Abstract Title

Congenital Hypothyroidism

RAD Assignment Number

1637

Presenter Name

Luke Cielonko

Abstract

Introduction

Congenital hypothyroidism (CH) is common, affecting between 1:3,000 and 4,000 newborn infants. Unrecognized or inadequately treated, CH leads to mental retardation. Newborn screening has made it possible to identify affected infants at a very early age, allowing thyroid therapy to be initiated usually within two weeks of birth. As a result of early diagnosis and appropriate treatment, many children with CH have normal cognitive development.

The American Academy of Pediatrics (AAP) and the European Society for Pediatric Endocrinology (ESPE) have published guidelines to assist physicians in the appropriate evaluation and treatment of children with CH. Although early detection, correct diagnosis and timely treatment are critical to facilitate the best outcomes, little is known about provider practices when confronted with infants with congenital hypothyroidism. We, therefore, conducted a survey of pediatric endocrine providers to categorize beliefs and clinical practices.

Methods

An on-line survey was conducted of pediatric endocrine providers in a four state region (Texas, Oklahoma, Arkansas and Louisiana). All responses were anonymous and participation voluntary. The survey was conducted from January 15th to February 15th, 2016.

Results

The survey consisted of two clinical scenarios of infants with elevated thyroid-stimulating hormone (TSH) levels in the first two weeks of life. Other than a difference in the initial TSH, Scenario 1 (50 mU/L) vs. Scenario 2 (150 mU/L), the two scenarios were identical. Survey questions were designed to explore variation in clinical practice in several key areas, including physical examination, thyroid imaging, laboratory testing and treatment/follow-up. Analysis of variance (ANOVA) was used to examine how responses to these 14 items were impacted by the differences between practitioners based on years of experience (< 15 vs. > 15 years), the differences within practitioners’ responses, and the interaction between these two predictors. At least one of the three predictors was significant, p < 0.05, for eight of the 14 items. In general, endocrine providers with ≥ 15 years of experience ordered more tests, particularly in the Scenario 1 (TSH of 50 mU/L). The largest difference seems to have occurred for thyroid blood tests. In regard to treatment, most endocrine providers used 10-15 mcg/kg/d of thyroid hormone replacement, as per current guidelines.

Conclusions

Our survey indicates that endocrine providers who completed the survey appear to understand and adhere to CH guidelines irrespective of the level of TSH elevation. Significant differences (p < 0.05) were found, however, in the responses between providers with < 15 vs. ≥ 15 years of experience and within providers when confronted with an infant who had an initial TSH of 50 vs 150 mU/L. The reason for provider variability was not addressed by our questionnaire but should be explored.

This document is currently not available here.

Share

COinS
 

Congenital Hypothyroidism

Introduction

Congenital hypothyroidism (CH) is common, affecting between 1:3,000 and 4,000 newborn infants. Unrecognized or inadequately treated, CH leads to mental retardation. Newborn screening has made it possible to identify affected infants at a very early age, allowing thyroid therapy to be initiated usually within two weeks of birth. As a result of early diagnosis and appropriate treatment, many children with CH have normal cognitive development.

The American Academy of Pediatrics (AAP) and the European Society for Pediatric Endocrinology (ESPE) have published guidelines to assist physicians in the appropriate evaluation and treatment of children with CH. Although early detection, correct diagnosis and timely treatment are critical to facilitate the best outcomes, little is known about provider practices when confronted with infants with congenital hypothyroidism. We, therefore, conducted a survey of pediatric endocrine providers to categorize beliefs and clinical practices.

Methods

An on-line survey was conducted of pediatric endocrine providers in a four state region (Texas, Oklahoma, Arkansas and Louisiana). All responses were anonymous and participation voluntary. The survey was conducted from January 15th to February 15th, 2016.

Results

The survey consisted of two clinical scenarios of infants with elevated thyroid-stimulating hormone (TSH) levels in the first two weeks of life. Other than a difference in the initial TSH, Scenario 1 (50 mU/L) vs. Scenario 2 (150 mU/L), the two scenarios were identical. Survey questions were designed to explore variation in clinical practice in several key areas, including physical examination, thyroid imaging, laboratory testing and treatment/follow-up. Analysis of variance (ANOVA) was used to examine how responses to these 14 items were impacted by the differences between practitioners based on years of experience (< 15 vs. > 15 years), the differences within practitioners’ responses, and the interaction between these two predictors. At least one of the three predictors was significant, p < 0.05, for eight of the 14 items. In general, endocrine providers with ≥ 15 years of experience ordered more tests, particularly in the Scenario 1 (TSH of 50 mU/L). The largest difference seems to have occurred for thyroid blood tests. In regard to treatment, most endocrine providers used 10-15 mcg/kg/d of thyroid hormone replacement, as per current guidelines.

Conclusions

Our survey indicates that endocrine providers who completed the survey appear to understand and adhere to CH guidelines irrespective of the level of TSH elevation. Significant differences (p < 0.05) were found, however, in the responses between providers with < 15 vs. ≥ 15 years of experience and within providers when confronted with an infant who had an initial TSH of 50 vs 150 mU/L. The reason for provider variability was not addressed by our questionnaire but should be explored.