SCREENING FOR CONGENITAL HYPOTHYROIDISM

ABSTRACT. Larsson, A., Ljunggren, J. G., Ekman, K., Nilsson, A. and Olin, P. (Departments of Paediatrics and Child Psychiatry, Karolinska Institute, St. Goran's Children's Hospital; the Department of Medicine, St. Göran's Hospital; and the PKU Section of the Department of Bacteriology, National Bacteriological Laboratory, Stockholm, Sweden). Screening for congenital hypothyroidism. I. Laboratory results of a pilot study based on dried blood samples collected for PKU screening. Acta Paediatr Scand, 70:141, 1981. – A pilot study was performed to establish optimal conditions for nation-wide screening for congenital hypothyroidism in Sweden. The levels of T₄ and TSH were determined by automated radioimmunoassay in the dried blood spots, routinely collected for PKU screening on the fifth postnatal day, from all 1979, 2 infants born in the Stockholm area during a 14-month period. To identify safe minimum recall criteria for routine use, infants were recalled if the TSH level was more than 30 mU/l of plasma or–if they were not preterm–the T₄ concentration was less than -2 S.D. of the mean. Altogether 160 infants were recalled. Seven newborns with congenital hypothyroidism were identified, 6 with primary and one with secondary hypothyroidism. Five infants had decreased levels of thyroxine-binding globulin. The results of the follow-up analyses from recalled infants showed that determination of the reverse-T₃ level may be of diagnostic value around the 23rd day of life. The results of the clinical investigation of recalled infants are reported in a subsequent paper and a programme for nation-wide screening for congenital hypothyroidism is proposed.     

CHANGES IN SERUM CONCENTRATIONS OF THYROID HORMONES AND THYROID HORMONE-BINDING PROTEINS DURING EARLY INFANCY Studies in Healthy Fullterm, Small-for-gestational Age and Preterm Infants Aged 7 to 240 Days

Abstract. Serum concentrations of thyrotropin (TSH), thyroxine (T₄), triiodothyronine (T₃), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) were determined in 492 blood samples from 127 fullterm (FT), 91 small-for-gestational age (SGA) and 88 preterm (PT) healthy infants aged 7 to 240 days. Serum T ₄ decreased about 20% during the first month of life. In infants aged 7–49 days, serum T₄ concentrations were significantly lower in SGA than in FT infants, and even lower values were found in PT infants. Serum T ₃ increased 50–70% reaching maximal values by 50–79 days of life. Serum T₃ levels were higher in FT than in SGA infants throughout the observation period. In PT infants serum T₃ increased from low values to levels which exceeded those of SGA and FT infants by 120–240 days of life. Serum TSH level did not change with age and was 5 mU/1 in all infants. Serum TBG values were high compared to normal adult values and did not change significantly with age. Comparable serum TBG values were found in FT, SGA and PT infants. Serum TBPA increased with age. Serum TBPA increased gradually in FT infants. In SGA infants serum TBPA increased from low values to levels which by 120–240 days of life exceeded those of PT and FT infants. In PT infants a decrease in serum TBPA appeared before the rise commenced. Serum Alb increased gradually in FT, SGA and PT infants during the observation period. Serum Alb in PT infants aged 30–119 days was lower than those in FT infants with similar ages. These physiological changes in serum concentrations of thyroid hormones and hormone-binding proteins during early infancy should be considered when interpreting thyroid function tests in infants with various maturity.     

Fetal hypopituitarism: perinatal endocrine and morphological studies in two cases

We report two infants with congenital absence of the anterior pituitary gland, documented by magnetic resonance imaging (MRI) or autopsy. In cord plasma obtained at birth from both infants, prolactin (PRL), pituitary growth hormone (hGH), placental growth hormone (hPGH) and thyrotropin (TSH) were undetectable; cortisol was low; thyroxine (T₄) was 31 nmol/l in one infant and 85 nmol/l in the other infant who had been treated prenatally with intra-amniotic L-T₄ administration. In maternal plasma at birth, PRL, hPGH and T₄ were normal and hGH was undetectable. These observations suggest that plasma hGH and PRL in the fetus are exclusively of fetal pituitary origin, hPGH is secreted into the maternal circulation and is not transferred to the fetus and fetal growth can be normal in the absence of hGH, hPGH and PRL in fetal plasma.     

