Effect of perinatal asphyxia on level of thyroid hormones in term neonates

Nishant Prabhakar, Avyact Agrawal, Neha Jain, Ashok Kumar Ahirwar


Background: To evaluate how perinatal asphyxia alters the thyroid function in term newborn by comparing cord blood and 18-24 hours venous blood in between newborns with and without asphyxia.

Methods: A prospective case-control study was carried out at Tertiary care pediatric center in central India. 60 Full term newborn with perinatal asphyxia requiring bag and mask ventilation for ≥1 minute or APGAR at 1 and 5 minute ≤7 or required intubation for resuscitation as cases and control -60 normal term newborn with APGAR ≥7 at 1 and 5 minute were selected. Cord blood and 18 to 24 hour after birth venous blood were collected in both groups and compared for level of thyroid hormones (T3, T4, TSH) via radioimmunoassay.

Results: There was no significant difference observed in cord blood thyroid hormones (P>0.05). But a significant lower level of thyroid hormones observed in asphyxiated group as compared to control group in venous sample 18-24 hours after birth [mean± standard deviation; T3 case=68.87 ± 21.08, T3 control=79.93 ± 20.52, P=0.004; T4 case 6.48 ± 2.41, T4 control=8.89 ± 1.46, P<0.001; TSH case=4.33 ± 4.36; TSH control=8.45 ± 1.70, P<0.001].

Conclusions: Perinatal asphyxia depresses the TSH level which further leads to decrease in T3 and T4 suggestive of central hypothyroidism.


Perinatal asphyxia, Term newborns, Thyroid function, Non-thyroidal illness syndrome

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Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969-87.

Phibbs RH. Delivery room management. In: Avery GB, Fletcher MA, MacDonald MG. Neonatology, Pathophysiology and Management of the Newborn. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 1999. p. 279-99.

Varela V, Houssay AB, Lopardo MI. Modification of the pituitary-thyroid axis induced by hypobaric hypoxia. Acta Physiol Lat Am. 1982;32(1):53-8.

Curbelo HJM, Karliner EC, Houssay AB. Effect of acute hypoxia on blood TSH levels. Horm Metab Res. 1979;11:155-7.

d'A Semple P, Beastall GH, Watson WS, Hume R. Hypothalamicpituitary dysfunction in respiratory hypoxia. Thorax. 1981;36:605-9.

Mordes J, Blume M, Boyer S, Braverman LE. High-altitude pituitary thyroid dysfunction on Mount Everest. N Engl J Med. 1983;308:1135-8.

Moshang T, Chance KH, Kaplan MN, Utiger RD. Effects of hypoxia on thyroid function tests. J Pediatr. 1980;97:602-4.

Borges M, Lanes R, Moret LA, Balochi D, Gonzalez S. Effect of asphyxia on free thyroid hormone levels in full term newborns. Pediatr Res 1985;19:1305-7.

Pereira DN, Procianoy RS. Transient elevation of aldosterone levels in perinatal asphyxia. Acta Paediatr. 1997;86:851-3.

Rashmi, Seth A, Sekhri T, Agarwal A. Effect of perinatal factors on cord blood thyroid stimulating hormone levels. J Pediatr Endocrinol Metab. 2007;20:59-64.

Gupta A, Srivastava S, Bhatnagar A. Cord Blood Thyroid Stimulating Hormone Level – Interpretation in Light of Perinatal Factors. Indian Pediatr. 2014;51:32-6 .

Kim EY, Park SK, Song CH, Lim SC. Perinatal factors affecting thyroid stimulating hormone (TSH) and thyroid hormone levels in cord blood. Korean J Pediatr. 2005;48:143-7.

Seth A, Sekri T, Agarwal A. Effect of perinatal factors on cord blood TSH levels. J pediatr endocrinaol metab. 2007;20(1):59-64.

Chan I, Chiu P, Lau T. Antepartum conditions af-fecting cord blood TSH level. Acta ob-stet. 2001;33:344-5.

Armanian A, Hashimepour M, Esnaashari A. Influence of perinatal factors on TSH hormone level in cord blood. Advance Biomedical Research. 2013;2(2):1-4.

Warner S, Simonides, Michelle A, Mulcahey, Everaldo M, Redout, et al. Huang Hypoxia-inducible factor induces local thyroid hormone inactivation during hypoxic-ischemic disease in disease in rats. I Clin Invest. 2008;118(3):973-83.

Borges M, Lanes R, Moret LA, Balochi D, Gonzalez S; Effect Of Asphyxia On Free Thyroid Hormone Levels In Full Term Newborn: pediatr research. 1985;1305-7.

Procianoy RS, Pareira DN. Effect of Birth Asphyxiaon Thyroid Hormone in Full Term Infants. American Pediatr Society and Society for the Pediatric Research. 1998;43:190.

Procianoy RS, Pareira DN. Effect of Perinatal Asphyxia on Thyroid Stimulating Hormone and Thyroid Hormone levels. Acta Pediatr. 2003;92(3):339-45.

Frank L 1998. Development of the antioxidant in fetal life. Semin Neonatol. 3:173-182.

Tahirovic HF. Transient hypothyroxemia in neonates with birth asphhyxia on free thyroid hormone levels in full term newborns. Pediatr Res. 1985;19:1305-7.

DeGroot LJ. Non-thyroidal illness syndrome is functional central hypothyroidism, and if severe, hormone replacement is appropriate in light of present knowledge. J Endocrinol Invest. 2003;26:1163-70.

Procianoy RS, Pareira DN. Effect of perinatal asphyxia on thyroid hormones. J Pediatr Rio J. 2001;77(3):175-8.

Galton VA. Some effects of altitude on thyroid function. Endocrinology. 1972;91:1393-7.

Joshi G, Menon R. Profile of umbilical cord blood TSH, T4 and influence of perinatal factors on thyroid functions in newborns. J Clin Biomed Sci. 2014;4(2):282-5.

Durga D, Rudrappa S, Kumar R, Manjunath SN. Prenatal factors influencing the interpretation of cord blood TSH levels. International Journal of Scientific Study. 2015;2(12):104-9.