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Uehara E, Abe K, Tanase-Nakao K, Muroya K, Hattori A, Matsubara K, Fukami M, Narumi S. Molecular and Clinical Features of Congenital Hypothyroidism Due to Multiple DUOX2 Variants. Thyroid 2024; 34:827-836. [PMID: 38757580 DOI: 10.1089/thy.2024.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background: DUOX2 is one of the major causative genes of congenital hypothyroidism (CH). Still, the mutation spectrum and clinical outcomes of biallelic DUOX2 variants are not fully understood. This study aimed to elucidate the molecular features and long-term clinical manifestations of CH caused by multiple pathogenic DUOX2 variants. Methods: A total of 255 patients with CH were screened for rare variants of 11 known causative genes. DUOX2 variants were classified according to their protein structure and residual activity. In vitro assays were performed for several variants of unknown functions. Clinical analyses were conducted for patients with multiple pathogenic variants of DUOX2 but not of other genes. Results: We identified 24 pathogenic variants of DUOX2, together with two benign variants and seven variants of uncertain significance, in 63 patients. The pathogenic variants included three missense substitutions and one frameshift variant that have not yet been linked to CH. Twenty-one patients carried multiple pathogenic DUOX2 variants without any other pathogenic gene variants. Three of the 21 patients harbored homozygous variants. Family analysis, long-read amplicon sequencing, and haplotype phasing confirmed compound heterozygosity of the DUOX2 variants in 14 patients, whereas the allelic positions of the variants in the remaining four patients could not be determined. Of the 21 patients, 19 were treated with levothyroxine; their ages at drug withdrawal ranged from 9 months to 21.4 years. Three patients required retreatment after drug-free intervals of 6 months, 8 months, and 10 years. There were no differences in clinical severity among patients with DUOX2 amorphic/amorphic, amorphic/hypomorphic, and hypomorphic/hypomorphic variants. Conclusions: These results broaden the mutational spectrum of DUOX2. Furthermore, our data imply that patients with multiple pathogenic DUOX2 variants typically exhibit transient CH without significant genotype-phenotype correlations. Most importantly, this study demonstrated for the first time that these patients are at risk of developing recurrent hypothyroidism after a long drug-free interval.
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Affiliation(s)
- Erika Uehara
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
- Department of Advanced Pediatric Medicine, Tohoku University School of Medicine, Tokyo, Japan
| | - Kiyomi Abe
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
- Department of Pediatrics, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Kanako Tanase-Nakao
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Koji Muroya
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Atsushi Hattori
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
- Division of Diversity Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Keiko Matsubara
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
- Division of Diversity Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
- Division of Diversity Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Satoshi Narumi
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Narumi S, Nagasaki K, Kiriya M, Uehara E, Akiba K, Tanase-Nakao K, Shimura K, Abe K, Sugisawa C, Ishii T, Miyako K, Hasegawa Y, Maruo Y, Muroya K, Watanabe N, Nishihara E, Ito Y, Kogai T, Kameyama K, Nakabayashi K, Hata K, Fukami M, Shima H, Kikuchi A, Takayama J, Tamiya G, Hasegawa T. Functional variants in a TTTG microsatellite on 15q26.1 cause familial nonautoimmune thyroid abnormalities. Nat Genet 2024; 56:869-876. [PMID: 38714868 PMCID: PMC11096107 DOI: 10.1038/s41588-024-01735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
Insufficient thyroid hormone production in newborns is referred to as congenital hypothyroidism. Multinodular goiter (MNG), characterized by an enlarged thyroid gland with multiple nodules, is usually seen in adults and is recognized as a separate disorder from congenital hypothyroidism. Here we performed a linkage analysis of a family with both nongoitrous congenital hypothyroidism and MNG and identified a signal at 15q26.1. Follow-up analyses with whole-genome sequencing and genetic screening in congenital hypothyroidism and MNG cohorts showed that changes in a noncoding TTTG microsatellite on 15q26.1 were frequently observed in congenital hypothyroidism (137 in 989) and MNG (3 in 33) compared with controls (3 in 38,722). Characterization of the noncoding variants with epigenomic data and in vitro experiments suggested that the microsatellite is located in a thyroid-specific transcriptional repressor, and its activity is disrupted by the variants. Collectively, we presented genetic evidence linking nongoitrous congenital hypothyroidism and MNG, providing unique insights into thyroid abnormalities.
