The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development

I Made Rian Amerta Dananjaya; I Made Arimbawa; Ni Putu Siadi Purniti; I Gusti Ayu Trisna Windiani; Made Sukmawati; Ni Putu Veny Kartika Yantie

doi:doi:10.11648/j.ajp.20251102.19

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The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development

I Made Rian Amerta Dananjaya^*

, I Made Arimbawa

, Ni Putu Siadi Purniti

, I Gusti Ayu Trisna Windiani

, Made Sukmawati

, Ni Putu Veny Kartika Yantie

Published in American Journal of Pediatrics (Volume 11, Issue 2)

Received: 17 April 2025 Accepted: 28 April 2025 Published: 29 May 2025

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Abstract

Thyroid hormones play an important role in the formation and maturation of the central nervous system. Congenital hypothyroid very rarely shows clinical symptoms in early life so that cases of delayed treatment increase. Babies with untreated congenital hypothyroidism can develop into individuals with intellectual disabilities and be accompanied by motor deficits, such as impaired gross and fine motor function and balance coordination. This study aims to proving that there is a relationship between the onset of therapy in congenital hypothyroid patients and the child's language and cognitive development. The study was conducted using a cross sectional design. This research was conducted at the Children's Polyclinic at Ngoerah Hospital and Wangaya Hospital Denpasar from Desember 2022 until August 2023, using the consecutive sampling method. Based on the sample size formula of 2 unpaired proportions, the minimum number of samples is 96. Inclusion criteria are congenital hyothyroid patients were diagnosed based on TSH levels >10 uIU/mL, currently undergoing therapy and carrying out control to monitor the success of therapy for a minimum of 6 months with age < 3 years and obtain written consent from parents by signing an informed consent form. Exclusion criteria included incomplete data and clinicaly down syndrome. This study involved 107 subjects, with 45 subjects had been therapy under 3 months old and 62 subjects had been therapy more than 3 months old. Initial characteristics of the study showed that the mean age was 13.3 (±3.64) in therapy under 3 months old compare with 16.5 (±6.32) in therapy more than 3 months old. Bivariate analysis, we found significant relationship between levothyroxine therapy on language and cognitive function (p = 0.032, PR 1.74, CI=1.156-5.594). Multivariate analysis, therapy < 3 months had a significant relationship with language and cognitive development in hypothyroid children with an adjusted OR of 3.404 (95% CI 1.330 – 8.710, P value 0.011). There is a relationship between the onset of therapy in congenital hypothyroid patients and children's language development and cognition.

Published in	American Journal of Pediatrics (Volume 11, Issue 2)
DOI	10.11648/j.ajp.20251102.19
Page(s)	93-100
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Congenital Hypothyroid, Levothyroxine, Children, Language and Cognitive Development

References

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[4]	Léger, J., et al. (2014). Congenital hypothyroidism: A clinical update. Annales d'Endocrinologie, 75(3), 113-123.
[5]	Chen CY, Lee KT, Lee CTC, Lai WT dan Huang YB. 2013. Epidemiology and Clinical Characteristics of Congenital Hypothyroidism in an Asian Population: A Nationwide Population-Based Study. Kaohsiung Medical University Taiwan. Journal of Epidemiology. 23(2): 85-94.
[6]	Jo HY, Yang EH, Kim YM, Choi SH, Park KH, Yoo Hw dkk. 2023. Incidence of congenital hypothyroidism by gestational age: a retrospective observational study. Journal of Yeungnam Medical Science 2023; 40(1): 30-36.
[7]	Rezaeian S, Khazaei S, Hooshmand E, Esmailnasab N. 2017. Gender and Risk of Congenital Hypothyroidism: A Systematic Review and Meta-Analysis. International Journal of Pediatrics 5(12).
[8]	Lazarus, J. H. (2011). Thyroid hormone and obesity. Journal of Clinical Endocrinology & Metabolism, 96(11), 3460–3467.
[9]	Zhang Y, Fan Y, Yu X, Wang X, Bao S, Li J, Fan C 2014. Maternal subclinical hypothyroidism impairs neurodevelopment in rat offspring by inhibiting the CREB signaling pathway. Molecular Neurobiology. Thyroid Research 8.2.
[10]	Zhou J, Luo J, Lin J, Zeng Y, Qiu X, Zhu W, Liu G. 2020. Perinatal risk factors for congenital hypothyroidism. Medicine (Baltimore). 99(26): e20838.
[11]	Letarte J, Guyda H, Dussault JH. 2019. Clinical, biochemical and radiological features of neonatal hypothyroid infants. In: Burrow GN, ed. Neonatal thyroid screening. New York: Raven Press. p. 225–35.
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[13]	Pulungan AB, Oldenkamp ME, Trostsenburg ASPV, Windarti W, Gunardi H. 2019. Effect of delayed diagnosis and treatment of congenital hypothyroidism on intelligence and quality of life: an observational study. pISSN: 0853-1773 • eISSN: 2252-8083. Medical Journal Indonesia. 2019; 28: 396–401.
[14]	Adi W, Sunartini, Bikin S, Soetjiningsih. 2013. Growth and development of children with congenital hypothyroidism treated early with high initial doses of levothyroxine. Sari Pediatri Vol 15, No. 2.
[15]	Melda D, Jose RL, Bambang T, Aman BP. 2003. Congenital Hypothyroidism in the Department of Pediatrics Congenital Hypothyroidism in the Department of Pediatrics Ciptomangunkusumo Hospital Jakarta, 1992-2002. H. Adam Malik Medan Hospital.
[16]	Debrinna T. 2024. Perspektif Neuropsikologi mengenai Dampak Screen Time terhadap Perkembangan Anak Usia Dini. Jurnal Pendidikan Anak Usia Dini. e-ISSN: 2723-6390, hal. 1004-1017 Vol. 5, No. 1.
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APA Style

