Прогнозирование гипотиреоза на основе анализа психического поведения новорожденных

Феруза Шарипова; Феруза Шарипова

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Hypothyroidism Prediction Analyzing Psychic

Behavior in Newborns

Sharipova Farida Komilyevna

1*

,

Sharipova Feruza Ibragimovna

2

Abstract

Thyroid function disorders are the most common pathology of endocrine glands, which has a significant
impact on the physical and mental development of children.

Diagnosis of thyroid pathology in newborns and infants is very difficult. They are caused by peculiarities of
functional activity of the thyroid gland in newborns and infants, postnatal modifications of pituitary-thyroid

system, as well as numerous "masks" of other pathological processes, under which thyroid pathology can

hide. In addition, the formation and functional activity of the child's thyroid gland is closely related to the

health of the mother and the course of pregnancy. Transient neonatal hypothyroidism (TNH) is reversible,
and thyroid function subsequently recovers, but intellectual development disorders remain lifelong.

Unfortunately, data on the consequences of neonatal transient hypothyroidism are rather fragmentary and

contradictory.
Aim. The aim of the present study was to investigate the features of mental development in children with

congenital transient hypothyroidism during the neonatal period.
Material and Methods: clinical-psychopathological, clinical-catamnestic, experimental-psychological and

statistical research methods.
Results. Based on learning and applying research methods, were first studied long-term results of neonatal

transient form of hypothyroidism to 11 years. The validity of the timely use of thyroid drugs in combination

with neuroprotective showed efficiency.

Conclusion. Given the paramount role of thyroid hormones in the formation and maturation of the nervous
system in children, the special significance of transient hypothyroidism among other endocrinopathies of

newborns and children becomes obvious, which necessitates its further study.

Key Words:

Behavior, Prediction, Analyzing.

DOI Number: 10.14704/nq.2022.20.8.NQ44073 NeuroQuantology 2022; 20(8):656-662

Introduction

Thyroid gland regulates the functional activity

of the central nervous system throughout

human life (1-3).
Thyroid hormone deficiency at any stage of
brain formation turns into trouble: the brain

stops in development, it is subjected to

degenerative changes, which dramatically

worsens the intellectual and motor functions of
the person. As a result of hypothyroxinemia,

dysontogenesis of higher mental functions
occurs in the developing brain. This is

associated with impaired maturation and
migration of nerve cells, weakened myelination

and inhibition of neurocyte outgrowth and
synaptogenesis, reduced synthesis of nerve

growth

factor,

neurotransmitters

and

neuropeptides. Such

abnormalities are a prerequisite for impaired

formation of human cognitive functions (4,5).

Thyroid function disorders are the most
common pathology of endocrine glands, which
have a significant impact on the physical and

mental development of children (6-8).

Diagnostics of thyroid pathology in newborns

and infants is very difficult. They are caused by
peculiarities of functional activity of the thyroid

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gland in newborns and infants, postnatal

rearrangements of pituitary-thyroid system, as

well as numerous "masks" of other pathological
processes under which thyroid pathology can

hide (9-11).

Corresponding author:

Sharipova Farida Komilyevna

In addition, the formation and functional
activity of the thyroid gland in the child is
closely related to the health of the mother and

the course of pregnancy. (12-14). In case of

pregnancy pathology, an important aspect is the
diagnosis and timely correction of transient

thyroid function abnormalities in children.

Thyroid hormone deficiency often occurs at the
end of pregnancy and in the first week of
postnatal life, i.e. in that critical period of CNS

formation when the cortex is actively maturing.

Transient hypothyroidism in newborns (TNH)

is reversible and thyroid function subsequently
restores,

but

intellectual

development

disorders remain for life (15,16). Unfortunately,
data on the consequences of neonatal transient

hypothyroidism are rather fragmentary and

contradictory (17-19).
Given the paramount role of thyroid hormones

in the formation and maturation of the nervous

system in children, the special importance of
transient

hypothyroidism

among

other

endocrinopathies of newborns and children

becomes apparent, which necessitates its

further study.