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Affiliation(s)
- Satoshi Narumi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan.
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mitsuo Kiriya
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Erika Uehara
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kazuhisa Akiba
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kanako Tanase-Nakao
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kazuhiro Shimura
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kiyomi Abe
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Chiho Sugisawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Tomohiro Ishii
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kenichi Miyako
- Department of Endocrinology and Metabolism, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Koji Muroya
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| | | | - Eijun Nishihara
- Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Yuka Ito
- Department of Genetic Diagnosis and Laboratory Medicine, Dokkyo Medical University, Mibu, Japan
| | - Takahiko Kogai
- Department of Genetic Diagnosis and Laboratory Medicine, Dokkyo Medical University, Mibu, Japan
| | - Kaori Kameyama
- Department of Pathology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
- Department of Human Molecular Genetics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hirohito Shima
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takayama
- Department of AI and Innovative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Integrative Genomics, Tohoku Medical Megabank Organization (ToMMo) Tohoku University, Sendai, Japan
- Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Gen Tamiya
- Department of AI and Innovative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Integrative Genomics, Tohoku Medical Megabank Organization (ToMMo) Tohoku University, Sendai, Japan
- Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Ha EK, Kim JH, Cha HR, Lee GC, Shin J, Lee E, Lee WS, Yoo EG, Jung MK, Han MY. Assessment of Neurodevelopment and Growth in Congenital Hypothyroidism: Serial 6-Year Follow-up Study of 408 Patients. J Clin Endocrinol Metab 2023; 108:e1588-e1596. [PMID: 37335967 DOI: 10.1210/clinem/dgad364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
CONTEXT The link between congenital hypothyroidism (CH) and neurodevelopment is suggested, yet studies applying quantifiable measures are lacking. Moreover, socioeconomic disparities and subtle variation in timing of approach make the relationship difficult to detect. OBJECTIVE To evaluate associations between CH and abnormalities in neurodevelopment and growth and determine the critical period for intervention. METHODS We utilized a nationwide database to conduct a longitudinal analysis of 919 707 children. Exposure to CH was identified using claims-based data. The primary outcome of interest was suspected neurodevelopmental disorder, as measured using the Korean Ages & Stages Questionnaires (K-ASQ) administered annually from 9 to 72 months of age. Secondary outcomes were height and BMI z-scores. After randomly matching cases and controls at a 1:10 ratio, we employed inverse probability of treatment weighting and generalized estimating equation models for our analyses. We conducted subgroup analysis based on the age of treatment initiation. RESULTS The prevalence of CH in our population was 0.05% (n = 408). Relative to the control group, the CH group had higher risk of suspected neurodevelopmental disorders (propensity score-weighted odds ratio: 4.52; 95% CI: 2.91, 7.02), and significantly increased risk in each of the 5 K-ASQ domains. No time interactions were noted at any rounds for the outcomes according to when the neurodevelopmental assessment was conducted (all P for interaction >.05). The CH group also had higher risk for low height-for-age z-score, but not for elevated BMI-for-age z-score. In subgroup analysis, delayed medication for CH correlated with worse neurodevelopmental outcomes. CONCLUSION The CH group had worse neurodevelopmental outcomes and reduced height-for-age z-score. Outcomes were worse when onset of treatment was increasingly delayed.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, 07441 Seoul, Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Hospital, Kyung Hee University School of Medicine, 02447 Seoul, Korea
| | - Hye Ryeong Cha
- Department of Computer Science and Engineering, Sungkyunkwan University, 16419 Suwon, Korea
| | - Gi Chun Lee
- School of Computer Science and Engineering, Konkuk University, 05029 Seoul, Korea
| | - Jeewon Shin
