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

  • Published Date:

    May 11 2020

  • Source:
    J Pediatr. 223:136-140
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  • Alternative Title:
    J Pediatr
  • 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.
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