Dananjaya, I. M. R. A., Arimbawa, I. M., Purniti, N. P. S., Windiani, I. G. A. T., Sukmawati, M., et al. (2025). The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development. American Journal of Pediatrics, 11(2), 93-100. https://doi.org/10.11648/j.ajp.20251102.19

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ACS Style

Dananjaya, I. M. R. A.; Arimbawa, I. M.; Purniti, N. P. S.; Windiani, I. G. A. T.; Sukmawati, M., et al. The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development. Am. J. Pediatr. 2025, 11(2), 93-100. doi: 10.11648/j.ajp.20251102.19

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AMA Style

Dananjaya IMRA, Arimbawa IM, Purniti NPS, Windiani IGAT, Sukmawati M, et al. The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development. Am J Pediatr. 2025;11(2):93-100. doi: 10.11648/j.ajp.20251102.19

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@article{10.11648/j.ajp.20251102.19,
  author = {I Made Rian Amerta Dananjaya and I Made Arimbawa and Ni Putu Siadi Purniti and I Gusti Ayu Trisna Windiani and Made Sukmawati and Ni Putu Veny Kartika Yantie},
  title = {The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development
},
  journal = {American Journal of Pediatrics},
  volume = {11},
  number = {2},
  pages = {93-100},
  doi = {10.11648/j.ajp.20251102.19},
  url = {https://doi.org/10.11648/j.ajp.20251102.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20251102.19},
  abstract = {Thyroid hormones play an important role in the formation and maturation of the central nervous system. Congenital hypothyroid very rarely shows clinical symptoms in early life so that cases of delayed treatment increase. Babies with untreated congenital hypothyroidism can develop into individuals with intellectual disabilities and be accompanied by motor deficits, such as impaired gross and fine motor function and balance coordination. This study aims to proving that there is a relationship between the onset of therapy in congenital hypothyroid patients and the child's language and cognitive development. The study was conducted using a cross sectional design. This research was conducted at the Children's Polyclinic at Ngoerah Hospital and Wangaya Hospital Denpasar from Desember 2022 until August 2023, using the consecutive sampling method. Based on the sample size formula of 2 unpaired proportions, the minimum number of samples is 96. Inclusion criteria are congenital hyothyroid patients were diagnosed based on TSH levels >10 uIU/mL, currently undergoing therapy and carrying out control to monitor the success of therapy for a minimum of 6 months with age < 3 years and obtain written consent from parents by signing an informed consent form. Exclusion criteria included incomplete data and clinicaly down syndrome. This study involved 107 subjects, with 45 subjects had been therapy under 3 months old and 62 subjects had been therapy more than 3 months old. Initial characteristics of the study showed that the mean age was 13.3 (±3.64) in therapy under 3 months old compare with 16.5 (±6.32) in therapy more than 3 months old. Bivariate analysis, we found significant relationship between levothyroxine therapy on language and cognitive function (p = 0.032, PR 1.74, CI=1.156-5.594). Multivariate analysis, therapy < 3 months had a significant relationship with language and cognitive development in hypothyroid children with an adjusted OR of 3.404 (95% CI 1.330 – 8.710, P value 0.011). There is a relationship between the onset of therapy in congenital hypothyroid patients and children's language development and cognition.
},
 year = {2025}
}

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TY  - JOUR
T1  - The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development

