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Büyükavcı MA, Dundar I. Comparison of developmental outcomes in children with permanent and transient congenital hypothyroidism. J Pediatr Endocrinol Metab 2023; 36:364-370. [PMID: 36794655 DOI: 10.1515/jpem-2022-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Congenital hypothyroidism (CH) is still one of the most common causes of preventable cognitive impairment in children, and its early detection and treatment prevent irreversible neurodevelopmental delay. Depending on the underlying cause, cases with CH may be transient or permanent. This study aimed to compare the developmental evaluation results of transient and permanent CH patients and to reveal any differences. METHODS A total of 118 patients with CH, who were followed up jointly in pediatric endocrinology and developmental pediatrics clinics, were included. The patients' progress was evaluated per the International Guide for Monitoring Child Development (GMCD). RESULTS Of the cases, 52 (44.1%) were female, and 66 (55.9%) were male. While 20 (16.9%) cases were diagnosed with permanent CH, 98 (83.1%) were diagnosed with transient CH. According to the results of the developmental evaluation made with GMCD, the development of 101 (85.6%) children was compatible with their age, while 17 (14.4%) children had delays in at least one developmental area. All 17 patients had a delay in expressive language. Developmental delay was detected in 13 (13.3%) of those with transient CH and 4 (20%) with permanent CH. CONCLUSIONS There is difficulty in expressive language in all cases of CH with developmental delay. No significant difference was found between the developmental evaluations of permanent and transient CH cases. The results revealed the importance of developmental follow-up, early diagnosis and interventions in those children. GMCD is thought to be an important guide to help monitoring the development of patients with CH.
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Affiliation(s)
- Mehmet Akif Büyükavcı
- Department of Developmental Pediatrics, Faculty of Medicine, Inonu University, Malatya, Türkiye
| | - Ismail Dundar
- Department of Pediatric Endocrinology, Faculty of Medicine, Inonu University, Malatya, Türkiye
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2
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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 2023; 32:26-51. [PMID: 36761493 PMCID: PMC9887297 DOI: 10.1297/cpe.2022-0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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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3
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Dündar İ, Büyükavcı MA, Çiftçi N. Etiological, clinical, and laboratory evaluation of congenital hypothyroidism and determination of levothyroxine (LT4) dose at treatment interruption in differentiating permanent vs. transient patients. Turk J Med Sci 2022; 52:1863-1871. [PMID: 36945978 PMCID: PMC10390198 DOI: 10.55730/1300-0144.5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Congenital hypothyroidism (CH) is the most common cause of preventable but irreversible mental retardation in children, although the risk has been widely abolished by national neonatal screening programs. The aim of this study was to determine, (a) the cause of CH, (b) the etiological cause of persistent CH and (c) to investigate the role of laboratory and clinical data in predicting persistent and transient CH. METHODS Patients diagnosed with CH, who started L-thyroxine treatment and were followed up for at least three years were included. Patient data were reviewed retrospectively. Serum thyroid hormones were measured four weeks after discontinuation of therapy at age three or earlier. Cases with a thyroid-stimulating hormone (TSH) value of >10 mIU/mL were accepted as permanent hypothyroidism, while cases with normal TSH values for six months after cessation were accepted as transient hypothyroidism. RESULTS There were 232 treated cases, of whom 108 (46.6%) were female, and 169 (72.8%) were eventually diagnosed with transient CH. The best cut-off point for predicting permanent status was determined as LT4 cut-off dose ≥1.45 mcg/kg/day. The median (range) duration of L-thyroxine treatment in transient hypothyroid cases was 24 (range: 6-36) months, and treatment was discontinued before the age of three years in 64%. DISCUSSION There were 232 treated cases, of whom 108 (46.6%) were female, and 169 (72.8%) were eventually diagnosed with transient CH. The best cut-off point for predicting permanent status was determined as LT4 cut-off dose ≥1.45 mcg/kg/day. The median (range) duration of L-thyroxine treatment in transient hypothyroid cases was 24 (range: 6-36) months, and treatment was discontinued before the age of three years in 64%.
