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. 2022 Aug 5;11(5):e220060.
doi: 10.1530/ETJ-22-0060. Print 2022 Oct 1.

Benefits of rescreening newborns of mothers affected by autoimmune hypothyroidism

Paolo Cavarzere  1 , Laura Palma  1 , Lara Nicolussi Principe  1 , Monica Vincenzi  2   3 , Silvana Lauriola  4 , Rossella Gaudino  1   2 , Virginia Murri  5 , Luigi Lubrano  6 , Giuliana Rossi  7 , Alessia Sallemi  8 , Ermanna Fattori  9 , Marta Camilot  2   3 , Franco Antoniazzi  1   2   10
Affiliations

Benefits of rescreening newborns of mothers affected by autoimmune hypothyroidism

Paolo Cavarzere et al. Eur Thyroid J. .

Abstract

Introduction: Infants of mothers with autoimmune hypothyroidism (AH) are at risk of developing late-onset hypothyroidism, often escaping at newborn screening. This condition might be caused both by the action of maternal antibodies and/or by maternal treatment.

Objectives: The aim of this study is to evaluate the prevalence of AH in the mothers of children born in Veneto region, Italy, and to define what is the most appropriate management for these newborns.

Methods: Newborns of six different hospitals with a mother suffering from AH and with negative neonatal screening for congenital hypothyroidism (CH) were included in the study. Between 15 and 20 days of life, we collected a serum sample for the evaluation of thyroid function (thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3)) and anti-thyroid antibodies. On the same occasion, a capillary blood sampling was performed for a second screening test.

Results: Maternal AH has a prevalence of 3.5%. A total of 291 newborns were enrolled from November 2019 to May 2021. Whereas the 11.4% of infants had a slight elevated serum TSH (>6 mU/L) and required a follow-up, only 2 children presented an elevated TSH level at the second screening test. One of these, with the gland in situ, showed persistently elevated serum TSH levels and required treatment with levothyroxine.

Conclusions: Maternal AH rarely caused neonatal thyroid dysfunction. We suggest to reassess newborns from mothers with AH 15 days after birth by means of a second neonatal screening test. This procedure avoids false negatives due to maternal thyroid status, is less invasive and cheaper than the serum TSH evaluation, and prevents a long follow-up.

Keywords: anti-thyroid antibodies; maternal autoimmune hypothyroidism; neonatal hypothyroidism; newborn screening.

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Figures

Figure 1
Figure 1
Serum levels of TSH (A), FT4 (B), dried blood spot TSH at birth (C), and dried blood spot TSH at 15−20 days of life (D) in patients divided in relation to maternal levothyroxine treatment during pregnancy. The median values are represented as a horizontal line. The edges represent respectively the 25th and the 75th centile of the cohort. Vertical lines represent the range. FT4, free thyroxine; LT4, levothyroxine; DBS, dried blood spot; TSH, thyroid stimulating hormone.
Figure 2
Figure 2
Correlation between serum TSH values and dried blood spot TSH at 15–20 days of life (R2= 0.5304, P  < 0.01). DBS, dried blood spot.
Figure 3
Figure 3
Serum levels of TSH (A), FT4 (B), dried blood spot TSH at birth (C), and dried blood spot TSH at 15–20 days of life (D) in patients divided according to antibody status. The median values are represented as a line. The edges represent respectively the 25th and the 75th centile of the cohort. Vertical lines represent the range. DBS, dried blood spot; FT4, free thyroxine; TSH, thyroid stimulationg hormone.
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