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PEDIATRICS Vol. 112 No. 4 October 2003, pp. 923-930

Congenital Hypothyroidism: Influence of Disease Severity and L-Thyroxine Treatment on Intellectual, Motor, and School-Associated Outcomes in Young Adults

Beate Oerbeck, PhD^*,, Kjetil Sundet, PhD, Bengt F. Kase, MD, PhD^||, Sonja Heyerdahl, MD, PhD^*

^* Regional Center for Child and Adolescent Psychiatry, Region East and South, Oslo, Norway
Department of Psychiatry, University of Oslo, Oslo, Norway
Department of Psychology, University of Oslo, Oslo, Norway
^|| Department of Pediatric Research, Rikshospitalet University Hospital, Oslo, Norway

Objective. To describe intellectual, motor, and school-associated outcome in young adults with early treated congenital hypothyroidism (CH) and to study the association between long-term outcome and CH variables acting at different points in time during early development (CH severity and early L-thyroxine treatment levels [0–6 years]).

Methods. Neuropsychological tests were administered to all 49 subjects with CH identified during the first 3 years of the Norwegian neonatal screening program (1979–1981) at a mean age of 20 years and to 41 sibling control subjects (mean age: 21 years).

Results. The CH group attained significantly lower scores than control subjects on intellectual, motor, and school-associated tests (total IQ: 102.4 [standard deviation: 13] vs 111.4 [standard deviation: 13]). Twelve (24%) of the 49 CH subjects had not completed senior high school, in contrast to 6% of the control subjects. CH severity (pretreatment serum thyroxine [T4]) correlated primarily with motor tests, whereas early L-thyroxine treatment levels were related to verbal IQ and school-associated tests. In multiple regression analysis, initial L-thyroxine dose (ß = 0.32) and mean serum T4 level during the second year (ß = 0.48) predicted Verbal IQ, whereas mean serum T4 level during the second year (ß = 0.44) predicted Arithmetic.

Conclusions. Long-term outcome revealed enduring cognitive and motor deficits in young adults with CH relative to control subjects. Verbal functions and Arithmetic were associated with L-thyroxine treatment variables, suggesting that more optimal treatment might be possible. Motor outcome was associated with CH severity, indicating a prenatal effect.

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Key Words: congenital hypothyroidism • thyroid hormone • thyroxine treatment • adult outcome • intelligence • achievement • motor function

Abbreviations: CH, congenital hypothyroidism • T4, thyroxine • SES, socioeconomic status • TSH, thyroid-stimulating hormone • WASI, Wechsler Abbreviated Scale of Intelligence

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Received for publication Dec 20, 2002; Accepted Apr 9, 2003.

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