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Affiliation(s)
- İsmail Dündar
- Department of Pediatric Endocrinology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Mehmet Akif Büyükavcı
- Department of Developmental Pediatrics, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Nurdan Çiftçi
- Department of Pediatric Endocrinology, Malatya Training and Research Hospital, Malatya, Turkey
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Giovanella L, Avram AM, Ovčariček PP, Clerc J. Thyroid functional and molecular imaging. Presse Med 2022; 51:104116. [PMID: 35124101 DOI: 10.1016/j.lpm.2022.104116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/02/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Radioiodine uptake (RAIU) test with iodine-123 (Na[123I]I) or iodine-131 (Na[131I]I) enables accurate evaluation and quantification of iodine uptake and kinetics within thyroid cells. Thyroid Scintigraphy (TS) employing Na[123I]I or 99mTc-pertechnetate (Na[99mTc]TcO4) provides information regarding the function and topographical distribution of thyroid cells activity, including detection and localization of ectopic thyroid tissue. Destructive thyrotoxicosis is characterized by low RAIU with scintigraphically reduced radiotracer activity in the thyroid tissue, while productive thyrotoxicosis (i.e. hyperthyroidism "stricto sensu") is characterized by high RAIU with scintigraphically diffuse (i.e. Graves' Disease, GD and diffuse thyroid autonomy) or focal (i.e. autonomously functioning thyroid nodules, AFTN) overactivity. Accordingly, RAIU and/or TS are widely used to differentiate different causes of thyrotoxicosis. In addition, several radiopharmaceuticals are also available to help differentiate benign from malignant thyroid nodules and inform clinical decision-making: scintigraphic identification of AFTNs obviate fine-needle aspiration (FNA) biopsy, and [99mTc]Tc-hexakis-(2‑methoxy-2-isobutyl isonitrile ([99mTc]Tc-MIBI) and/or 18F-fluoro-d-glucose ([18F]FDG) may complement the work-up of cytologically indeterminate "cold" nodules for reducing the need for diagnostic lobectomies/thyroidectomies. Finally, RAIU studies are also useful for calculating the administered therapeutic activity of Na[131I]I to treat hyperthyroidism and euthyroid multinodular goiter. All considered, thyroid molecular imaging allows functional characterization of different thyroid diseases, even before clinical symptoms become manifest, and remains integral to the management of such conditions. Our present paper summarizes basic concepts, clinical applications, and potential developments of thyroid molecular imaging in patients affected by thyrotoxicosis and thyroid nodules.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Division of Endocrinology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Jerome Clerc
- Department of Nuclear Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, DMU Imagina, University of Paris France
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Shreder EV, Vadina TA, Konyukhova MB, Nagaeva EV, Shiryaeva TY, Zakharova SM, Degtyarev MV, Vyazmenov EO, Bezlepkina OB. [Ectopic thyroid gland: clinical features and diagnostics in children]. PROBLEMY ENDOKRINOLOGII 2022; 68:76-85. [PMID: 35841171 PMCID: PMC9762537 DOI: 10.14341/probl12876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND BACKGROUND: The frequency of ectopia of thyroid gland among all types of dysgenesis varies from 30 to 70%, its most common localization is the root of the tongue. Otorhinolaryngologists, oncologists, pediatricians can take lingual ectopia for hypertrophy of the lingual tonsil or fibroma of the tongue root, which leads to unreasonable surgical treatment. Thyroid scintigraphy plays a key role in the diagnosis of ectopia. AIM AIM: To assess the etiological structure of congenital hypothyroidism (CH) and demonstrate the clinical course in patients with ectopic thyroid tissue in the root of the tongue. MATERIALS AND METHODS MATERIALS AND METHODS: A group of patients with CH was examined. All patients underwent neck ultrasound and radionuclide imaging. The examination was carried out against the background of the abolition of hormone replacement therapy for 14 days or before its initiation. Patients with ectopia in the root of the tongue underwent videofibrolaryngoscopy. Some patients underwent a genetic study with using genes panel of a panel of candidate genes responsible for the development of CH using the NGS method. The molecular genetic study was conducted to some patients, next-generation sequencing with the genes panel. RESULTS RESULTS: The study included 73 patients with primary CH aged from 2 weeks to 17.3 years: 69 children were diagnosed based on the results of neonatal screening, 4 children with thyroid ectopia were first examined older than 6 years. The median