Desempenho em habilidades motoras, comunicativas e cognitivas de crianças com hipotireoidismo congênito tratadas desde o período neonatal
Performance in motor, communicative and cognitive skills of girls with congenital hypothyroidism treated from the neonatal period
Dionísia Aparecida Cusin Lamônica; Fernanda da Luz Anastácio-Pessan; Plínio Marcos Duarte Pinto Ferraz; Camila da Costa Ribeiro
Resumo
Objetivo: Comparar o desempenho das habilidades motora grossa, motora fina-adaptativa, linguagem, cognitiva e pessoal-social de meninas entre 36 e 70 meses com hipotireoidismo congênito tratado no período pós-natal com seus pares sem alterações tireoidianas.
Método: Participaram 15 meninas com diagnóstico de hipotireoidismo congênito, com idade cronológica variando de 36 a 70 meses no Grupo Experimental (GE); e 15 meninas sem alterações tireoidianas no Grupo Comparativo (GC), pareadas por idade cronológica e nível socioeconômico. Os instrumentos de avaliação utilizados foram: Entrevista com os pais; Teste de Vocabulário por Imagem Peabody (TVIP-R); e Teste de Triagem do Desenvolvimento de Denver II (TTDD-II). Foi realizada a avaliação psicológica, quanto ao nível intelectual, com a aplicação da Stanford-Binet Intelligence Scale (SBIS). A estatística foi realizada por meio de análise descritiva, teste “t” de Student e Teste de Mann-Whitney, nível de significância de p <5%.
Resultados: Na comparação do TVIP-R e SBIS, houve diferença estatisticamente significante entre o GE e o GC. Na comparação entre as áreas do TTDD-II, houve diferença estatisticamente significante entre os grupos para as áreas de Linguagem, Motora Grossa e Motora Fina-Adaptativa.
Conclusão: O presente estudo confirmou a interferência do Hipotireoidismo Congênito no desenvolvimento infantil, mesmo quando diagnosticado e tratado precocemente, levando a mudanças no desenvolvimento que podem trazer prejuízos nas áreas motora, cognitiva e linguística.
Palavras-chave
Abstract
Objective: To compare the performance in gross motor, fine motor-adaptive, language, cognitive and personal-social development skills of girls with a mean age of 36 to 71 months with Congenital Hypothyroidism treated from the neonatal period with that of their peers without thyroid alterations.
Methods: The participants included in the study were 30 children aged between 36 and 70 months divided into two groups paired for chronological age and socioeconomic status: 15 girls diagnosed with Congenital Hypothyroidism – Experimental Group (EG) and 15 girls without thyroid changes – Control Group (CG). The following assessment instruments were used: Interview with parents, Peabody Picture Vocabulary Test - Revised (PPVT-R), and Denver Developmental Screening Test - 2nd edition (DDST-II). Psychological testing of intellectual functioning was conducted with application of the Stanford-Binet Intelligence Scale (SBIS). The descriptive statistical analysis was performed using Student's t-test and the Mann-Whitney test at a significance level of 5% (p<0.05).
Results: Comparison of the PPVT-R and SBIS results showed a statistically significant difference between the EG and CG. Comparison of the DDST-II results showed a statistically significant difference between the groups for the fine motor-adaptive, language and gross motor areas.
Conclusion: The present study confirms that Congenital Hypothyroidism affects child development, even when children are diagnosed and treated early, leading to alterations that can impair their motor, cognitive and language development.
Keywords
References
1. Simic N, Khan S, Rovet J. Visuospatial, visuoperceptual, and visuoconstructive abilities in congenital hypothyroidism. J Int Neuropsychol Soc. 2013;19(10):1119-27. http://dx.doi.org/10.1017/S1355617713001136. PMid:24124766.
2. Afzal MF, Iqbal SMJ, Hanif A, Sultan MA, Anjum A. Congenital hypothyroidism in neonates. Indian J Endocrinol Metab. 2014;18(2):213-6. http://dx.doi.org/10.4103/2230-8210.129114. PMid:24741519.
