A Longitudinal Assessment of Thyroid Hormone Concentrations in Preterm Infants Younger Than 30 Weeks’ Gestation During the First 2 Weeks of Life and Their Relationship to Outcome

Abstract

OBJECTIVE: This trial examined the effects of triiodothyronine (T3) and hydrocortisone on lung disease. We present here the placebo data as this provides a natural history of thyroid hormone changes in this group of very preterm infants. We also examined the relationship between thyroid hormone levels and the outcome death and ventilator dependence at 2 weeks. METHODS: Plasma-free T3 (FT3), free thyroxine (FT4), total T3, total T4, and thyroid-stimulating hormone were measured prospectively in preterm infants who were <30 weeks' gestation during the first 14 days of life. The data were obtained from the placebo arm of a multicenter, randomized, double-blind, clinical trial of T3 and hydrocortisone, called the THORN Trial. RESULTS: A total of 128 infants were recruited into the placebo group. The mean FT3 level at <5 hours of age was 4.9 pmol/L and remained below this level. FT4 levels decreased from 15 pmol/L to 9.7 pmol/L at 7 days and then increased to 11.0 pmol/L by day 14. Total T3 and total T4 levels fell after 5 hours of age and reached a minimum on day 3. Thyroid-stimulating hormone levels fell markedly from 9.2 mU/L to 1.8 mU/L at 72 hours and then increased to approximately 4 mU/L. We found that all thyroid hormones but particularly FT3 and FT4 hormones were highly significantly related to outcome. The lower the hormone levels, the worse the outcome (death or ventilator dependence at 2 weeks of age). CONCLUSION: 1) Thyroid hormone levels in preterm infants <30 weeks were much lower than in term infants, 2) the postnatal surge of thyroid hormones normally seen at 24 to 48 hours of age in term infants did not occur in our group of preterm infant, and 3) low FT3 and FT4 levels are associated with higher mortality and severity of lung disease.