SERUM CONCENTRATIONS OF THYROTROPIN, THYROID HORMONES AND THYROID HORMONE BINDING PROTEINS DURING ACUTE AND RECOVERY STAGES OF IDIOPATHIC RESPIRATORY DISTRESS SYNDROME

Abstract. A total number of 27 premature infants with idiopathic respiratory distress syndrome (IRDS) and 52 healthy controls with comparable gestational age and body weights were studied during the first month of life. In infants with IRDS a reduced thyrotropin (TSH) response to birth was suggested, as serum TSH was lower in IRDS patients than in controls during the first two days of life. Low serum concentrations of thyroid hormones were found in the acute stage of IRDS reaching minimal values by day 3–5. After that period an increase in thyroid hormone levels occurred. The serum T₃ increased to the level of healthy prematures by day 6–10, whereas the serum T₄ increased to normal levels by day 21–30. Serum concentrations of thyroxine-binding globulin (TBG) were significantly lower in IRDS patients than in healthy controls; a gradual increase to normal levels occurred during recovery. Serum prealbumin (TBPA) levels in IRDS infants increased rapidly after birth and exceeded levels of healthy infants. Serum albumin values were not significantly different in the two groups of infants. The serum T₄/TBG ratios were low during recovery from IRDS.     

Smoking during Pregnancy–Effects on the Fetal Thyroid Function

ABSTRACT. Infants delivered at term by mothers smoking at least 10 cigarettes daily during pregnancy ( n =46) were found to be growth retarded compared to infants of non-smoking mothers ( n =49), birthweights 3445pM385 (SD) g and 3667pM392 g respectively ( p <0.05) in the two groups. Cord serum thyrotropin (TSH) was significantly decreased (8.2±4.(1 U/l vs. 10.3±4.9 U/l) and free thyroxine index (FT₄I)/TSH ratio significantly increased (18.8±9.0 vs. 14.4±7.6) ( p <0.05) in the smoking group compared to infants of non-smokers. Cord serum thyroxine (T₄) and FT₄I were higher in the smoking group (149.0±22.4 nmol/1 and 125.5± 14.9 respectively) compared to infants of non-smoking mothers (140.6±21.6 nmol/1 and 120.0±16.5 respectively), with borderline statistical significance (0.05< p <0.10). The results indicate that infants of smoking mothers may have a hyperfunction of the thyroid gland at birth compared to infants of non-smokers, with a negative feed-back on TSH production from the pituitary gland. Increased metabolic rate and oxygen consumption caused by fetal thyroid hyperfunction may be pathogenetic factors for the fetal growth retardation caused by maternal smoking.     

Syndrome of Generalized (Peripheral Tissue and Pituitary) Resistance to Thyroid Hormone

Generalized resistance to thyroid hormone (GRTH), or Refetoff syndrome, is a disease in which peripheral tissues show resistance to thyroid hormone. Three patients with this disease were investigated. Cases 1 and 2 involved identical 7-year-old female twins and case 3, a 5-year-old girl. All three patients had goiters, and cases 1 and 2 had sensorineural deafness. In all three, the blood levels of T₄, free T₄, and T₃ were high, while the blood levels of TSH were normal or slightly elevated. The responses shown by blood levels of the thyroid hormone and TSH to administration of propylthiouracil and T₃ suggest that the regulating mechanism in the hypothalamic-pituitary-thyroid system was functional. Upon administration of T₃, no sign of hyperthyroidism was observed.     

High and low dose initial thyroxine therapy for congenital hypothyroidism

Objective : To assess factors influencing thyroxine (T₄ levels 1 month after initiating replacement therapy for congenital primary hypothyroidism.
Methodology : A retrospective review of 41 children with congenital hypothyroidism who received either high or low dose initial T₄ therapy. Thyroid scintiscan was performed, and T₄ levels determined before starting treatment and after 1 month.
Results : T₄ levels at 1 month were correlated ( r ²=0.38, P <0.001) with the pretreatment T₄ level ( r = 0.48), as well as with the T₄ dose ( r = 0.46). Suboptimal treated T₄ levels (<130nmol/L) were seen with greater frequency in infants with thyroid agenesis (7/11) rather than ectopia (7/28, P <0.03), despite receiving similar doses of thyroxine. Infants with suboptimal treated T₄ levels had lower pretreatment T₄ levels than those with optimal levels (21±7 vs 48±34nmol/L, P <0.02). Biochemical hyperthyroidism (T₄ >216nmol/L) occurred in six patients: four of six had ectopia.
Conclusions : These data suggest that infants with little residual thyroid function should receive higher initial T₄ doses than those with significant ectopia.     