Material And Methods

The palpatory examination of the thyroid gland

was performed jointly with endocrinologists of

the Republican Scientific and Practical Center of
Endocrinology of the Ministry of Health of the

Republic of Uzbekistan; its degree of

enlargement was assessed according to the

WHO classification (20).
The maternal and fetal pituitary-thyroid
systems were studied by radioimmune analysis

(RIA).

The level of thyroid hormone (TSH) was

determined with standard commercial kits
"IMMUNOTECH" (Czech Republic) in the
laboratory of the Scientific Research Institute of

Obstetrics and Gynecology of the Ministry of

Health of the Republic of Uzbekistan. The

concentration of TSH in the newborns was
determined using standard DELPHIA kits.
Clinic-psychopathological examination of the

mental status was performed according to the

standard technique of early childhood
examination.

An

ethological

method

(observation

of

behavior

in

free

communication) was used to observe the child
and the mother in the "mother-child" system.
The clinical diagnosis of psychiatric disorders

was based on the clinical classification of

psychopathological syndromes specific to

childhood and the research diagnostic criteria
of Title V (Mental and behavioral disorders) of

the International Classification of Diseases, 10th
revision (ICD-10) (21).

To assess the level of neuropsychological

development of children at 1 year of age, the
quantitative-qualitative screening technique

was used. Psychomotor development of

children from 1 to 3 years of age was
investigated on the basis of the methodological
recommendations for evaluation of early

childhood

psychomotor

development

developed by A. Panasyuk and L. Budareva at

the Department of Child Psychiatry, COLLIUW,
headed by Professor V. V. Kovalev (22). At

preschool age, as well as at school age, attention
was paid to the development of speech,

thinking, memory, social contacts, and general
mental status.

The obtained data were statistically processed

on a Pentium-4 personal computer using the

programs developed in the EXCEL package
using the library of statistical functions,
calculating arithmetic mean (M), standard

deviation (), standard error (m), relative

values (frequency, %), Student's test (t) with the

calculation of the probability of error (P).
Differences of mean values were considered

reliable at significance level P<0.005.
Correlation coefficient (r) was calculated to

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determine the nature of the relationship

between the indices.

Results

The work reflects the study of extra-genital
history, pregnancy and childbirth complications

in women, as well as the condition of newborns

with high and normal levels of thyrotropic
hormone (TSH).

The observations suggest that thyroid

pathology was significantly more common in
the study group (P<0.001), and chronic
infections were more common in the control

group mothers (P<0.001).

The most common extragenital pathology in

mothers who gave birth to children with
hypothyroidism phenomena was thyroid

disease (62.5% of cases), whereas in women
who gave birth to children without signs of

hypothyroidism

chronic

infection

was

predominantly encountered (26.7% of cases,

P<0.001).

At the next stage of our study, when assessing

the condition of newborns according to the
Apgar scale, we found that in children of the 3rd

group the mean score was significantly lower

than that of children in the first two groups.

A dynamic study of umbilical cord and capillary

blood TTH levels in children showed that in the
first day of life the mean TTH value in the

control group was 7.65±0.20 mEU/l, which was
significantly higher than in the first (28.9±0.49

mEU/l, P<0.001) and third (30.7±1.22 mEU/l,
P<0.001) groups. The level of TSH in children in

the second group (7.74±0.20 mEU/L)

corresponded to the control values (Fig. 1).

The study of statomotor function showed that in
groups 2 and 3, significantly fewer children held

their heads upright by the third month of life

(Table 1). In the second and third groups, the

delay in the formation of walking function was
very significant.

Thus, only 5.0% and 3.3% of the children
walked independently before one year of age,

while in the first group, there were no

significant differences compared to controls. In
addition, a significantly lower number (36.7%)

of children in the third group were able to sit up

independently without support until 9 months

of age.