AU  - I Made Rian Amerta Dananjaya
AU  - I Made Arimbawa
AU  - Ni Putu Siadi Purniti
AU  - I Gusti Ayu Trisna Windiani
AU  - Made Sukmawati
AU  - Ni Putu Veny Kartika Yantie
Y1  - 2025/05/29
PY  - 2025
N1  - https://doi.org/10.11648/j.ajp.20251102.19
DO  - 10.11648/j.ajp.20251102.19
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 93
EP  - 100
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20251102.19
AB  - Thyroid hormones play an important role in the formation and maturation of the central nervous system. Congenital hypothyroid very rarely shows clinical symptoms in early life so that cases of delayed treatment increase. Babies with untreated congenital hypothyroidism can develop into individuals with intellectual disabilities and be accompanied by motor deficits, such as impaired gross and fine motor function and balance coordination. This study aims to proving that there is a relationship between the onset of therapy in congenital hypothyroid patients and the child's language and cognitive development. The study was conducted using a cross sectional design. This research was conducted at the Children's Polyclinic at Ngoerah Hospital and Wangaya Hospital Denpasar from Desember 2022 until August 2023, using the consecutive sampling method. Based on the sample size formula of 2 unpaired proportions, the minimum number of samples is 96. Inclusion criteria are congenital hyothyroid patients were diagnosed based on TSH levels >10 uIU/mL, currently undergoing therapy and carrying out control to monitor the success of therapy for a minimum of 6 months with age < 3 years and obtain written consent from parents by signing an informed consent form. Exclusion criteria included incomplete data and clinicaly down syndrome. This study involved 107 subjects, with 45 subjects had been therapy under 3 months old and 62 subjects had been therapy more than 3 months old. Initial characteristics of the study showed that the mean age was 13.3 (±3.64) in therapy under 3 months old compare with 16.5 (±6.32) in therapy more than 3 months old. Bivariate analysis, we found significant relationship between levothyroxine therapy on language and cognitive function (p = 0.032, PR 1.74, CI=1.156-5.594). Multivariate analysis, therapy < 3 months had a significant relationship with language and cognitive development in hypothyroid children with an adjusted OR of 3.404 (95% CI 1.330 – 8.710, P value 0.011). There is a relationship between the onset of therapy in congenital hypothyroid patients and children's language development and cognition.

VL  - 11
IS  - 2
ER  -

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Author Information

I Made Rian Amerta Dananjaya

Pediatric Medical Faculty, Udayana University, Pediatric Department Ngoerah Hospital, Denpasar, Indonesia

Contact Email

http://orcid.org/0009-0000-7074-0600
I Made Arimbawa

Pediatric Medical Faculty, Udayana University, Pediatric Department Ngoerah Hospital, Denpasar, Indonesia

http://orcid.org/0000-0003-1670-4662
Ni Putu Siadi Purniti

Pediatric Medical Faculty, Udayana University, Pediatric Department Ngoerah Hospital, Denpasar, Indonesia

http://orcid.org/0000-0003-4870-4915
I Gusti Ayu Trisna Windiani

Pediatric Medical Faculty, Udayana University, Pediatric Department Ngoerah Hospital, Denpasar, Indonesia

http://orcid.org/0000-0002-1673-6210
Made Sukmawati

Pediatric Medical Faculty, Udayana University, Pediatric Department Ngoerah Hospital, Denpasar, Indonesia

http://orcid.org/0000-0002-1104-2711
Ni Putu Veny Kartika Yantie

Pediatric Medical Faculty, Udayana University, Pediatric Department Ngoerah Hospital, Denpasar, Indonesia

http://orcid.org/0000-0002-1381-2572

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APA Style

Dananjaya, I. M. R. A., Arimbawa, I. M., Purniti, N. P. S., Windiani, I. G. A. T., Sukmawati, M., et al. (2025). The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development. American Journal of Pediatrics, 11(2), 93-100. https://doi.org/10.11648/j.ajp.20251102.19

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ACS Style

Dananjaya, I. M. R. A.; Arimbawa, I. M.; Purniti, N. P. S.; Windiani, I. G. A. T.; Sukmawati, M., et al. The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development. Am. J. Pediatr. 2025, 11(2), 93-100. doi: 10.11648/j.ajp.20251102.19

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AMA Style

Dananjaya IMRA, Arimbawa IM, Purniti NPS, Windiani IGAT, Sukmawati M, et al. The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development. Am J Pediatr. 2025;11(2):93-100. doi: 10.11648/j.ajp.20251102.19