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 13496 Seongnam, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 61469 Gwangju, Korea
| | - Won Seok Lee
- Department of Pediatrics, CHA Ilsan Medical Center, CHA University, 10414 Goyang, Korea
| | - Eun-Gyong Yoo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 13496 Seongnam, Korea
| | - Mo Kyung Jung
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 13496 Seongnam, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 13496 Seongnam, Korea
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Sugisawa C, Narumi S, Tanase-Nakao K, Ayako H, Suzuki N, Ohye H, Fukushita M, Matsumoto M, Yoshihara A, Watanabe N, Sugino K, Hishinuma A, Noh JY, Katoh R, Taniyama M, Ito K. Adult Thyroid Outcomes of Congenital Hypothyroidism. Thyroid 2023; 33:556-565. [PMID: 36792927 DOI: 10.1089/thy.2022.0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND More than 40 years have passed since the introduction of newborn screening for congenital hypothyroidism (CH), and many early diagnosed patients have reached adulthood. Their thyroid morphology and function have been little studied. This cross-sectional, observational study was conducted to characterize the thyroid morphology and function of adult CH patients diagnosed in the framework of newborn screening for CH. METHODS A total of 103 adult CH patients born after 1979 were enrolled at Ito Hospital, Tokyo, Japan, and were classified into Goiter, Normal gland, and Dysgenesis groups based on ultrasonographic findings. For 60 patients, genetic analysis was performed. Thyroid function test results and the proportion of patients with thyroid nodules were compared among the three groups and between 56 female CH patients and 168 non-CH women matched for TSH levels. RESULTS A significantly low serum free T3/free T4 ratio (0.22) was observed in the Dysgenesis group. Thyroid nodules were detected in 14.3% (8/56) of female CH patients, more frequently than in non-CH women. Thyroid nodules were detected the most frequently in the Goiter group (71%, 10/14). Genetic defects were identified in 89% (8/9) of patients belonging to the Goiter group, including thyroglobulin defect (33%, 3/9), thyroid peroxidase defect (33%, 3/9), and dual oxidase 2 defect (22%, 2/9). CONCLUSIONS Our results suggest that adults with thyroid dysgenesis on levothyroxine replacement therapy have relative T3 deficiency. Most adults with goitrous CH have genetic dyshormonogenesis. They are at high risk of developing thyroid nodules. Our findings support the current guideline recommendation that CH patients with dyshormonogenesis should undergo periodic thyroid ultrasonography.
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Affiliation(s)
- Chiho Sugisawa
- Showa Daigaku Fujigaoka Byoin, 26858, 1-30 Fujigaoka, Aoba-ku, Yokohama-si, Kanagawa 227-8501, Japan, Yokohama, Kanagawa, Japan, 227-8501;
| | - Satoshi Narumi
- National Research Institute for Child Health and Development, Molecular Endocrinology, 2-10-1 Ohkura, Setagaya-ku, Tokyo, Japan, 1578535;
| | - Kanako Tanase-Nakao
- National Research Institute for Child Health and Development, Molecular Endocrinology, Tokyo, Japan;
| | | | - Nami Suzuki
- Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, Japan, 150-8308;
| | | | - Miho Fukushita
- Ito Hospital, internal medicine, jingu-mae 4-3-6, Tokyo, Shibuyaku, Japan, 150-8308;
| | | | - Ai Yoshihara
- Ito Hospital, internal medicine, 4-3-6 Jingumae, Shibuya-ku, Tokyo, Japan, 1508308;
| | - Natsuko Watanabe
- Ito Hospital, Internal Medicine, 4-3-6 Jingumae, Shibuya-ku, Tokyo, Japan, 150-8308;
| | - Kiminori Sugino
- Ito Hospital, Surgery, 4-3-6 Jingumae, Shibuyaku, Tokyo, Japan, 150-8308;
| | - Akira Hishinuma
- Dokkyo Medical University, 12756, Department of Infection Control and Clinical Laboratory Medicine, 880 Kitakobayashi, Mibu, Tochigi, Japan, 321-0293;
| | | | - Ryohei Katoh
- Ito Hospital, Department of Pathology, 4-3-6 Jingumae, Shibuya-ku, Tokyo, Tokyo, Japan, 150-8308;
| | - Matsuo Taniyama
- Showa University Fujigaoka Hospital, Internal Medicine, Endocrinology & Metabolism, 1-3- Fujigaoka, Aoba, Yokohama, Kanagawa, Japan, 227-8501;
| | - Koichi Ito
- Ito Hospital, Surgery, 4-3-6 Jingumae, Shibuyaku, Tokyo, Japan, 150-0001;
