ross I, McDougall IR, Bayer MF, Hintz RL, Stevenson DK, Rosenfeld RG (1982) Serum free thyroxine values in term, premature and sick infants. J Pediatr 101:113–117
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rooman, R.P., Du Caju, M.V.L., Op De Beeck, L. et al. Low thyroxinaemia occurs in the majority of very preterm newborns. Eur J Pediatr 155, 211–215 (1996). https://doi.org/10.1007/BF01953940
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01953940