Copy | Download

@article{10.11648/j.ajp.20251102.19,
  author = {I Made Rian Amerta Dananjaya and I Made Arimbawa and Ni Putu Siadi Purniti and I Gusti Ayu Trisna Windiani and Made Sukmawati and Ni Putu Veny Kartika Yantie},
  title = {The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development
},
  journal = {American Journal of Pediatrics},
  volume = {11},
  number = {2},
  pages = {93-100},
  doi = {10.11648/j.ajp.20251102.19},
  url = {https://doi.org/10.11648/j.ajp.20251102.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20251102.19},
  abstract = {Thyroid hormones play an important role in the formation and maturation of the central nervous system. Congenital hypothyroid very rarely shows clinical symptoms in early life so that cases of delayed treatment increase. Babies with untreated congenital hypothyroidism can develop into individuals with intellectual disabilities and be accompanied by motor deficits, such as impaired gross and fine motor function and balance coordination. This study aims to proving that there is a relationship between the onset of therapy in congenital hypothyroid patients and the child's language and cognitive development. The study was conducted using a cross sectional design. This research was conducted at the Children's Polyclinic at Ngoerah Hospital and Wangaya Hospital Denpasar from Desember 2022 until August 2023, using the consecutive sampling method. Based on the sample size formula of 2 unpaired proportions, the minimum number of samples is 96. Inclusion criteria are congenital hyothyroid patients were diagnosed based on TSH levels >10 uIU/mL, currently undergoing therapy and carrying out control to monitor the success of therapy for a minimum of 6 months with age < 3 years and obtain written consent from parents by signing an informed consent form. Exclusion criteria included incomplete data and clinicaly down syndrome. This study involved 107 subjects, with 45 subjects had been therapy under 3 months old and 62 subjects had been therapy more than 3 months old. Initial characteristics of the study showed that the mean age was 13.3 (±3.64) in therapy under 3 months old compare with 16.5 (±6.32) in therapy more than 3 months old. Bivariate analysis, we found significant relationship between levothyroxine therapy on language and cognitive function (p = 0.032, PR 1.74, CI=1.156-5.594). Multivariate analysis, therapy < 3 months had a significant relationship with language and cognitive development in hypothyroid children with an adjusted OR of 3.404 (95% CI 1.330 – 8.710, P value 0.011). There is a relationship between the onset of therapy in congenital hypothyroid patients and children's language development and cognition.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - The Relationship Between the Onset of Levothyroxine Therapy in Congenital Hypothyroidism and Children's Language and Cognitive Development

AU  - I Made Rian Amerta Dananjaya
AU  - I Made Arimbawa
AU  - Ni Putu Siadi Purniti
AU  - I Gusti Ayu Trisna Windiani
AU  - Made Sukmawati
AU  - Ni Putu Veny Kartika Yantie
Y1  - 2025/05/29
PY  - 2025
N1  - https://doi.org/10.11648/j.ajp.20251102.19
DO  - 10.11648/j.ajp.20251102.19
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 93
EP  - 100
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20251102.19
AB  - Thyroid hormones play an important role in the formation and maturation of the central nervous system. Congenital hypothyroid very rarely shows clinical symptoms in early life so that cases of delayed treatment increase. Babies with untreated congenital hypothyroidism can develop into individuals with intellectual disabilities and be accompanied by motor deficits, such as impaired gross and fine motor function and balance coordination. This study aims to proving that there is a relationship between the onset of therapy in congenital hypothyroid patients and the child's language and cognitive development. The study was conducted using a cross sectional design. This research was conducted at the Children's Polyclinic at Ngoerah Hospital and Wangaya Hospital Denpasar from Desember 2022 until August 2023, using the consecutive sampling method. Based on the sample size formula of 2 unpaired proportions, the minimum number of samples is 96. Inclusion criteria are congenital hyothyroid patients were diagnosed based on TSH levels >10 uIU/mL, currently undergoing therapy and carrying out control to monitor the success of therapy for a minimum of 6 months with age < 3 years and obtain written consent from parents by signing an informed consent form. Exclusion criteria included incomplete data and clinicaly down syndrome. This study involved 107 subjects, with 45 subjects had been therapy under 3 months old and 62 subjects had been therapy more than 3 months old. Initial characteristics of the study showed that the mean age was 13.3 (±3.64) in therapy under 3 months old compare with 16.5 (±6.32) in therapy more than 3 months old. Bivariate analysis, we found significant relationship between levothyroxine therapy on language and cognitive function (p = 0.032, PR 1.74, CI=1.156-5.594). Multivariate analysis, therapy < 3 months had a significant relationship with language and cognitive development in hypothyroid children with an adjusted OR of 3.404 (95% CI 1.330 – 8.710, P value 0.011). There is a relationship between the onset of therapy in congenital hypothyroid patients and children's language development and cognition.

VL  - 11
IS  - 2
ER  -

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