The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism

D. A. Fisher, E. J. Schoen, Stephen Lafranchi, S. H. Mandel, J. C. Nelson, E. I. Carlton, J. H. Goshi

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Abstract

Measurements of serum concentrations of free T4, T3, TSH, and thyroglobulin (Tg) were conducted in 42 infants (2-9 months of age) detected and treated through the Northwest Newborn Regional Screening Program and 63 children and adolescents (1-18 yr of age) with congenital hypothyroidism (CH) detected and managed in the Northern California Kaiser Permanente Medical Care Program. Normal feedback control axis data were developed by Quest Diagnostics, Inc. - Nichols Institute Diagnostics and Loma Linda University, from free T4 and TSH measurements in 589 healthy subjects, 2 months to 54 yr of age; 83 untreated hypothyroid patients; and 116 untreated hyperthyroid patients. Twenty-four of the 42 CH infants and 57 of the 63 CH children manifested serum TSH concentrations appropriate for the measured free T4 level. In the remaining 18 infants and 6 children, serum free T4 values were increased 0.2-1.4 ng/dL (2.6-18.0 pmol/L) for the prevailing TSH level, suggesting a state of mild to moderate pituitary-thyroid hormone resistance. In the treated children, the mean T3 concentration was lower (by 32%, 102 vs. 150 ng/dL; 1.57 vs. 2.31 nmol/L) than in normal children, in agreement with earlier data in hypothyroid adults treated with exogenous T4. Serum Tg concentrations were normal or elevated in 90% of the 19 children with ectopic glands and 93% of 27 children with eutopic glands in whom measurements were available. There was a positive correlation between serum TSH and Tg concentrations (P <0.001), suggesting significant endogenous thyroid hormone production in these children. Our results suggest that the majority of infants and children with CH have a normal hypothalamic-pituitary-thyroid negative feedback control axis during treatment and that the measurement of serum TSH is a useful marker complementing the free T4 measurement in the management of children with CH. A minority have variable pituitarythyroid hormone resistance, with relatively elevated serum TSH levels for their prevailing serum free T4 concentration. The prevalence of resistance is greater (43%) in young infants (

Original languageEnglish (US)
Pages (from-to)2722-2727
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume85
Issue number8
DOIs
StatePublished - 2000

Fingerprint

Congenital Hypothyroidism
Feedback control
Thyroid Gland
Thyroglobulin
Feedback
Serum
Thyroid Hormones
Health care
Screening
Loma
Thyroid Hormone Resistance Syndrome
Hormones
Pituitary Hormones
Hyperthyroidism
Healthy Volunteers
Newborn Infant

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Fisher, D. A., Schoen, E. J., Lafranchi, S., Mandel, S. H., Nelson, J. C., Carlton, E. I., & Goshi, J. H. (2000). The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism. Journal of Clinical Endocrinology and Metabolism, 85(8), 2722-2727. https://doi.org/10.1210/jc.85.8.2722

The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism. / Fisher, D. A.; Schoen, E. J.; Lafranchi, Stephen; Mandel, S. H.; Nelson, J. C.; Carlton, E. I.; Goshi, J. H.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 85, No. 8, 2000, p. 2722-2727.

Research output: Contribution to journalArticle

Fisher, D. A. ; Schoen, E. J. ; Lafranchi, Stephen ; Mandel, S. H. ; Nelson, J. C. ; Carlton, E. I. ; Goshi, J. H. / The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism. In: Journal of Clinical Endocrinology and Metabolism. 2000 ; Vol. 85, No. 8. pp. 2722-2727.
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AU - Carlton, E. I.

AU - Goshi, J. H.

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