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Nagasaki K, Minamitani K, Nakamura A, Kobayashi H, Numakura C, Itoh M, Mushimoto Y, Fujikura K, Fukushi M, Tajima T. Guidelines for Newborn Screening of Congenital Hypothyroidism (2021 Revision). Clin Pediatr Endocrinol 2022; 32:26-51. [PMID: 36761493 PMCID: PMC9887297 DOI: 10.1297/cpe.2022-0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/06/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose of developing the guidelines: Newborn screening (NBS) for congenital hypothyroidism (CH) was started in 1979 in Japan, and early diagnosis and treatment improved the intelligence prognosis of CH patients. The incidence of CH was once about one in 5,000-8,000 births, but has been increased with diagnosis of subclinical CH. The disease requires continuous treatment and specialized medical facilities should conduct differential diagnosis and treatment in patients who are positive by NBS to avoid unnecessary treatment. The Guidelines for Mass Screening of Congenital Hypothyroidism (1998 version) were developed by the Mass Screening Committee of the Japanese Society for Pediatric Endocrinology in 1998. Subsequently, the guidelines were revised in 2014. Here, we have added minor revisions to the 2014 version to include the most recent findings. Target disease/conditions: Primary congenital hypothyroidism. Users of the Guidelines: Physician specialists in pediatric endocrinology, pediatric specialists, physicians referring pediatric practitioners, general physicians, laboratory technicians in charge of mass screening, and patients.
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Affiliation(s)
- Keisuke Nagasaki
- Mass Screening Committee, Japanese Society for Pediatric Endocrinology
- Thyroid Committee, Japanese Society for Pediatric Endocrinology
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kanshi Minamitani
- Thyroid Committee, Japanese Society for Pediatric Endocrinology
- Department of Pediatrics, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Akie Nakamura
- Mass Screening Committee, Japanese Society for Pediatric Endocrinology
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan
| | - Hironori Kobayashi
- Mass Screening Committee, Japanese Society for Pediatric Endocrinology
- Laboratories Division, Shimane University Hospital, Izumo, Japan
| | - Chikahiko Numakura
- Mass Screening Committee, Japanese Society for Pediatric Endocrinology
- Department of Pediatrics, Yamagata University School of Medicine, Yamagata, Japan
| | - Masatsune Itoh
- Thyroid Committee, Japanese Society for Pediatric Endocrinology
- Department of Pediatrics, Kanazawa Medical University, Kanazawa, Japan
| | - Yuichi Mushimoto
- Thyroid Committee, Japanese Society for Pediatric Endocrinology
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kaori Fujikura
- Japanese Society for Neonatal Screening
- Sapporo City Institute of Public Health, Sapporo, Japan
| | - Masaru Fukushi
- Japanese Society for Neonatal Screening
- Sapporo Immuno Diagnostic Laboratory (IDL), Sapporo, Japan
| | - Toshihiro Tajima
- Mass Screening Committee, Japanese Society for Pediatric Endocrinology
- Department of Pediatrics, Jichi Medical University Tochigi Children's Medical Center, Tochigi, Japan
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Simonetti S, D'Amato G, Esposito B, Chiarito M, Dentico D, Lorè T, Cardinali R, Russo S, Laforgia N, Faienza MF. Congenital hypothyroidism after newborn screening program reorganization in the Apulia region. Ital J Pediatr 2022; 48:131. [PMID: 35906638 PMCID: PMC9335966 DOI: 10.1186/s13052-022-01328-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Congenital hypothyroidism (CH) is the most frequent congenital endocrine disorder. The purpose of the present study was to evaluate the incidence and etiological classification of CH in Apulia in a three-year period according to the reorganization of the regional screening program in a single central laboratory, as well as to analyze the growth characteristics and the associated risk factors of the CH newborns diagnosed during the study period. Methods Data derived from the reorganization of the newborn screening program for CH in a single central laboratory that collects dried blood spot (DBS) from 27 Maternity Hospitals are analyzed over a three-year period. Birth weight and length, daily dose of L-T4 at specific key points (3, 6, 12 and 18 months, 2, 2.5 and 3 years) were also obtained from medical records of the CH newborns during the study period and calculated as standard deviation score (SDS). Results The screening program diagnosed 90 newborns with confirmed CH (incidence 1:990; recall rate: 3.6%). In detail, 75.6% newborns had an eutopic thyroid, and 24.4% had thyroid dysgenesis; 33 out of the 90 newborns (36.6%) had one or more risk factors. Among these, the multiple pregnancies are the most important because they tripled the risk of CH. At diagnosis, TSH levels were different between patients with dysgenesis and those with an eutopic thyroid (p = 0.005). Treatment was started at a mean of 18.5 ± 12.8 days of life. The mean starting dose of levothyroxine (L-T4) was 11.38 ± 2.46 μg/kg/day. Conclusions The results of these study show an increase of CH cases in newborns with an eutopic thyroid compared to the traditional classification. The centralization of the screening program allows a closer cooperation between laboratory and clinical centers and facilitates the implementation of appropriate diagnostic evaluations and timely initiation of treatment, with positive effects on the management of the condition.