age of patients at the time of the examination was 6.9 years [4.8; 10.0]. By data of ultrasound aplasia was diagnosed in 47.9% of patients, one child had hemiagenesis and ectopic thyroid tissue of various localization was detected in 26.0% of children. In 24.7% of children thyroid tissue was found in a typical location. Scintigraphy confirmed thyroid aplasia in 65.7% of children. Examination revealed various variants of ectopically located thyroid tissue in 31 children (42.4%): thyroid ectopia in the root of the tongue in 25 children (80.6%), ectopia in the sublingual region in 5 children (16.2%), double ectopia was detected in 1 child. The median level of TSH in newborns with ectopic thyroid gland was 124 IU/ml and was significantly lower than in children with aplasia — 219 IU/ml, p<0.05. On the other side the level of TG in children with ectopia was significantly higher than in children with aplasia — 37.12 ng/ml versus 0.82 ng/ml, p><0.05. CONCLUSION: Combination of two methods is the best diagnostic approach to determine the etiology of CH — ultrasound and scintigraphy studies compensates deficiencies of each other. Our study demonstrates the importance of scintigraphy in children with CH and patients with the formation of the root of the tongue and the anterior surface of the neck in order to avoid unnecessary removal of the thyroid gland. In case of confirmation of thyroid ectopia in the root of the tongue and in the absence of symptoms of obstruction or bleeding, it is recommended to refer the patient to an endocrinologist for conservative treatment. ><0.05. On the other side the level of TG in children with ectopia was significantly higher than in children with aplasia — 37.12 ng/ml versus 0.82 ng/ml, p< 0.05. CONCLUSION CONCLUSION: Combination of two methods is the best diagnostic approach to determine the etiology of CH — ultrasound and scintigraphy studies compensates deficiencies of each other. Our study demonstrates the importance of scintigraphy in children with CH and patients with the formation of the root of the tongue and the anterior surface of the neck in order to avoid unnecessary removal of the thyroid gland. In case of confirmation of thyroid ectopia in the root of the tongue and in the absence of symptoms of obstruction or bleeding, it is recommended to refer the patient to an endocrinologist for conservative treatment.
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Affiliation(s)
- E. V. Shreder
- Endocrinology Research Center;Morozov Children’s Municipal Clinical Hospital
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McGrath N, Hawkes CP, Ryan S, Mayne P, Murphy N. Infants Diagnosed with Athyreosis on Scintigraphy May Have a Gland Present on Ultrasound and Have Transient Congenital Hypothyroidism. Horm Res Paediatr 2021; 94:36-43. [PMID: 34044405 DOI: 10.1159/000514989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Scintigraphy using technetium-99m (99mTc) is the gold standard for imaging the thyroid gland in infants with congenital hypothyroidism (CHT) and is the most reliable method of diagnosing an ectopic thyroid gland. One of the limitations of scintigraphy is the possibility that no uptake is detected despite the presence of thyroid tissue, leading to the spurious diagnosis of athyreosis. Thyroid ultrasound is a useful adjunct to detect thyroid tissue in the absence of 99mTc uptake. AIMS We aimed to describe the incidence of sonographically detectable in situ thyroid glands in infants scintigraphically diagnosed with athyreosis using 99mTc and to describe the clinical characteristics and natural history in these infants. METHODS The newborn screening records of all infants diagnosed with CHT between 2007 and 2016 were reviewed. Those diagnosed with CHT and athyreosis confirmed on scintigraphy were invited to attend a thyroid ultrasound. RESULTS Of the 488 infants diagnosed with CHT during the study period, 18/73 (24.6%) infants with absent uptake on scintigraphy had thyroid tissue visualised on ultrasound (3 hypoplastic thyroid glands and 15 eutopic glands). The median serum thyroid-stimulating hormone (TSH) concentration at diagnosis was significantly lower than that in infants with confirmed athyreosis (no gland on ultrasound and no uptake on scintigraphy) (74 vs. 270 mU/L), and median free T4 concentration at diagnosis was higher (11.9 vs. 3.9 pmol/L). Six of 10 (60%) infants with no uptake on scintigraphy but a eutopic gland on ultrasound had transient CHT. CONCLUSION Absent uptake on scintigraphy in infants with CHT does not rule out a eutopic gland, especially in infants with less elevated TSH concentrations. Clinically, adding thyroid ultrasound to the diagnostic evaluation of infants who have athyreosis on scintigraphy may avoid committing some infants with presumed athyreosis to lifelong levothyroxine treatment.
