Journal of Pediatric Perspectives

Journal of Pediatric Perspectives

Neurocognitive Profiles of Children with Permanent vs. Transient Congenital Hypothyroidism: A Comparative Study Using the CANTab Assessment

Document Type : original article

Authors
Maryam Heidarpour 1
Sina Fadaei Tehrani 2, 3
Parisa Pourabadi 4
Mansoureh Moghtadaie 4
Parisa Jafari Khouzani 5
Sadegh Mazaheri Tehrani 2, 3
Mahin Hashemipour 1
1 Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.
4 Department of Psychology, Faculty of Literature and Humanities, Islamic Azad University of Najafabad, Najafabad, Isfahan, Iran.
5 Isfahan University of Medical Sciences, Isfahan, Iran.
10.22038/jpp.2025.89824.5571
Abstract
Background: Congenital hypothyroidism (CH) is one of the most common and preventable causes of intellectual disability. Early diagnosis and treatment can prevent severe developmental delays, but subtle cognitive impairments may persist into childhood. Differences in neurocognitive outcomes between permanent and transient congenital hypothyroidism have not been well characterized.
Objective: This study aimed to compare cognitive function in children with permanent versus transient congenital hypothyroidism using the Cambridge Neuropsychological Test Automated Battery (CANTab), a validated and language-independent cognitive assessment tool.
Methods: A total of 60 children aged 7 to 10 years (30 with permanent and 30 with transient congenital hypothyroidism) were recruited from the Isfahan Endocrine and Metabolism Research Center. Three cognitive domains were assessed using the CANTab battery: memory, executive function, and attention & psychomotor speed. Data were analyzed using multivariate analysis of covariance (MANCOVA), adjusting for age, followed by univariate ANOVAs. Effect sizes were reported using partial eta squared (η²), and statistical power was calculated.
Results: MANCOVA revealed a significant overall difference in cognitive function between groups (Wilks’ Lambda = 0.156, F (5,54) = 148.95, p < 0.0001, η² = 0.844). Children with permanent hypothyroidism demonstrated significantly lower performance across all domains, with the most pronounced impairments in memory and executive function. Moderate deficits were observed in attention.
Conclusion: Children with permanent congenital hypothyroidism exhibit widespread cognitive impairments compared to those with transient hypothyroidism. These findings underscore the need for ongoing neurocognitive monitoring and early supportive interventions in this high-risk population.
Keywords
Congenital hypothyroidism
Cognitive function
CANTab
Pediatric neurodevelopment
Permanent congenital hypothyroidism
Transient congenital hypothyroidism
  1. Rosenthal NA, Bezar E, Mann S, Bachrach LK, Banerjee S, Geffner ME, et al. Primary care provider management of congenital hypothyroidism identified through newborn screening. Annals of thyroid research. 2017 Apr 18;3(1):95.
  2. Seo MK, Yoon JS, So CH, Lee HS, Hwang JS. Intellectual development in preschool children with early treated congenital hypothyroidism. Annals of pediatric endocrinology & metabolism. 2017 Jun 28;22(2):102-7.
  3. Esmailnasab N, Moasses Ghaffari B, Afkhamzadeh AR. Investigation of the risk factors for congenital hypothyroidism in the newborns in Kurdistan Province. 2012. 17(4).
  4. Ordooei M, RABIE A, Soleimanizad R, Mirjalili F. Prevalence of permanent congenital hypothyroidism in children in Yazd, Central Iran. Iranian journal of public health. 2013 Sep;42(9):1016.
  5. Campos MP, Musso M, Keselman A, Gruñeiro L, Bergadá I, Chiesa A. Cognitive profiles of patients with early detected and treated congenital hypothyroidism. Arch Argent Pediatr. 2017 Feb 1;115(1):12-7.
  6. Arreóla-Ramírez G, Barrera-Reyes RH, Jiménez-Quiroz R, Ramírez Torres MA, Segura-Cervantes E, Granados-Cepeda ML, et al. Neurodesarrollo en infantes con antecedente de hipotiroidismo congénito. Perinatología y reproducción humana. 2005;19(3-4):141-51.