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Affiliation(s)
- Simonetta Simonetti
- Clinical Pathology and Neonatal Screening, Azienda Ospedaliera Universitaria Policlinico-Giovanni XXIII, Bari, Italy
| | | | - Benedetta Esposito
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Mariangela Chiarito
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | | | - Tania Lorè
- Clinical Pathology and Neonatal Screening, Azienda Ospedaliera Universitaria Policlinico-Giovanni XXIII, Bari, Italy
| | - Roberta Cardinali
- Clinical Pathology and Neonatal Screening, Azienda Ospedaliera Universitaria Policlinico-Giovanni XXIII, Bari, Italy
| | - Silvia Russo
- Clinical Pathology and Neonatal Screening, Azienda Ospedaliera Universitaria Policlinico-Giovanni XXIII, Bari, Italy
| | - Nicola Laforgia
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy.
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Tanase-Nakao K, Muroya K, Adachi M, Abe K, Hasegawa T, Narumi S. A patient with congenital hypothyroidism due to a <i>PAX8</i> frameshift variant accompanying a urogenital malformation. Clin Pediatr Endocrinol 2022; 31:250-255. [DOI: 10.1297/cpe.2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/15/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kanako Tanase-Nakao
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Koji Muroya
- Department of Endocrinology and Metabolism, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Masanori Adachi
- Department of Endocrinology and Metabolism, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Kiyomi Abe
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Narumi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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8
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Scavone M, Giancotti L, Anastasio E, Pensabene L, Sestito S, Concolino D. Evolution of congenital hypothyroidism in a cohort of preterm born children. Pediatr Neonatol 2020; 61:629-636. [PMID: 32771362 DOI: 10.1016/j.pedneo.2020.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Congenital hypothyroidism (CH) is reported to be more common in preterm infants than in term infants, especially in sick preterm infants. Though a frequent possibility of transitory thyroidal alterations in this category of neonates, the evolution of CH to transient or permanent forms is unpredictable. METHODS We retrospectively analyzed medical records of 28 preterm infants (<37 weeks gestation) who had exhibited a positive screening for CH at birth during the period 2000-2015 followed in our Center. Children were divided into three groups: permanent CH (PCH) with thyroid dysgenesis, PCH with eutopic normal-sized thyroid gland, and transient CH (TCH) with eutopic normal-sized thyroid gland. In all groups we described clinical and biochemical characteristics. Secondly, we analyzed the differences between patients with thyroid dysgenesis and patients with eutopic normal-sized gland and we compared PCH and TCH groups with normal-sized thyroid gland in order to identify clinical or biochemical data for early detection of transient forms. RESULTS Of all patients, 21.4% showed thyroid dysgenesis while 78.6% presented eutopic normal-sized gland. Infants with thyroid dysgenesis had higher median (IQR) baseline s-TSH and levothyroxine (L-T4) dose per weight at 12 months (12 m-dose) than patients with eutopic normal-sized gland. At re-evaluation of the patients with eutopic normal-sized gland, 36% showed PCH and 64% had TCH. The age of the patients at the beginning of L-T4 treatment, gestational age (GA), birth weight, blood thyroid stimulating hormone levels (b-TSH) at first newborn screening (NBS), baseline serum thyroid stimulating hormone (s-TSH), and L-T4 12 m-dose were statistically different between the two groups. CONCLUSIONS Our results demonstrate that factors as GA, birth weight, b-TSH levels at first NBS, baseline s-TSH, L-T4 12 m-dose and age at the start of the treatment may be considered useful predictive elements for the evolution of CH.