Delayed development of self-care skills due to
impaired development of motor components

was found more often in children in the main
group (4.0% in group 1, 10.0% in group 2, and

26.7% in group 3 vs. 3.3% in the control group

P<0.005).
General motor activity was characterized by the

following features: in the main group (6.0% in

the 1st group, 15.0% in the 2nd group, and

30.0% in the 3rd group vs. 3.3% control;
P<0.005)

children

were

disinhibited,

hyperdynamic, fidgety. It should be noted that

the number of children with hypodynamic

syndrome was significantly higher in Group 3
(40.0% vs. 3.3% of controls; P<0.005).

The conducted studies showed that by the 3rd
month, the complex of cheerful face appeared in

88.0% (vs. 96.7% in the control, P>0.005),
67.5% (P<0.005) and 36.7% (P<0.001) of the

children of the 1st, 2nd and 3rd groups,

respectively. Sensory reactions such as visual

fixation, auditory concentration, typical for this
age, were evoked inconstantly in 33.3% (vs.
6.7% in controls, P<0.005) of children in group

3. In 13 (43.3%) children of the same group,

already in the first 3 months of life, a delay in the

formation of emotional symptom complexes
and modes of interaction with adults was

observed.

Elements

of

visual-motor

coordination were absent in 20.0% of the

children. The majority of Group 3 children were
characterized by lethargy, insufficiently

expressed positive emotional reactions. By the

4th-6th months, distinct positive emotional

reactions were already noted in 30.0% of
children, though the complex did not contain all
of its components (motor, vocal, emotional).

The study of children with HHT showed that in

Groups 1 and 2, children in the quantitative
assessment

of

neuro-psychological

development belonged to the unconditional risk

group, although positive developmental
dynamics were noted. By one year of

observation,

the

PDC

(psychological

development sufficiency) in these groups was

25.7±0.4

points

and

25.4±0.7

points,

respectively.

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In the structure of mental disorders in children

with HHT at the age of one year in the second

and third groups, hyperexcitability syndrome
(respectively, 37.5±7.8%, P<0.005; 50.0±9.3%,

P<0.001),

and

neuropathy

syndrome

(respectively, 35.0±7.6%, P<0.001; 40±9.1%,

P<0.001) dominated. Temporal delay of pre-

speech development was noted in all three
groups. The appearance of babbling by 5-6

months was observed in a significantly lower

number of children in Group 3 (36.7±9.0;

P<0.001), while in the control, first and second
groups this figure was 86.7±6.3%, 82.5±6.1%,

and 80.0±7.4% (P<0.001), respectively.

Analysis of the formation of eating and self-

service skills lagged in significantly more
children in all three groups compared to

controls.
In the second year of life, children with HHT had

a significantly lower mean developmental rate
(92.4±1.5 points in Group 1, 90.5±1.5 points in

Group 2, and 88.4±1.6 points in Group 2) than

controls (96.2±1.4 points, P<0.001). There were

no significant differences in CRC (P>0.005)
between the groups of children who underwent
HHT .

In the third year of life, PDC in children with

HHT was also significantly lower (94.2±1.5

points - group 1, 91.6±1.6 points - group 2, and
89.8±1.5 points) than in the control group

(97.9±1.4 points, P<0.001). It should be noted
that the PDC of Group 3 children was

significantly lower than that of Group 1
(P<0.005), but did not differ from that of Group

2 (P>0.005).

Partial mental retardation (20.0%) and

hyperkinetic disorders (12%) at the age of 5-7
years were recorded only in children of the
main group. At this age, specific disorders of

speech development were significantly more

frequent in children in the main group
(P<0.005) and were represented mainly by

specific disorders of articulation (24.0%) and

disorders of expressive (12.0%) and receptive
(6.0%) speech. Disorders of school skills

formation were recorded significantly more
frequently in 12 (24.0±6.1%; P<0.005) children

of the main group. Their structure was

dominated by specific reading disorder -

dyslexia in 11 (22.0%) cases, specific counting

disorder - dyscalculia in 9 (18.0%) cases, and

specific writing disorder - dysgraphia in 8
(16%) cases. There was a significant correlation

between speech disorders at 5-7 years of age
and disorders in the development of school

skills (r=0.72, P<0.005).

