Urinary iodine and thyroglobulin are useful markers in infants suspected of congenital hypothyroidism based on newborn screening.

Abstract

Iodine deficiency and excess both cause thyroid dysfunction. Few data describe the relationship between iodine status and outcomes of congenital hypothyroidism (CH) in iodine-sufficient areas. We investigated urinary iodine (UI) concentration and its relationship with the clinical course of CH. We reviewed and retrospectively analyzed patients with positive newborn screening (NBS) for CH from January 2012 to June 2019 in Japan, obtaining UI and UI-urine creatinine ratio (UI/Cr), serum TSH, free T4, free T3 and thyroglobulin (Tg) at the first visit, TSH at NBS, levothyroxine (LT4) dose, and subsequent doses. A UI value of 100-299μg/L was considered adequate. Forty-eight patients were included. Median UI and UI/Cr were 325μg/L and 3,930 µg/gCr, respectively. UI was high (≥300μg/L) in 26 (54%) and low (≤99μg/L) in 11 (23%). LT4 was administered to 34 patients. Iodine status was not related to the need for treatment. We found a U-shaped relationship between Tg and UI/Cr. Patients with high Tg (≥400ng/mL) and abnormal UI levels required significantly lower LT4 doses (≤20µg/day) at three years of age. Even if they showed severe hypothyroidism initially, they did not need subsequent dose increments. Abnormal UI levels with Tg elevation were associated with lower LT4 dose requirements. The evaluation of iodine status and Tg concentrations were considered useful in patients suspected of CH.