Treatment Discontinuation by 3 Years After Levothyroxine Initiation among Children Diagnosed with Congenital Hypothyroidism

Details

• Alternative Title:
  J Pediatr
• Personal Author:
  Kemper, Alex R. ; Grosse, Scott D. ; Baker, Mei ; Pollock, Allison J. ; Hinton, Cynthia F. ; Shapira, Stuart K.
• Description:
  Background:
  
  Newborn screening identifies infants with congenital hypothyroidism (CH) for whom levothyroxine (L-T4) prevents cognitive impairment but also can identify infants with transient hypothyroidism. For some, transient hypothyroidism can be ruled out by thyroid gland imaging; otherwise, it is confirmed when thyroid stimulating hormone (TSH) concentrations remain normal after a supervised trial off L-T4, typically after age 3 years.
  
  Objectives:
  
  To measure the rates of thyroid gland imaging and L-T4 discontinuation and to assess whether discontinuation was monitored with TSH testing.
  
  Methods:
  
  This is a retrospective analysis of claims data from the IBM® MarketScan® Databases for children born during 2010–2016 and continuously enrolled in a non-capitated employer-sponsored private health insurance plan or in Medicaid for ≥36 months from the date of the first filled L-T4 prescription.
  
  Results:
  
  263 privately-insured and 241 Medicaid-enrolled children met the inclusion criteria. More privately-insured than Medicaid-enrolled children had imaging between the first filled prescription and 180 days after the last filled prescription (24.3% vs. 12.9%; P=0.001). By 36 months, 35.7% discontinued L-T4, with no difference by insurance status (P=0.48). Among those who discontinued, 29.1% of privately-insured children and 47.7% of Medicaid-enrolled children had no claims for TSH testing within the next 180 days (P=0.01).
  
  Conclusions:
  
  Nearly one-third of children with suspected CH discontinued L-T4 by 3 years and fewer Medicaid-enrolled than privately-insured children received timely follow-up TSH testing. Future studies are indicated to understand the quality of care and developmental outcomes for children with CH and barriers to guideline adherence in evaluating for transient CH.
  
  
• Subjects:
  Article Congenital Hypothyroidism Female Follow-Up Studies Guideline Adherence Hormone Replacement Therapy Humans Infant Infant, Newborn Male Prognosis Retrospective Studies Thyroxine Time Factors Withholding Treatment

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• Source:
  J Pediatr. 223:136-140
• Pubmed ID:
  32437757
• Pubmed Central ID:
  PMC7427425
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  223
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:99c06338429f9146aa176fa7a40c902a774ddab80759cd51e8fb2d9e37db1e34
• Download URL:
  https://stacks.cdc.gov/view/cdc/92140/cdc_92140_DS1.pdf
• File Type:
  [PDF - 114.82 KB ]