Subclinical Thyroid Hormone Abnormalities in Type I Diabetic Children and Adolescents. Relationship to Metabolic Control

ABSTRACT. The serum levels of thyroid hormones and thyroid stimulating hormone were compared in 64 type I diabetic children and adolescents without ketosis and in 28 age matched normal subjects. Only T₃ levels were significantly different in the diabetic patients (2.38±0.41 nmol/1) than in controls (2.64±0.52 nmol/1) (p<0.01) confirming the existence of the'low T₃ syndrome'in diabetic children. A negative correlation was found between T₃ and blood glucose as well as glycosylated haemoglobin suggesting that short-term hyperglycaemia could regulate T₃ concentration. Thyroid function was not different in diabetic children with or without thyroid antibodies. We conclude that serum T₃, level is influenced by the degree of metabolic control and that thyroid function in diabetic children should be assessed by the measurement of the serum concentration of T₄, FT₄ and TSH.     

Transient congenital hypothyroidism due to maternal thyrotrophin binding inhibiting immunoglobulin

Transient congenital hypothyroidism due to maternal thyrotrophin binding inhibitor immunoglobulin (TBII), a thyroid-stimulating hormone (TSH)-receptor blocking antibody, is described in three male siblings born to a mother with autoimmune thyroiditis. These cases are believed to be the first described in Australia. The first child was found to have a serum TSH of 565 mU/L and had a negative thyroid scan when presented for neonatal screening. He was treated with thyroxine but became thyrotoxic at 3 months of age when he was on a dosage of 85 μg/m² of body surface area. He was euthyroid 6 months after discontinuation of therapy. Nine years later a second hypothyroid sibling was born, with a serum TSH of 709 mU/L on day 4. Both mother and child were demonstrated to be strongly positive for TBIl. Again this child was able to cease therapy by the age of 9 months. A third sibling, also TBIl positive, was born 12 months after the second. His TSH was 90 mU/L and his serum thyroxine (T₄) was 169 nmol/L. On this occasion, thyroid stimulation-blocking antibody was found to be present in the serum of both mother and child. Thyroxine therapy was ceased at 1 month. The family present a picture of varying degrees of transient neonatal hypothyroidism due to the transplacental passage of a maternal receptor blocking antibody. The condition is self-limiting, resolving when the immunoglobuiin is cleared from the infant's circulation.     

COMPARISONS BETWEEN SERUM CONCENTRATIONS OF THYROXINE AND THYROXINE-BINDING PROTEINS IN SAMPLES SIMULTANEOUSLY OBTAINED FROM CAPILLARY, PERIPHERAL VEIN, CENTRAL VEIN AND AORTA IN NEWBORN INFANTS

Abstract. Jacobsen, B. B. and Peitersen, B. (University Clinic of Paediatrics, Children's Hospital, Fuglebakken, Copenhagen, Denmark). Comparisons between serum concentrations of thyroxine and thyroxine-binding proteins in samples simultaneously obtained from capillary, peripheral vein, central vein and aorta in newborn infants. Acta Paediatr Scand, 68: 43, 1979.—A total number of 40 newborn infants with various maturity were studied: 13 babies without perinatal events, 19 infants recovered from transient diseases, 6 infants with idiopathic respiratory distress syndrome and 2 infants with asphyxia indicating artificial ventilation. Comparisons were performed between serum concentrations of thyroxine (T₄), thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) in capillary versus peripheral vein, aorta versus central vein and, finally, in peripheral versus central veins. In healthy infants serum T₄ concentrations in capillary blood and peripheral vein did not differ significantly. Although serum concentrations of thyroid hormone-binding proteins tended to be increased in aortic compared to central venous specimens no statistically significant differences appeared. In infants in good clinical conditions serum T₄, TBG, TBPA, and Alb levels were 6–8% higher in peripheral than in central veins, possibly primarily due to a hemo-concentrating effect of venous stasis. Therefore, in evaluation of the thyroid variables in newborn infants the technique of blood sampling must be considered. In most infants with idiopathic respiratory distress syndrome and in one asphyxiated baby a remarkable tendency to a low serum TBG and T₄ concentration in peripheral compared to central vein samples, were observed.     