Children with HHT had rather frequent sleep
disorders. They manifested as parasomnias

(sleepwalking and sleep speaking with

elementary motor automatisms, less often as

nightmares) in 3 children (10.0%), as disomnias
(restless sleep, difficulty falling asleep) in 6

children (20.0%), while in the control group

only 1 child (3.3%) had such disorders. The

structure of neurosis-like disorders also
included enuresis (12.0%) and stuttering

(4.0%). Neurosis-like enuresis was detected
from an early age, initially appearing as a delay

in the formation of tidiness skills. Neurosis-like
stuttering had the following characteristic

features: monotony, low dependence on

circumstances, unexpressed experience of a

speech defect, etc.
In the clinical picture in 40.0% of the children
who had HHT, cerebrasthenic syndromes

dominated, asthenodynamic variant with

violations of school skills, mainly related to

insufficient development of spatial perceptions
(children learned mathematics, physics,

geography worse). Mental infantilism was
revealed in 30,0% of the children.

Mild cognitive disorders in the main group
occurred approximately twice as often as in the

control group (13.4% and 6.7%). Mental

retardation in children of the main group was

aggravated by the hyperdynamic syndrome and
disorders of sleep, appetite, and adaptation.
Mental infantilism occurred about 4.5 times

more frequently in the main group than in the

control group. Organic variant of mental
infantilism was revealed in 3 (10,0%) children,

inorganic - in 6 (20,0%) schoolchildren. There

was a moderate correlation between speech
disorders at 5-7 years of age and disorders of

school skills development in the same children
at the age of 10-11 years (r=0.35, P<0.005).

The clinical picture of mental disorders

included decreased intellectual productivity,

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memory, inertness of mental processes, slowed

thinking, difficulties in switching active

attention, low work capacity, increased fatigue,
easy exhaustion in the process of teaching

children school skills.

Discussion

The results of the study allowed us to formulate
the following conclusions:

Maternal complications of pregnancy (anemia,

gestosis, acute infections during pregnancy)
and childbirth (delayed childbirth, labor
anomalies, abdominal childbirth) preceded the

birth of children with transient hypothyroidism

with high frequency. Cases of asphyxia,

hemolycdynamic

disorders,

respiratory

distress syndrome, intrauterine hypotrophy,

and prolonged hyperbilirubinemia were
statistically significantly more frequent among

neonates with transient hypothyroidism
compared to control groups. There was a strong

association between the presence of maternal

thyroid pathology and the level of thyroid

hormone in the blood of the newborn in the
early neonatal period.

In this study, we found that 30% of newborns

with high and normal levels of thyrotropic

hormone (TSH) had elevated delayed mental

development and we also noted that thyroid
pathology was significantly more common in

newborns whose mothers have extragenital
pathology. Of note, the most common cause of

TSH elevation in newborns with signs of
hypothyroidism was thyroid pathology and

chronic infections of their mothers. Elevations

of umbilical cord and capillary blood TTH levels

were highly common in newborns with signs of
hypothyroidism and there was a significant

correlation between control and study groups.

However, Apgar scale elevation was showed

low indicators for the third group (generally
mild and transient newborns). We also noted

that in newborns signs of hypothyroidism not
developed statomotor functions compared to

newborns with mild signs of hypothoridism.

