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Developmental Trends in Cord and Postpartum Serum Thyroid Hormones in Preterm Infants

Community Health Sciences (F.L.R.W., S.A.O.) and Maternal and Child Health Sciences (J.S., C.D., R.H.), University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom; Department of Pediatrics (J.J.B.-S.), Division of Endocrinology, Erasmus University Medical Center/Sophia Children’s Hospital, 3015 GJ Rotterdam, The Netherlands; Department of Paediatrics (N.M.), The Rotunda Hospital, Parnell Square, Dublin 1, Ireland; Department of Internal Medicine (H.v.T., T.J.V.), Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands; and Nuclear Medicine Service (S.-Y.W.), Veterans Affairs Medical Center, University of California–Irvine Medical Center, Long Beach, California 90822

Address all correspondence and requests for reprints to: Professor Robert Hume, Maternal and Child Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, United Kingdom. E-mail: r.hume{at}dundee.ac.uk.

The purpose of this study was first to clarify postnatal trends in sera T₄, free T₄ (FT₄), T₄-binding globulin, TSH, T₃, rT₃, and T₄ sulfate levels in cord and at 7, 14, and 28 d in groups of preterm infants at 23–27 wk (n = 101), 28–30 wk (n = 196), and 31–34 (n = 253) wk gestation, and second to compare these trends to those of term infants and also with cord sera levels of equivalent gestational ages (n = 812; 23–42 wk gestation). In all preterm groups, TSH and rT₃ decrease to below, T₄-binding globulin increases to within, and T₃ and T₄ sulfate increase to above cord levels of equivalent gestational age. Term infants are hyperthyroxinemic relative to cord and nonpregnant adult levels of T₄. Postnatal T₄ increases are attenuated in 31- to 34-wk infants, absent in 28- to 30-wk infants (although levels are equivalent to gestational age), and crucially reversed in 23- to 27-wk infants. This immature group is hypothyroxinemic relative to other groups and to cord levels of equivalent gestational age. Compared with term infants, postnatal FT₄ increases are lower in 31- to 34-wk infants, attenuated in 28- to 30-wk infants, and absent in 23- to 27-wk infants. The 23- to 27-wk group is distinctive; they are hypothyroxinemic on T₄ levels, yet FT₄ levels are within the cord levels of equivalent gestational age.

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