EFFECT OF CYPROTERONE ACETATE (CA) ON GROWTH AND ENDOCRINE FUNCTION IN PRECOCIOUS PUBERTY

Abstract. Stahnke, N., Ilicki, A. and Willig, R. P. (Department of Paediatrics, University Hospital, Hamburg, West Germany). Effect of cyproterone acetate (CA) on growth and endocrine function in precocious puberty. Acta Paediatr Scand, Suppl. 277: 32, 1979.–16 girls with precocious puberty have been studied. Following low dosage cyproterone acetate (CA) therapy (mean daily dosage 65 mg/m² BSA) a beneficial effect on growth and skeletal maturation was observed. During high dosage therapy (150 mg/m² per day) endocrinological studies were performed in 10 of these patients. There was no significant difference in HGH levels (insulin-and arginine-test), T₃ and TSH values (TRH-test) between patients and controls, T₄ concentration was significantly increased. Basal prolactin levels and prolactin response to TRH was definitely elevated. Oral glucose load and arginine infusion resulted in a significantly enhanced insulin release. There was a significant reduction in basal LH levels and an increase in FSH response to LH-RH. Basal and diurnal plasma cortisol values were markedly reduced and the cortisol release due to corticotrophin injection, (lsinevasopressin (LVP) injection and insulin-hypoglycemia as well. A definite increase in basal ACTH levels was observed, during LVP-and insulin-hypoglycemia test ACTH concentrations were within or significantly above normal range. In our patients a primary adrenocortical insufficiency due to CA treatment was evident.     

Medulloblastoma in Nordic Children. III Long Term Growth and Endocrine Sequelae

ABSTRACT. Growth and endocrine status of 38 Nordic children surviving from medulloblastoma were reevaluated 5–15 years after the diagnosis. Group I included children treated before the age of 10, and group II were the patients > 10 years at onset of tumour therapy. The median time interval from diagnosis to reexamination was 9 and 7 8/12 years in groups I and II ( p >0.1). The trunchal and standing height were highly affected at the follow-up. The median standing height standard deviation score (SDS) was -2.0 in group I and - 1.7 in group II. The corresponding median sitting height SDS was -2.5 in group I and +2.0 in group II. Growth hormone deficiency was found in 23 % of the patients, and only in group I. In both groups 69 96 had increased serum TSH concentrations (median 6.5 mU/I, range 1.3–30 mU/I) in spite of normal free T₄ and total T₃ levels. Hypogonadism and ACTH deficiency were rarely seen.
Conclusion: In patients treated for medulloblastoma, particularly when treated in early childhood, pronounced alterations appear in growth and endocrine systems. In the general clinical control of these patients anthropometric and endocrinological tests have to be included.     

PITUITARY-THYROID RESPONSIVENESS TO THYROTROPIN-RELEASING HORMONE IN PRETERM AND SMALL-FOR-GESTATIONAL AGE NEWBORNS

Abstract. A dose of 40 μg TRH was injected intravenously in 12 preterm (PT) and 15 small-for-gestational age (SGA) babies (with advanced gestational ages) between 5 and 167 hours after birth. Serum-thyrotropin (TSH) was measured prior to and 30 and 180 min after TRH; serum-thyroxine (T₄) and serum-triiodothyronine (T₃) were measured prior to and 180 min after TRH. The percentage increase in serum-TSH in PT and SGA babies was comparable to that of fullterm newborns. The serum-TSH 30 min after TRH in SGA newborns was significantly correlated to basal TSH values, such a correlation could not be shown in the preterms. One SGA and four PT babies had a repeat TRH-test performed later in infancy: In all but one PT with a gestational age of 27 weeks the TSH rise was lower than in the neonatal period. The thyroid hormone responses after TRH were similar in the two groups of babies. The percentage increase above basal levels were: Median serum-T₃ increase about 46% and median serum-T₄ increase about 14%. It is concluded that in low-birth-weight newborn babies the pituitary TSH response to exogenous TRH was like that detected in fullterm newborns and more pronounced than later in infancy. The effect of endogenous TSH as measured by thyroid hormone increases was of the same magnitude as observed in fullterms and in adults.     