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Affiliation(s)
- Maria Scavone
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Laura Giancotti
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elisa Anastasio
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Simona Sestito
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Daniela Concolino
- Pediatric Unit, Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy.
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9
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Saba C, Guilmin-Crepon S, Zénaty D, Martinerie L, Paulsen A, Simon D, Storey C, Dos Santos S, Haignere J, Mohamed D, Carel JC, Léger J. Early Determinants of Thyroid Function Outcomes in Children with Congenital Hypothyroidism and a Normally Located Thyroid Gland: A Regional Cohort Study. Thyroid 2018; 28:959-967. [PMID: 29968521 DOI: 10.1089/thy.2018.0154] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND An increase in the incidence of congenital hypothyroidism (CH) with a normally located gland has been reported worldwide. Affected individuals display transient or permanent CH during follow-up in childhood. This study aimed to determine the prevalence of transient CH and to investigate the possibility of distinguishing between transient and permanent CH in early infancy. METHODS This observational cohort study included all patients identified by systematic neonatal screening for CH in the northern Parisian region between 2002 and 2012 and treated for CH with a normally sited gland. A standardized data collection form was completed prospectively at diagnosis. Patients were classified during follow-up as having transient or permanent CH. RESULTS Of the 92 patients initially treated for CH with a normally located gland during the neonatal period, 49 (54%) had a transient form of CH after the cessation of levothyroxine (LT4) treatment at 1.5 (0.6-3.2) years of age. Multivariate analysis revealed that transient CH was associated with a lower likelihood of having a first-degree family history of CH (p = 0.03) and a lower LT4 dose at six months of age (p = 0.03) than permanent CH. Sex, ethnicity, neonatal problems (e.g., prematurity, being small for gestational age, and/or neonatal distress), iodine status, coexisting malformations, initial CH severity, and thyroid morphology at diagnosis had no effect. Receiver operating characteristics curve analysis showed that a cutoff of 3.2 μg/kg/day for LT4 dose requirement at six months of age had a sensitivity of 71% and a specificity of 79% for predicting transient CH, with values below this threshold considered predictive of transient CH. CONCLUSION In patients with CH and a normally located gland, these findings highlight the need to evaluate LT4 dose requirements early, at six months of age, particularly in patients with no family history of CH, for early identification of the approximately 50% of patients for whom treatment should be stopped.