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Affiliation(s)
- Niamh McGrath
- Department of Paediatric Endocrinology, Children's Health Ireland at Temple St, Dublin, Ireland.,Department of Paediatrics, School of Medicine, University College, Dublin, Ireland
| | - Colin Patrick Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie Ryan
- Department of Radiology, Children's Health Ireland at Temple St, Dublin, Ireland
| | - Philip Mayne
- National Newborn Screening Laboratory, Children's Health Ireland at Temple St, Dublin, Ireland.,Department of Paediatrics and Biochemistry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nuala Murphy
- Department of Paediatric Endocrinology, Children's Health Ireland at Temple St, Dublin, Ireland.,Department of Paediatrics, School of Medicine, University College, Dublin, Ireland
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Song H, Dong C, Zhang X, Wu W, Chen C, Ma B, Chen F, Chen C, Lv X. Rapid identification of papillary thyroid carcinoma and papillary microcarcinoma based on serum Raman spectroscopy combined with machine learning models. Photodiagnosis Photodyn Ther 2021; 37:102647. [PMID: 34818598 DOI: 10.1016/j.pdpdt.2021.102647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/07/2021] [Accepted: 11/19/2021] [Indexed: 12/18/2022]
Abstract
Thyroid carcinoma is one kind of cancer with the highest diagnosis rate in the endocrine system, and its main histological subtype is papillary thyroid carcinoma (PTC) accounting for 80% of thyroid malignancies. In recent years, the incidence of thyroid cancer has increased exponentially, and its substantial increase was closely related to the overdiagnosis of papillary microcarcinoma (PMC). Therefore, early and accurate identification of PTC and PMC can prevent patients from being irreversibly damaged. This study aimed to identify PTC and PMC using Raman spectroscopy. We collected serum Raman spectra from 16 patients with PTC and 31 patients with PMC. Firstly, the collected imbalance data were preprocessed using the synthetic minority over-sampling technique (SMOTE). Then, the equalized data were dimensionality reduced by principal component analysis (PCA). Finally, the processed data were fed into the single decision tree (DT) classifier, as well as the random forest (RF) built on the idea of Boosting ensemble and the Adaptive Boosting (Adaboost) model built on the idea of Bagging ensemble for classification. The classification accuracy of the three models in the testing set were 75.38%, 81.54%, and 84.61%, respectively. Compared with the DT classifier, the accuracy of the models introducing the idea of ensemble learning was enhanced by 6.16% and 9.23%, respectively. The best model was the Adaboost. This result demonstrates that serum Raman spectroscopy combined with an ensemble learning algorithm was feasible in rapidly identifying PTC and PMC. At the same time, the method has great potential for application in the field of clinical diagnosis.