EFFECT OF LONG-TERM GH ADMINISTRATION ON PITUITARY-THYROID FUNCTION IN IDIOPATHIC HYPOPITUITARISM

Abstract. Twenty-four euthyroid children with idiopathic pituitary dwarfism were studied. The euthyroid state for seven of these patients was determined by negative physical examinations, normal plasma T₄ assays and normal ¹³¹I uptakes. For the other children, thyroid function was evaluated with T₃ and T₄assays and on the basis of the TRH test. Each of the children was treated with HGH in one of three different ways. The first group (five cases) was given a HGH dose, ranging from 12.4 to 17.2 IU/m²/week. The second and third groups (nine and ten cases, respectively) were treated with 10 and 20 IU/m²/week, respectively. Treatment was carried out for periods ranging from 6 months to 6 years. After no less than 6 months of treatment, and at intervals of 6 months (or some multiple of 6 months) plasma T₃ and T₄ assays, as well as a TRH test were performed in each patient. In some patients one of the indices was once beyond the upper or lower limit of the normal range (none of the children presented simultaneous abnormal levels of more than one index during the controls). This value, however, returned to within normal limits at the following control. There was no correlation between T₃, T₄ and TSH with the duration of HGH therapy. There was no significant difference between the groups of children treated with the different HGH doses. These data seem to demonstrate that the risk of inducing an alteration in thyroid function in hypopituitary patients during HGH treatment is very slight, and that the irregularly abnormal thyroid indices observed in some of the children during one of the controls might be an expression of their metabolic status at that moment.     

IMMUNOELECTROPHORETIC DETERMINATION OF SERUM GLOBULINS 1N NEWBORN INFANTS OF DIABETIC MOTHERS

ABSTRACT. Davidsen, Otto (Diabetes Centre, Royal Maternity Department B, Rigshospitalet and Department of Clinical Chemistry, Sundby Hospital, Copenhagen, Denmark) Immunoelectrophoretic Determination of Serum Globulins in Newborn Infants of Diabetic Mothers. Acta Paediatr Scand, 63: 833, 1974.—Serum globulins were investigated by means of crossed immunoelectrophoresis in the cord blood from 40 infants of diabetic mothers and 92 infants with non-diabetic mothers. In infants of non-diabetic mothers the concentration of most globulins was lower than in adults and positively correlated to the gestational age of the infant. For α₂-HS-glycoprotein and an unidentified α₂-glob-uEn, however, a negative correlation to the gestational age was observed. Infants of diabetic mothers had a higher Concentration of transferrin and lower concentrations of α₂-macroglohulin and α₁-lipoprotein as compared with infants of the reference group. In the diabetes group the globulin concentrations were correlated neither to the gestational age nor to their increased birth weight, but the ratio α₂,-macroglobulin/α₂-HS-glycoprotein, which was expected to be independent of variations in the degree of hydremia of the infants, was significantly correlated to the gestational age. As judged from this parameter, infants of diabetic mothers are comparable to infants of non-diabetic mothers of about 4 weeks lower gestational age.     

RENAL FUNCTION IN INFANTS WITH HYPERBILIRUBINEMIA

Abstract. Broberger, U. & Aperia, A. (Departments of Paediatrics at Karolinska Sjukhuset and St. Göran's Children's Hospital, Stockholm, Sweden). Renal function in infants with hyperbilirubinemia. Acta Paediatr Scand, 68, 1979.—A total of 45 infants were studied on the fourth or fifth day of life: 13 term and 10 pre-term infants with serum bilirubin levels ranging between 257 and 390 µmol/l were compared with 12 term and 10 pre-term infants with serum bilirubin levels below 195 µmol/l. The groups did not differ with regard to mean gestational age or mean post-natal age. GFR and C_PAH were determined with the single injection clearance method and ability to excrete Na⁺ was determined following an oral loading of sodium chloride. GFR was lower in infants with hyperbilirubinemia and correlated negatively to the highest recorded serum bilirubin value. C_PAH was similar in hyperbilirubinemic infants and controls. The urinary sodium excretion was significantly higher in infants with hyperbilirubinemia.     