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Affiliation(s)
- Carole Saba
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
| | - Sophie Guilmin-Crepon
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 2 Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 3 Institut National de la Santé et de la Recherche Médicale (INSERM) , CIC-EC 1426, Paris, France
| | - Delphine Zénaty
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
| | - Laetitia Martinerie
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
- 5 Paris Diderot University , Sorbonne Paris Cité, Paris, France
| | - Anne Paulsen
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
| | - Dominique Simon
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
| | - Caroline Storey
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
| | - Sophie Dos Santos
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
| | - Jeremie Haignere
- 2 Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 3 Institut National de la Santé et de la Recherche Médicale (INSERM) , CIC-EC 1426, Paris, France
| | - Damir Mohamed
- 2 Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 3 Institut National de la Santé et de la Recherche Médicale (INSERM) , CIC-EC 1426, Paris, France
| | - Jean-Claude Carel
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
- 5 Paris Diderot University , Sorbonne Paris Cité, Paris, France
| | - Juliane Léger
- 1 Department of Pediatric Endocrinology Diabetology, Reference Centre for Endocrine Growth and Development Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital , Paris, France
- 4 Institut National de la Santé et de la Recherche Médicale (INSERM) , UMR 1141, DHU Protect, Paris, France
- 5 Paris Diderot University , Sorbonne Paris Cité, Paris, France
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Heidari Z, Feizi A, Hashemipour M, Kelishadi R, Amini M. Growth development in children with congenital hypothyroidism: the effect of screening and treatment variables-a comprehensive longitudinal study. Endocrine 2016; 54:448-459. [PMID: 27477291 DOI: 10.1007/s12020-016-1010-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/30/2016] [Indexed: 11/26/2022]
Abstract
Investigating the screening and early treatment factors potentially affects the growth status of the patients with congenital hypothyroidism. In a longitudinal study, 760 (45 % girl) neonates born in 2002-2009 with congenital hypothyroidism diagnosed by neonatal screening in Isfahan-Iran were followed up to 5 years from the time of diagnosis (i.e., 3-4 records for the first year of age and 2-3 records after that). During follow-up, height, weight, and head circumferences of the patients were measured. Diagnostic and therapeutic factors included serum thyroxine and thyroid stimulating hormone concentration at diagnosis and after treatment initiation, the age at onset of treatment, the first therapeutic dosage, and age at first normalization of thyroxine and thyroid stimulating hormone. Quantile regression for longitudinal data was used for determining the effects of main factors on growth development. Longitudinal growth in height and weight was significantly correlated with the age at onset of treatment and the first therapeutic dosage (p < 0.01), while head circumference only with first therapeutic dosage (p < 0.05). Growth in weight and head circumference was affected by thyroid stimulating hormone at the time of diagnosis (p < 0.05). Also the age of thyroxine normalization had heterogeneous significant impact over the proposed quantiles on weight (p < 0.05), height (p < 0.01), and head circumference (p < 0.001). Among studied factors, the first therapeutic dosage, age at onset of treatment and age of thyroxine normalization seem to be more important for anthropometric development, suggesting that more optimal outcome might be achievable through earlier treatment and appropriate levothyroxine dosage.
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Affiliation(s)
- Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
- Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mahin Hashemipour
- Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Pediatric, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Roya Kelishadi
- Department of Pediatric, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Massoud Amini
- Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Messina MF, Aversa T, Salzano G, Zirilli G, Sferlazzas C, De Luca F, Lombardo F. Early Discrimination between Transient and Permanent Congenital Hypothyroidism in Children with Eutopic Gland. Horm Res Paediatr 2016; 84:159-64. [PMID: 26160341 DOI: 10.1159/000435811] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/08/2015] [Indexed: 11/19/2022] Open
Abstract
AIM To analyze the factors that might allow an early discrimination between permanent (P) and transient (T) congenital hypothyroidism (CH). METHODS Clinical, biochemical and imaging data of 64 children with eutopic gland, who were positively screened and treated for CH during the period 1998-2011, were retrospectively analyzed. RESULTS During a 3-year treatment period, the mean doses of <smlcap>L</smlcap>-thyroxine (L-T4) per kilogram of body weight at various times were significantly lower in the 46 children with T CH than in the remaining 18 with P CH. No patients with T CH had required any increment of the doses of L-T4 per kilogram of body weight to maintain normal thyroid-stimulating hormone levels over time, whereas 16/18 children with P CH during the same period had needed some dose increments (p < 0.0001). CONCLUSIONS (a) L-T4 requirements >4.9 µg/kg/day at 12 months or >4.27 µg/kg/day at 24 months are highly suggestive of P CH, irrespective of gland ultrasonography; (b) L-T4 requirements <1.7 µg/kg/day at 12 months or <1.45 µg/kg/day at 24 months are highly suggestive of T CH, at least in the cases with eutopic gland, and (c) the analysis of L-T4 requirements during the first years of treatment might allow an early discrimination between T and P CH in the cases with eutopic gland.
