Combined use of thyroid stimulating hormone plus free thyroxine levels and gestational age at birth for the prediction of neonatal hypothyroidism and associated risk factors

Li,Junqi; Cheng,Jing; Li,Qiuyue

doi:10.3892/etm.2020.9349

Combined use of thyroid stimulating hormone plus free thyroxine levels and gestational age at birth for the prediction of neonatal hypothyroidism and associated risk factors

Authors:
- Junqi Li
- Jing Cheng
- Qiuyue Li
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Affiliations: Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China, Department of Obstetrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
Published online on: October 15, 2020 https://doi.org/10.3892/etm.2020.9349
Article Number: 219

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Abstract

The present study aimed to explore the effectiveness of the combined use of thyroid‑stimulating hormone (TSH) and free thyroxine [(FT4); TSH+FT4] levels and gestational age at birth to predict neonatal hypothyroidism and to identify the risk factors associated with the disease. The clinical data of 686 neonates with suspected hypothyroidism (TSH >10 mIU/l) who were admitted to The First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. From these, 70 neonates with confirmed hypothyroidism were assigned to the patient group and another 70 neonates with normal thyroid function to the normal (control) group. Sex, gestational age at birth, Apgar score, birth weight, body length, head circumference and heart rate data were collected. TSH and FT4 levels were measured by electrochemiluminescence immunoassay, and the predictive value of combined use of TSH+FT4 and gestational age at birth on neonatal hypothyroidism was analyzed. The prespecified secondary outcomes were the risk factors for neonatal hypothyroidism determined using univariate and logistic regression analyses. TSH levels were significantly higher, whereas FT4 levels were lower in the patient group at 3 days of age compared with the control group (P<0.05). After 8‑week treatment with thyroxine, these levels were not significantly different between the patient and control groups (P<0.05). The combined use of TSH+FT4 levels and gestational age at birth to predict neonatal hypothyroidism demonstrated a significantly improved sensitivity, specificity, accuracy, positive predictive value and negative predictive value (92.86, 97.26, 96.76, 81.25 and 99.07%, respectively) compared with the use of only TSH+FT4 levels (P<0.05). Logistic regression analysis revealed a low gestational age at birth, maternal thyroid dysfunction and low birth weight were risk factors for neonatal hypothyroidism (P<0.05). The combined use of TSH+FT4 levels and gestational age at birth resulted in an improved prediction of neonatal hypothyroidism and contributed to early therapeutic intervention. Thus, special intervention is necessary for pregnant women with thyroid dysfunction to reduce the incidence of neonatal hypothyroidism.

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