ESPEYB15 3 Thyroid Follow-up paper from Yearbook 2012 (1 abstracts)
3.5 Controlled Antenatal Thyroid Screening II: effect of treating maternal suboptimal thyroid function on child cognition
Hales C , Taylor PN , Channon S , Paradice R , McEwan K , Zhang L , Gyedu M , Bakhsh A , Okosieme O , Muller I , Draman MS , Gregory JW , Dayan C , Lazarus JH , Rees DA & Ludgate M
Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
To read the full abstract: J Clin Endocrinol Metab 2018;103:1583-1591
The Controlled Antenatal Thyroid Screening (CATS) study started in 2002 and was the first randomized controlled trial to evaluate the effect of screening and treatment of mild hypothyroidism during pregnancy on child cognition1. A large number of women (n=21,846) were recruited at a median of 12 gestational weeks in UK and Italy, and offspring of mothers with gestational mild hypothyroidism (median TSH 3.6 mU/L) or hypothyroxinemia (median FT4 11.1 pmol/L) were evaluated at age of 3 years. No difference in IQ was found then between children of treated and untreated mothers. The same results were confirmed by a more recent study (Casey et al.)2 presented in the 2017 Yearbook. They reported no difference on offspring cognition up to age 5 years born to mothers treated or not treated for subclinical hypothyroidism (median TSH 4.4 mU/L) or hypothyroxinemia (median FT4 0.83 ng/dl) at 16.7 or 17.8 gestational weeks, respectively.
Here, Hales et al. report CATSII, which is the age 9.5 years cognitive assessment of CATS children initially evaluated at 3 years, and represents the longest follow-up of a randomized controlled trial on this topic. Again, the authors found no difference in any IQ measure between offspring of treated or untreated mothers with suboptimal gestational thyroid function. However, a high number of children initially evaluated were lost to follow-up for CATSII: only 119/303 children of the original treatment group and 98/306 children of the control group were available for IQ testing at 9.5 years. On the other hand, here the authors also studied children of mothers with optimal gestational thyroid function from the original CATS cohort as a further control group. The authors did not find a significant difference in the odds of IQ <85 between offspring of mothers with optimal versus suboptimal gestational thyroid function, irrespective of treatment. In summary, there was a lack of treatment effect if started in the second trimester. However, the question remains, whether earlier intervention with LT4 substitution in the first trimester would have a positive effect on child cognitive development and at what TSH or FT4 levels such a treatment effect could be expected and treatment recommended. Further studies are awaited.
1. Lazarus JH, Bestwick JP, Channon S, Paradice R, Maina A, Rees R, Chiusano E, John R, Guaraldo V, George LM, Perona M, Dall’Amico D, Parkes AB, Joomun M, Wald NJ. Antenatal thyroid screening and childhood cognitive function. N Engl J Med 2012; 366:493-501
2. Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, Reddy UM, Wapner RJ, Thorp JM, Jr., Saade G, Tita AT, Rouse DJ, Sibai B, Iams JD, Mercer BM, Tolosa J, Caritis SN, VanDorsten JP, Eunice Kennedy Shriver National Institute of Child H, Human Development Maternal-Fetal Medicine Units N. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy. N Engl J Med 2017; 376:815-825
Volume 15
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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