3. Vigone MC, Di Frenna M, Weber G. Heterogeneous phenotype in children affected by non-autoimmune hypothyroidism: an update. J Endocrinol Invest. 2015;38(8):835-40. http://dx.doi.org/10.1007/s40618-015-0288-5. PMid:25916430.
4. Nascimento ML. Current situation of neonatal screening for congenital hypothyroidism: criticisms and perspectives. Arq Bras Encodrinol Metab. 2011;55(8):528-33. http://dx.doi.org/10.1590/S0004-27302011000800005. PMid:22218433.
5. Maciel LMZ, Kimura ET, Nogueira CR, Mazeto GMFS, Magalhães PKR, Nascimento ML, et al. Congenital hypothyroidism: recommendations of the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism Arq Bras Endocrinol Metab 2013;57(3):184-92. http://dx.doi. org/10.1590/S0004-27302013000300004.
6. Agrawal P, Philip R, Saran S, Gutch M, Razi MS, Agroiya P, et al. Congenital hypothyroidism. Indian J Endocrinol Metab. 2015;19(2):221-7. http://dx.doi.org/10.4103/2230-8210.131748. PMid:25729683.
7. Dimitropoulos A, Molinari L, Etter K, Torresani T, Lang-Muritano M, Jenni OG, et al. Children with congenital hypothyroidism: long-term intellectual outcome after early high-dose treatment. Pediatr Res. 2009;65(2):242-8. http://dx.doi.org/10.1203/PDR.0b013e31818d2030. PMid:18787501.
8. Wheeler SM, Mc Andrews MP, Sheard ED, Rovet J. Visuospatial associative memory and hippocampal functioning in congenital hypothyroidism. J Int Neuropsychol Soc. 2012;18(1):49-56. http://dx.doi.org/10.1017/ S1355617711001378. PMid:22114849.
9. Albert BB, Heather N, Derraik JG, Cutfield WS, Wouldes T, Tregurtha S, Mathai S, Webster D, Jefferies C, Gunn AJ, Hofman PL. Neurodevelopmental and body composition outcomes in children with congenital hypothyroidism treated with high-dose initial replacement and close monitoring. J Clin Endocrinol Metab. 2013;98(9):3663-70.
10. Torres AO, Pías NC, Rodrígues CM, Gesen CP, Martinez FC, Acosta C, et al. Atención sostenida en niños en edad escolar con hipotireoidismo congénito. Rev Cuba Endocrinol. 2004;15(2). http://dx.doi.org/10.1016/j. nrl.2017.08.003.
11. Rovet JF. The role of thyroid hormones for brain development and cognitive function. Endocr Dev. 2014;26:26-43. http://dx.doi.org/10.1159/000363153. PMid:25231442.
12. Rovet JF. Children with congenital hypothyroidism and their siblings: do they really differ? Pediatr. 2005;115(1):52-7. http://dx.doi.org/10.1542/ peds.2004-1492. PMid:15629966.
13. Bargagna S, Astrea G, Perelli V, Rafanelli V. Neurophychiatric outcome in patients with congenital hypothyroidism precautiously treated: risk factors analysis in a group of patients from Tuscany. Minerva Pediatr. 2006;58(3):279-87. PMid:16832334.
14. Gejão MG, Ferreira AT, Silva GK, Anastácio-Pessan FL, Lamônica DAC. Communicative and psycholinguistic abilities in children with phenylketonuria and congenital hypothyroidism. J Appl Oral Sci. 2009;17(Suppl):69-75. http://dx.doi.org/10.1590/S1678-77572009000700012. PMid:21499658.
15. Komur M, Ozen S, Okuyaz C, Makharoblidze K, Erdogan S. Neurodevelopment evaluation in children with congenital hypothyroidism by Bayley III. Brain Dev. 2013;35(5):392-7. http://dx.doi.org/10.1016/j.braindev.2012.07.003. PMid:22858380.
16. Muñoz MB, Dassie-Leite AP, Behlau M, Filho LL, Hamerschmidt R, NesiFrança S. Alterações fonoaudiológicas em crianças com hipotireoidismo congênito: revisão crítica da literatura. Rev CEFAC. 2014;16(6):2006-14. http://dx.doi.org/10.1590/1982-0216201413013.