  7. Álvarez M, Caravajal F, Fernández Yero JL, Niurka C. Manual de trabajo de la red nacional para la evaluación neurocognitiva del niño con hipotiroidismo congénito. Criterios para la evaluación periódica y acciones a realizar sobre el desarrollo del sistema nervioso. La Habana: UNICEF. 2004.
  8. Gruñeiro de Papendieck L, Chiesa A, Prieto L. Prevención de la discapacidad mental y física que originan enfermedades genéticas y metabólicas inaparentes al nacimiento. Experiencia argentina. Segunda parte. Rev. Hosp. Niños B. Aires. 1999:233-42.
  9. Kooistra L, Vulsma T, van der Meere J. An investigation of impulsivity in children with early-treated congenital hypothyroidism. Developmental neuropsychology. 2004 Oct 1;26(2):595-610.
  10. Rovet JF. Congenital hypothyroidism: an analysis of persisting deficits and associated factors. Child Neuropsychology. 2002 Sep 1;8(3):150-62.
  11. Rovet J, Daneman D. Congenital hypothyroidism: a review of current diagnostic and treatment practices in relation to neuropsychologic outcome. Pediatric Drugs. 2003 Mar;5(3):141-9.
  12. Selva KA, Harper A, Downs A, Blasco PA, Lafranchi SH. Neurodevelopmental outcomes in congenital hypothyroidism: comparison of initial T4 dose and time to reach target T4 and TSH. The Journal of pediatrics. 2005 Dec 1;147(6):775-80.
  13. Zanín L, Gil E, de Bortoli MÁ. Atención y memoria: su relación con la función tiroidea. Fundamentos en humanidades. 2004(10):31-42.
  14. Zoeller RT, Rovet J. Timing of thyroid hormone action in the developing brain: clinical observations and experimental findings. Journal of neuroendocrinology. 2004 Oct;16(10):809-18.
  15. Song SI, Daneman D, Rovet J. The influence of etiology and treatment factors on intellectual outcome in congenital hypothyroidism. Journal of Developmental & Behavioral Pediatrics. 2001 Dec 1;22(6):376-84.
  16. Wheeler SM, Willoughby KA, McAndrews MP, Rovet JF. Hippocampal size and memory functioning in children and adolescents with congenital hypothyroidism. The Journal of Clinical Endocrinology & Metabolism. 2011 Sep 1;96(9):E1427-34.
  17. Hepworth SL, Pang EW, Rovet JF. Word and face recognition in children with congenital hypothyroidism: An event-related potential study. Journal of Clinical and Experimental Neuropsychology. 2006 May 1;28(4):509-27.
  18. Ramírez Y, Marchena H. Características neuropsicológicas del niño preescolar con Hipotiroidismo Congénito en la Provincia de Cienfuegos. Revista chilena de Neuropsicología. 2009;4(1):36-43.
  19. Chiesa A, Pardo ML, Keselman A. Gruñeiro de Papendieck L. Desempeño Escolar y Evolución Madurativa en el Hipotiroidismo Congénito detectado por Pesquisa Neonatal. Rev Argent Endocrinol Metabol. 2003;40:143.
  20. LENEMAN M, BUCHANAN L, ROVET J. Where and what visuospatial processing in adolescents with congenital hypothyroidism. Journal of the International Neuropsychological Society. 2001 Jul;7(5):556-62.
  21. Bernal Carrasco JR. Las hormonas tiroideas en el desarrollo del cerebro. Monografías de la Real Academia Nacional de Farmacia. 2010 Mar 17.
  22. Gutiérrez, A.L. and F. Ostrosky, Desarrollo de las Funciones Ejecutivas y de la Corteza Prefrontal. Revista Neuropsicología, Neuropsiquiatría y Neurociencias, 2011. 11(1): p. 158-172.
  23. Rourke BP, Ahmad SA, Collins DW, Hayman-Abello BA, Hayman-Abello SE, Warriner EM. Child clinical/pediatric neuropsychology: Some recent advances. Annual review of psychology. 2002 Feb;53(1):309-39.
  24. Oerbeck B, Sundet K, Kase BF, Heyerdahl S. Congenital hypothyroidism: no adverse effects of high dose thyroxine treatment on adult memory, attention, and behaviour. Archives of disease in childhood. 2005 Feb 1;90(2):132-7.
  25. Olivares Torres A, Carlos Pías N, Mar Rodríguez C, Pérez Gesen C, Carvajal Martínez F, Rojas E, et al. Atención sostenida en niños en edad escolar con hipotiroidismo congénito. Revista Cubana de Endocrinología. 2004 Aug;15(2):0-.
  26. Hepworth SL. Verbal working memory in children with congenital hypothyroidism (microform). Toronto: Thesis-University of Toronto. 2005.
Journal of Pediatric Perspectives
Volume 13, Issue 8
August 2025
Pages 19628-19634