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Affiliation(s)
- Haitao Song
- Department of Breast, Head and Neck Surgery, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China
| | - Chao Dong
- Department of Breast, Head and Neck Surgery, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China
| | - Xudan Zhang
- College of Information Science and Engineering, Xinjiang University, Urumqi, 830046, China
| | - Wei Wu
- College of Software, Xinjiang University, Urumqi, 830046, China
| | - Cheng Chen
- College of Software, Xinjiang University, Urumqi, 830046, China.; Key Laboratory of Signal Detection and Processing, Xinjiang University, Urumqi, 830046, China..
| | - Binlin Ma
- Department of Breast, Head and Neck Surgery, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China..
| | - Fangfang Chen
- College of Information Science and Engineering, Xinjiang University, Urumqi, 830046, China
| | - Chen Chen
- College of Information Science and Engineering, Xinjiang University, Urumqi, 830046, China
| | - Xiaoyi Lv
- College of Software, Xinjiang University, Urumqi, 830046, China.; Key Laboratory of Signal Detection and Processing, Xinjiang University, Urumqi, 830046, China.; College of Information Science and Engineering, Xinjiang University, Urumqi, 830046, China
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McNally RJ, Jones JH, Shaikh MG, Donaldson MD, Blakey K, Cheetham TD. Congenital Hypothyroidism: Space-Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology. Thyroid 2021; 31:876-883. [PMID: 33183175 PMCID: PMC8215409 DOI: 10.1089/thy.2020.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The etiology of most cases of congenital hypothyroidism (CHT) due to thyroid dysgenesis (DG) is unknown. If transient environmental factors can impact on thyroid gland development, then clustering of cases in time and/or space may occur, and this would be more likely in thyroid DG than dyshormonogenesis (DHG). Methods: The newborn screening program for CHT in Scotland is linked to a central database that includes case details such as postcode. The etiology of CHT is investigated in many cases of CHT using scintigraphy and/or ultrasonography. We looked for evidence of a change in CHT incidence with year of birth and according to season of the year. We then undertook space-time clustering analysis (using a method based on K-functions, with nearest neighbor thresholds) of CHT in Scotland between 1979 and 2015. We also looked for evidence of overall changes associated with sex and area-based birth density. Results: Of 531 cases with CHT during the study period, 290 cases had been categorized as DG (n = 229) or DHG (n = 61) following more detailed investigation. The incidence of CHT increased with year of birth and was in part linked to changing methodology, but there was no seasonality. There was no evidence of overall space-time clustering (p = 0.06), but there was evidence of clustering in babies with DG (p = 0.007). This picture appeared to be most closely linked to underlying thyroid gland hypoplasia rather than thyroid gland agenesis or ectopia. There was significant space-time clustering for both males and females, but clustering was restricted to lesser birth density areas. There was also evidence of clustering for unknown cases (p < 0.001). Clustering of these cases was restricted to females but was present for cases from both greater and lesser birth density areas. There was no evidence of clustering in cases of DHG. Conclusions: These data suggest that an unidentified environmental factor or factors may be involved in the etiology of thyroid DG in Scotland. The variation in CHT incidence observed internationally may reflect environmental as well as genetic factors.