The most common symptom of hypothyroidism
as elements of visual-motor coordination were

absent in 20% of newborns with signs of

hypothyroidism expressed in lethargy,

insufficiently expressed positive emotional

reactions,

visual

fixation,

auditory

concentration. We also found a correlation

between neuro-psychological development and
psychological development sufficiency in these

newborns, which implicates that the negative

effect of increased TTH on the brain is reflected
in appearcne of mental disorders such as

hyperexcitability syndrome. A previous study

investigated the influence of iodine deficiency

on neuro-psychical development of children
with neonatal transient hypothyroidism and

revealed subclinical hypothyroidism and low

neuropsychological development index (13).

Another study reported that elevation of high
level of TSH at mothers that occurred during the

pregnancy

indicated

neuro-intellectual

impairment of the child and the study also noted

that

association

between

subclinical

hypothyroidism

(SCH)

and

impaired

neuropsychological

development

has

a

prognostic significance (9). In the present study,

we found that increase in the number of
children with neuro-psychiatric developmental
disorders is elevated due to the growth of TH

values (22). Similarly, in our study, a significant

increase in mental disorders was noted,

particularly in patient with high level of TH.

Conclusion

The results of our survey showed that the

majority of children with HHT In the first year
of life had delayed neuropsychological

development, manifested by delayed formation

of motor skills, emotional reactions, and

cognitive components. The frequency and
severity of mental disorders were found to

depend on the dynamic characteristics of HHT.

1.

With sufficient development of gross motor

skills in the second year of life, the majority
of children who had HHT in early childhood

(1-3 years) showed delayed development
of fine movements and speech, as well as

formation of self-care and tidiness skills.

Children with the least favorable dynamics
of HHT most often showed signs of general

and partial mental retardation, decreased

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or pathologically increased motor activity

and attention deficit.

2.

Subsequent age dynamics of mental
disorders in children who had HHT was

characterized by a relative alignment of
age-specific indicators of intellectual

development, while in some cases,

phenomena of mental infantilism, specific
disorders of speech development and

formation of school skills persisted. At

school age, productive psychopathological

disorders

of

borderline

level

predominated, most often in the form of

cerebrasthenic or neurosis-like syndromes.

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Table 1. Statomotor Function Indices in Children with Transient Hypothyroidism

Groups

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Age

1

n= 50

2

n=40

3

n=30

Control

n=30

Abs

%

Abs %

Abs

%

Aba %

Keeping

the

head

upright

< 3 m.

34

68.0±6.5

24

60.0±6.9

17 56.7±9.0 26

86.7±6.2

>3 m.

16

32.0±6.5

16

40.0±6.9

13 43.3±9.0 4

13.4±6.2

*<, to control

0.005

0.001

0.005

Sitting
without

support

< 9 m.

29

58.0±6.9

22

55.0±7.8

11 36.7±8.7 20

66.7±8.6

9-12 m.

21

42.0±5.8# 18

45.0±7.8

19 63.3±8.7 10

33.3±8.6

*<, to control

0.005

Walking

9-10 m.

5

10.0±4.2

2

5.0±3.4

1

3.3±3.2

7

23.4±7.7

1 year

36

72.0±6.8#

##

28

70.0±7.2##

#

5

16.7±6.8 22

73.3±8.1

> 15 m.

9

18.0±4.0#

##

10

25.0±6.4## 24 80.0±7.7 1

3.3±3.2

*<, to control

-

0.001

0.005

-

0.001

0.005

0.001

Note: *- p, ### - Reliability of the data to the 3rd group

Table 2: Indicators of Neurological-Psychological Development of Children in the First Month of

Life

Groups

PDC

Total

27-29 points

23-26 points

> 23 points

I (n=50)

9 (18%)

29 (58%)

12 (24%)

50 (41.7%)

II (n=40)

-

30 (75%)

10 (25%)

40 (33.3%)

III (n=30)

-

12 (40%)

18 (60%)

30 (25%)

Total:

9 (7.5%)

71 (59.2%)

40 (33.3%)

120 (100%)

Прогнозирование гипотиреоза на основе анализа психического поведения новорожденных

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