The growth of children with congenital hypothyroidism: the importance of congenital hypothyroidism screening

ORIGINAL ARTICLE

The Growth of Children with Congenital Hypothyroidism: The Importance of Congenital Hypothyroidism Screening

Novina Novina¹, Yunita Puji Astuti¹, Erni Nuraeni¹, Erwin Affandi Soeriadi², Faisal Faisal¹.

¹Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia,
²Department of Nuclear Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.

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Abstract
Background: The thyroid hormone is an important hormone that affects children's growth, especially in early life. In 2014, the Indonesia Minister of Health issued congenital hypothyroidism screening (CHS) regulations for every newborn. This screening is crucial because early detection can prevent significant negative impacts on children’s growth and development. This study aimed to evaluate growth and verify the implementation of CHS in children with congenital hypothyroidism (CH).
Methods: A cross-sectional study using secondary data from medical records from January 2020 to December 2021 was conducted. Data were collected, including age, gender, CHS engagement, thyroid scintigraphy, duration of treatment, Z-scores of height for age (HAZ) and body mass index for age (BAZ), and also levels of free tetraiodothyronine (ft4) and thyroid stimulating hormone (TSH). Data were analyzed using the paired t-test and the Wilcoxon test.
Results: 25 children with CH never engaged in CHS, primarily boys (52%) aged less than three years old at the first visit (80%). After appropriate treatment during a 45-month observation period, mean HAZ and BAZ increased significantly from the first to last visit (p<0.001 and p=0.037, respectively). Also, levels of ft4 and TSH improved significantly from the first to last visit (p=0.014 and p=0.001, respectively).
Conclusion: None of the children with CH treated at RSHS ever had CHS, despite the regulations already existing. Significant improvements of growth indicators (HAZ and BAZ) and thyroid hormone levels occurred after appropriate treatment. These findings emphasize the critical need for the establishment of CHS in Indonesia.

Why this article important?

This study aimed to evaluate the growth of children with congenital hypothyroidism (CH) and examine the implementation of congenital hypothyroidism screening (CHS) in West Java Indonesia, despite regulations mandating congenital hypothyroidism screening since 2014 in Indonesia. Because the thyroid hormone is an important hormone that affects children's growth, especially in early life. By analyzing growth parameters and thyroid function before and after treatment, the study provides compelling evidence that early diagnosis and intervention significantly improve outcomes. These findings reinforce the urgent need for nationwide CHS enforcement to prevent developmental delays and long-term health consequences, ultimately contributing to better pediatric healthcare policies and practices.

Summary of article

This study aimed to evaluate the growth of children with congenital hypothyroidism (CH) and examines the implementation of congenital hypothyroidism screening (CHS) in Indonesia. Despite regulations mandating CHS since 2014, none of the 25 children included in the study had experienced screening at birth. The study, conducted at Hasan Sadikin General Hospital using secondary data from 2020-2021, analyzed parameters such as height-for-age Z-score (HAZ), body mass index-for-age Z-score (BAZ), free tetraiodothyronine (fT4), and thyroid-stimulating hormone (TSH) levels before and after treatment with levothyroxine. Results showed significant improvements in growth and hormone levels following treatment over a 45-month observation period. HAZ and BAZ increased significantly (p<0.001 and p=0.037, respectively), and thyroid function improved with increased fT4 and decreased TSH levels (p=0.014 and p=0.001, respectively). The most common cause of CH was thyroid agenesis (44%). These findings highlight the critical need for widespread implementation of CHS in Indonesia to ensure early diagnosis and treatment, preventing adverse effects on children's growth and development.

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