S. Bargagna et al., NEUROPSYCHOLOGICAL DEVELOPMENT IN A CHILD WITH EARLY-TREATED CONGENITAL HYPOTHYROIDISM AS COMPARED WITH HER UNAFFECTED IDENTICAL TWIN, European journal of endocrinology, 136(1), 1997, pp. 100-104
Objective: Neonatal screening for congenital hypothyroidism (CH) preve
nts the serious neuropsychological features of CH, but the question re
mains whether intelligence and motor skills of CH children treated ear
ly are completely normal. Design: In this report we describe the rare
case of two genetically identical twins, only one of whom was affected
by CH due to thyroid agenesis. L-Thyroxine (9 mu g/kg body weight/day
) therapy was initiated al 27 days of age and was adequate throughout
the follow-up. Methods: Neuropsychological evaluation was performed on
the twins in parallel from 3 months to 8 years of age. Results: The C
H twin (NB) did not show major neuromotor impairments but, compared wi
th the unaffected twin (EB), she had a slight delay in postural/motor
achievements and in language development that completely disappeared a
t 8 years of age, On standardised tests of intelligence, NE was indist
inguishable from control children but, compared with her twin, she had
lower IQ scores in most testing occasions up to 7 years of age (NB =
108 vs EB = 115). School achievements of NE did not significantly diff
er from those of her classmates but, compared with her twin, she score
d worse in writing, mechanical reading, verbal memory, and possibly in
arithmetic. Conclusions: Because the twins were genetically and pheno
typically identical, were raised in the same environment, and received
a similar education, it is concluded that hypothyroidism in utero and
in the first neonatal month was responsible for the lower neuropsycho
logical achievements of the CH twin. While foetal hypothyroidism is at
present unavoidable, earlier diagnosis and initiation of treatment in
neonates with CH are important and highly recommended.