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Affiliation(s)
- Maria Francesca Messina
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
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Perlsteyn M, Deladoëy J, Van Vliet G. Similar age-dependent levothyroxine requirements of schoolchildren with congenital or acquired hypothyroidism. Eur J Pediatr 2016; 175:869-72. [PMID: 26856857 DOI: 10.1007/s00431-016-2701-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
Abstract
UNLABELLED A recent study in children suggested that levothyroxine requirements are higher in congenital than in acquired hypothyroidism but did not match for severity of disease. Here, we studied only children with congenital or acquired hypothyroidism who had an undetectable fT4 at diagnosis. There were eight girls with congenital hypothyroidism due to athyreosis and eight girls with acquired hypothyroidism due to autoimmune thyroid disease. The median levothyroxine dose received at the most recent visit when serum TSH was <5.0 mU/L (at a median age of 7.86 and 14.29 years, respectively) was 3.2 mcg/kg/day in the former and 2.4 mcg/kg/day in the latter (N.S.). Combining both groups, the levothyroxine requirement decreased by 0.5 mcg/kg/day for every 4-year period. CONCLUSION When strictly matched for severity of disease, levothyroxine requirements are similar in school-age children with congenital or acquired hypothyroidism and decrease with age. Thus, in congenital hypothyroidism treated early with high-dose levothyroxine, pituitary resistance to thyroxine feedback does not appear to be present at school age. WHAT IS KNOWN • Pediatric studies unmatched for severity have suggested that levothyroxine requirements are higher in congenital than in acquired hypothyroidism. What is new: • When strictly matched for severity, levothyroxine requirements are similar in children with congenital or acquired hypothyroidism and decrease with age.
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Affiliation(s)
- Martin Perlsteyn
- Endocrinology Service and Research Center, Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, Université de Montréal, Room 1719, 3175 chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Johnny Deladoëy
- Endocrinology Service and Research Center, Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, Université de Montréal, Room 1719, 3175 chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1C5, Canada.,Department of Biochemistry, Université de Montréal, Montréal, QC, Canada
| | - Guy Van Vliet
- Endocrinology Service and Research Center, Centre Hospitalier Universitaire Sainte-Justine and Department of Pediatrics, Université de Montréal, Room 1719, 3175 chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1C5, Canada.
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13
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Final height in Italian patients with congenital hypothyroidism detected by neonatal screening: a 20-year observational study. Ital J Pediatr 2015; 41:82. [PMID: 26511640 PMCID: PMC4625434 DOI: 10.1186/s13052-015-0190-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/16/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Linear growth and final height are reported as normal in congenital hypothyroid patients in the neonatal screening era. METHODS We evaluated the final height in 215 patients with congenital hypothyroidism to assess if it improved over the last 2 decades. RESULTS Final height (-0.1 ± 1.0 SDS) was higher than target height (-0.8 ± 1.0 SDS, p < 0.001) and not different among the 4 quartiles for birthdate. It was correlated with target height (r(2) = 0.564, p < 0.001) and height at puberty onset (r(2) = 0.685, p < 0.001), but not with age at diagnosis or the starting LT4/kg/day dose. The curve fitting analysis showed that the age at diagnosis progressively decreased during the 20-year study period, while the target height and the starting LT4/kg/day increased. Final height was not affected by the birthdate, the age at diagnosis, the starting LT4 dose. CONCLUSIONS The final height is higher than the target height, but despite the improvement in the screening and the treatment, it did not improve over the last 20 years. These findings are in keeping with the described secular trend and suggest that earlier diagnosis and replacement therapy do not significantly modify final height in these patients.
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