| Objective: To investigate physical growth, neuropsychological development and behavior characteristics in children with early-treated congenital hypothyroidism (CH) at the age between 4 and 6 years and to evaluate the effect of CH on physical growth and psychological development in these children so as to provide a basis for intervention.Methods: A historical cohort study was performed in 4-6 years old children with congenital hypothyroidism detected by neonatal screening in Qingdao. 47 children with permanent congenital hypothyroidism who had been born from November 1996 to November 2002 were studied at the age between 4 and 6 years and compared to 58 matched children born at the same time, but having normal thyroid function at birth. Physical and mental development of the children was evaluated on the basis of growth and bone age indices, thyroid function and neurodevelopmental assessments, respectively. Neurodevelopmental assessments of 105 subjects included self-made inventory questionnaire, Wechsler Intelligence Scale for Children Chinese Version, S-M Social Adaptability Testing Form, Achenbach Child Behavior checklist, Temperament assessment battery for children at the age between 3 and 7 years, Family Environment Scale-Chinese Version.Results:①In preschool, the children with congenital hypothyroidism were significantly lower than the control group in the weight, height and bone age.②Thyroid-stimulating hormone (TSH) concentrations of the children with CH (3.27±4.57pmol/1) were comparable to that of the controls (3.27±1.48pmol/1), but free triiodothyronine concentrations (FT3) (7.41±2.86pmol/l) and free thyroxine concentrations (FT4) (22.67±7.22pmol/1) were higher.③Seven eighths of case group mean verbal IQ (VIQ), performance IQ (PIQ) and total scores in cognitive tests were within the normal range, but lower than those of the controls. The balance of VIQ and PIQ between children with CH and the controls was no different(χ~2=0.039, p=0.844).④The occurrence rate of behavior problems in children with CH was higher than that in normal children. Melancholy, sexual problems, schizophreniform anxiety and offensive behavior were more common in males with CH than those in normal ones. While somatic complaints, depressed, obesity, aggressive and restless behavior was more common in female with CH than those in the controls.⑤There was a statistically significant difference (χ~2=16.781, p=0.000) in the type of temperament between the case group and the controls. In the case group, the number of difficult temperament children was significantly larger than those in the controls. The scores of persistence, quality of mood and distractibility were significantly higher in the case group than that in the control group.⑥The scores of social communication were significantly lower in the case group than that in the control group, but not total scores or standard scores. Children with early-treated CH have normal social adjustment ability.⑦Children with CH lived in worse family environment. The cohesion, achievement orientation and active-recreational orientation scores were lower.⑧Thyroid function, the commencement of treatment and intervention, family environment and parents' general state of health, economy and heredity are major factors in affecting cognitive development in children with early-treated CH.Conclusion: The present findings strongly suggest that abnormalities in thyroid function at birth, though having been early-diagnosed and early-treated, can adversely affect long-term physical growth, thyroid function and mental development.
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