17. Buluş AD, Tiftik E. Evaluation of neurodevelopment of children with congenital hypothyroidism by the Denver Developmental Screening Test. J Pediatr Endocrinol Metab. 2017;30(10):1061-6. http://dx.doi.org/10.1515/ jpem-2016-0188. PMid:28917084.
18. Núñez A, Bedregal P, Becerra C, Grob LF. Neurodevelopmental assessment of patients with congenital hypothyroidism. Rev Med Chil. 2017;145(12):1579- 87. http://dx.doi.org/10.4067/s0034-98872017001201579. PMid:29652955.
19. Oerbeck B, Sundet K, Kase BF, Heyerdahl S. Congenital hypothyroism: no adverse effects of high dose throxine treatment on adult memory, attention, and behaviour. Arch Dis Child. 2005;90(2):132-7. http://dx.doi. org/10.1136/adc.2003.043935. PMid:15665163.
20. Kempers MJ, van der Sluijs Veer L, Nijhuis-van der Sanden RW, Lanting CI, Kooistra L, Wiedijk BM, et al. Neonatal screening for congenital hypothyroidism in the Netherlands: cognitive and motor outcome at 10 years of age. J Clin Endocrinol Metab. 2007;92(3):919-24. http://dx.doi. org/10.1210/jc.2006-1538. PMid:17164300.
21. Blasi V, Longaretti R, Giovanettoni C, Baldoli C, Pontesilli S, Vigone C, et al. Decrese parietal córtex activity during mental rotation in children with congenital hypothyroidism. Neuroend. 2009;89(1):56-65. http://dx.doi. org/10.1159/000151397. PMid:18698134.
22. Carreón-Rodríguez A, Pérez-Martinez L. Clinical implications of thyroid hormones effects on nervous system development. Pediatr Endocrinol Rev. 2012;9(3):644-9. PMid:22523832.
23. van der Sluijs Veer L, Kempers MJ, Last BF, Vulsma T, Grootenhuis MA. Quality of life, developmental milestone, and self-esteem of young adults with congenital hypothytoidism diagnosed by neonatal screening. J Clin Endocrinol Metab. 2008;93(7):2654-61. http://dx.doi.org/10.1210/ jc.2007-1560. PMid:18460566.
24. Yang R, Gao W, Li R, Zhao Z. Effect of atomoxetine on the cognitive functions in treatment of attention deficit hyperactivity disorder in children with congenital hypothyroidism: a pilot study. Int J Neuropsychopharmacol. 2015;18(8):pyv044. http://dx.doi.org/10.1093/ijnp/pyv044. PMid:25896257.
25. Frezzato RC, Santos DC, Goto MM, Ouro MP, Santos CT, Dutra V, et al. Fine motor skills and expressive language: a study with children with congenital hypotyreoidism. CoDAS. 2017;29(1):e20160064. http://dx.doi. org/10.1590/2317-1782/20172016064. PMid:28300959.
26. Brasil. Ministério da Saúde. Secretaria de Assistência à Saúde, Coordenação Geral de Atenção Especializada. Manual de normas técnicas e rotinas operacionais do programa nacional de triagem neonatal. Brasília: Ministério da Saúde; 2002 [citado em 19 Jan 2009]. Disponível em: http://bvsms. saude.gov.br/bvs/publicacoes/triagem_neonatal.pdf
27. ABED: Associação Brasileira de Empresas de Pesquisa [Internet]. Critério de Classificação Socioeconômica Brasil. São Paulo: ABEP; 2011 [citado em 6 Jun 2011]. Disponível em: http://www.abep.org/criterio-brasil
28. Terman LM, Merrill MA. Medida de la Inteligencia: Método para el empleo de las pruebas del Stanford- Binet. Madrid: Espasa-Calpe. 1975.
29. Frankenburg WK, Doods J, Archer P, Bresnick B, Maschka P, Edelman N, et al. DENVER-II Training Manual. Denver: Denver Developmental Materials; 1992.
30. Dunn LM. Peabody Picture Vocabulary Test-Revised (PPVT-R). Forms L and M. Circle Pines, Minn. American Guidance Service, 1981.
Submitted date:
01/30/2019
Accepted date:
05/07/2019
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