新筛高TSH血症患儿甲状腺功能恢复情况与生长发育状况的关系分析

Analysis of the Relationship between the Recovery of Thyroid Function and the Growth and Devel-opment of Children with Newly Screened High TSH Hyperthyroidemia

【目的】探讨新筛高促甲状腺素（Thyroid stimulating hormone，TSH）血症患儿甲状腺功能恢复情况与生长发育状况的关系，为临床治疗适应证及治疗目标的制定提供参考依据。【方法】选取本院2014年2月至2017年2月收治的281例新筛高TSH血症惠儿，按照其随访期间甲状腺功能恢复情况，将患儿分别纳入TsH自然恢复组、药物治疗组，同期选取60名月龄相仿的健康儿童作为对照组。对三组儿童1岁智能发育、身长发育进行比较，分析血清TSH变化对儿童生长发育的影响。【结果1281例高TSH血症患儿中，237例（84．34％）于随访期间血清TSH水平自然恢复至正常范围内，其中176例于3个月内恢复正常，55例于3～6个月内恢复正常，6例于6～9个月内恢复正常；其余44例因初始或随访期间血清TSH水平超过15mIU／mL接受左旋甲状腺素钠片治疗，除9例末次随访时仍为高TsH血症外，其余35例血清TSH水平均恢复正常。三组受试儿童1岁时MDI、PDI评分组间比较，差异均无统计学意义（P〉0．05）；三组受试儿童1岁时身长发育状况组间比较，差异均无统计学意义（P〉0．05）。【结论】多数新筛高TSH血症患儿甲状腺功能可在短期内恢复正常，且高TSH血症并不会对患儿生长发育造成明显影响，临床治疗中应慎重判断治疗适应证、避免过度治疗。

[Objective]To explore the relationship between the recovery of thyroid function and the growth and devel- opment of children with newly screened TSH （thyroid stimulating hormone） hyperthyroidemia, and to provide references for the formulation of therapeutic indications and treatment goals. [Methods] A total of 281 children with newly screened high TSH hyperthyroidemia who were admitted to our hospital from February 2014 to February 2017, according to the recovery of thyroid function during follow-up , were divided into the TSH natural recovery group and the drug treatment group. In the same time period, 60 healthy children of similar age were selected as the control group. We compared the in- telligence and growth development of the three groups at the age of one year, and analyzed the effects of serum TSH on childreffs growth and development. [Results]Of the 281 cases of high TSH hyperthyroidemia patients, 237 cases （84.34 %） showed their TSH returned to normal level naturally （without any treatment） during the follow-up period, of which 176 cases returned to normal within 3 months, 55 cases return to normal within 3-6 months, and 6 cases returned to normal within 6-9 months. The remaining 44 patients with high serum TSH more than 15 mIU/mL during the initial or follow-up period received levothyroxine sodium tablets. Of these, 35 cases returned to normal serum TSH level after treatment. However, the remaining 9 patients still maintained at high TSH hyperthyroidemia even after receiving the treatment. There were no significant differences between the MDI （mental development index） and PDI （psychological de- velopment index） scores of the three groups of children at the age of one year （ P 〉0.05）. The children＇s height of the three groups at the age of one year did not show significant difference （ P〉0.05）.[Conelusion]The thyroid function of most children with newly screened high serum TSH hyperthyroidemia can return to normal in a short time, and high TSH hyperemia does not have a significant influence on the growth and development of children.Clinical treatment indications should be carefully judged to avoid overtreatment.