TRI-IODOTHYRONINE AND THYROXINE IN HUMAN MILK

ABSTRACT. The concentration of tri-iodothyronine (T₃) and thyroxine (T₄) in human milk was determined by radioimmunoassay (RIA). The analysis of T₃ was performed on unextracted milk and on ethanol extracts of defatted milk. Analysis of unextracted milk was complicated by artifacts. Reliable and reproducible results were achieved only with the milk extracts. In 10 colostral milk samples the mean T₃ levels ± SD were 0.80 ± 0.52 nmol/l before feeding (early milk) and 0.93 ± 0.62 after feeding (hind milk). The T₃ concentration in colostrum did not change significantly during the feeding to the infant. In 12 mature milk samples collected between infant feedings, the mean T₃± SD was 1.19 ± 0.42 nmol/l. T₄ was not detected in any of the samples analysed (detection limit 3 nmol/l).     

Thyroid gland volume as measured by ultrasonography in preterm infants

The volume of the thyroid gland was determined by ultrasonography in 30 preterm infants (27-36 weeks' gestation) born in Madrid. Thyroid gland volume significantly increased (p < 0.01) with postnatal and postmenstrual age and was very well correlated with body weight, height and surface area (p < 0.01). Serum thyroid hormones 3,5,3'-triiodothyronine (T₃) and free thyroxine (FT₄) were linearly correlated with postnatal and postmenstrual age, thus T₃ and FT₄ levels were also correlated with thyroid gland volume (p < 0.05). We report measurements of the thyroid gland volume obtained by ultrasonography in this group of preterm infants. Quantitative determination of thyroid gland volume is more accurate for the diagnosis of goitre than clinical criteria. It is also interesting to determine the thyroid gland volume in the neonatal period when the thyroid is particularly hypersensitive to the effects of iodine deficiency and excess.     

COMBINED TEST OF HYPOTHALAMIC-PITUITARY FUNCTION IN GROWTH-RETARDED CHILDREN TREATED WITH GROWTH HORMONE: II. Secretion of LH, FSH, TSH, Prolactin and ACTH

Abstract. P. C. Eskildsen, B. B. Jacobsen, K. W. Kastrup, S. Krabbe, P. E. Lebech and K. E. Petersen (The Children's Hospital Fuglebakken, Herlev Hospital and Frederiksberg Hospital, Copenhagen, Denmark). Combined test of hypothalamic-pituitary function in growth-retarded children treated with growth hormone. Acta Paediatr Scand, Suppl. 277: 14, 1979.—A total number of 23 patients treated with human growth hormone were retested by use of a combined pituitary stimulation test. Plasma concentrations of GH, FSH, LH, TSH, T₄, T₃, prolactin (PRL), ACTH and cortisol were measured before and after stimulation with hypoglycemia, TRH and LHRH. The test was performed in patients with persistent GH deficiency (group A) and patients with transitory GH deficiency (group B). In group A a normal pubertal development was found in three patients, whereas in prepubertal subjects the FSH/LH responses were smaller than those of prepubertal patients in group B. Also plasma ACTH increase was less pronounced in group A patients than in group B. In contrast, the plasma TSH and PRL responses were more sustained in group A than in group B. The secretory pattern of TSH and PRL was comparable in the two groups of patients. Thus, in patients with persistent GH deficiency additional multiple disturbances of the hypothalamic-pituitary function often appeared whereas in most patients with transitory GH deficiency the combined pituitary test was normal at the reinvestigation.     

孕母患自身免疫性甲状腺疾病对婴儿智能发育影响的多因素分析

目的探讨孕母患自身免疫性甲状腺疾病对婴儿智能发育的影响因素。方法对77例孕母患自身免疫性甲状腺疾病的婴儿采用Gesell发育量表进行跟踪调查,采用病例对照研究的方法对可能影响婴儿应人能、应物能、粗动作能、细动作能发育的因素进行非条件Logistic回归分析。结果(1)孕母患自身免疫性甲状腺疾病的婴儿其应人能、应物能、粗动作能、细动作能发育落后,与健康孕母的婴儿比较差异有统计学意义(P<0.01),慢性淋巴细胞性甲状腺炎孕母的婴儿其细动作能、应物能的发育比Graves病孕母的婴儿差,二者比较差异有统计学意义(P<0.05)。(2)经多因素非条件Logistic回归分析筛选出婴儿体内的抗过氧化物酶抗体、母体内的促甲状腺激素受体抗体与婴儿的应物能、应人能,粗动作能有关,而母体内抗过氧化物酶抗体、孕期母亲甲状腺功能则与细动作能有关(P<0.05)。结论孕母患自身免疫性甲状腺疾病对婴儿的智能发育有影响。