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Affiliation(s)
- Richard J.Q. McNally
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Address correspondence to: Richard J.Q. McNally, PhD, Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, United Kingdom
| | | | | | - Malcolm D.C. Donaldson
- Section of Child Health, Royal Hospital for Children, University of Glasgow School of Medicine, Glasgow, United Kingdom
| | - Karen Blakey
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Tim D. Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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9
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Chun S, Lee YS, Yu J. Thyroid imaging study in children with suspected thyroid dysgenesis. Ann Pediatr Endocrinol Metab 2021; 26:53-59. [PMID: 33819958 PMCID: PMC8026338 DOI: 10.6065/apem.2040120.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/27/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Thyroid dysgenesis is one of the most common causes of permanent congenital hypothyroidism. Thyroid ultrasonography or scan is used to detect thyroid dysgenesis. We analyzed the sensitivity and specificity of thyroid ultrasonography and scan in diagnosing thyroid dysgenesis to determine the clinical utility of each thyroid imaging method. METHODS Sixty-one patients younger than 7 years of age were investigated via thyroid scan. Nineteen patients who were initially interpreted as having thyroid dysgenesis, such as ectopia, hemiagenesis, or aplasia, by thyroid scan were included in the study. Clinical characteristics and findings of a thyroid imaging study were reviewed. RESULTS Initially, thyroid scan results were interpreted as ectopia (n=9), hemiagenesis (n=1), and nonvisualization (n=9). In contrast, the results of thyroid ultrasonography were normal thyroid gland (n=5), ectopia (n=6), and hypoplasia (n=8). After reviewing the results of both studies, final imaging diagnoses were as follows: normal thyroid gland (n=5), hemiagenesis (n=1), ectopia (n=9) including 2 dual ectopy, hypoplasia (n=3), and aplasia (n=1). Thyroid ultrasonography showed higher sensitivity and specificity in detecting presence of normal thyroid gland. Thyroid scan was better to detect ectopia. Among 8 patients who were initially interpreted as having hypoplasia by ultrasonography, 4 were confirmed as ectopia and one as aplasia. CONCLUSION This study showed that thyroid ultrasonography is useful as the first-line imaging study to detect normal-sized eutopic thyroid gland. Thyroid scan should be performed to investigate the presence of ectopia if hypoplasia or aplasia is suspected by ultrasonography.
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Affiliation(s)
- Sangwoo Chun
- Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Young Seok Lee
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jeesuk Yu
- Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea,Address for correspondence: Jeesuk Yu Department of Pediatrics, Dankook Universit y Hospital, Dank ook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea
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10
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Mansour C, Ouarezki Y, Jones JH, Green M, Stenhouse EJ, Irwin G, Hermanns P, Pohlenz J, Donaldson MDC. Determination of thyroid volume in infants with suspected congenital hypothyroidism-the limitations of both subjective and objective evaluation. BJR Open 2020; 2:20200001. [PMID: 33178970 PMCID: PMC7594903 DOI: 10.1259/bjro.20200001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/21/2020] [Accepted: 04/30/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: To compare two methods of assessing gland size on thyroid ultrasound in newborn infants with suspected congenital hypothyroidism (CH). Methods: Images from infants with eutopic glands referred between 2007 and 2013 were evaluated blind by two sets of observers. Subjective gland size was categorised as small, borderline-small, normal, borderline-large and large. Objective gland volume, calculated as the sum of each lobe using the prolate ellipsoid formula (length x width x depth x π/6), was put into corresponding categories: <0.8, 0.81–1.0, 1.1– <2.2, 2.2–2.4 and >2.4 ml, derived from normative Scottish data. Results: Of 36 infants, permanent CH was present in 17, transient CH in 17, status uncertain in 2. Mean (SD) intraobserver error for thyroid volume measurement was 0.11 (0.23) ml [8.3%]. Subjective assessment by two observers was discordant in only four (10.8%) infants. However, subjective vs objective evaluation was discordant in 14 (39%). Eight (three permanent, five transient CH) had large glands subjectively but normal glands objectively; and six (four transient CH) had normal glands subjectively but small glands objectively. The former infants all showed a single flattened curve to the anterior thyroid margin, giving an impression of bulkiness. Gland shape was normal in the latter infants. Conclusion: Neither subjective nor objective evaluation predicts permanent vs transient CH. Altered gland shape may confound both methods, and undermine use of the conventional formula for measuring lobe volume. Advances in knowledge: Until more refined methods are available for assessing thyroid size, both subjective and objective evaluation are recommended in CH.
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Affiliation(s)
| | - Yasmine Ouarezki
- Hassen-Badi Public Health Establishment, El-Harrach, Algiers, Algeria
| | - Jeremy Huw Jones
- NHS Greater Glasgow and Clyde, Royal Hospital for Children, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, United Kingdom
| | - Morag Green
- NHS Greater Glasgow and Clyde, Department of Radiology, Royal Hospital for Children, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, United Kingdom
| | - Emily Jane Stenhouse
- NHS Greater Glasgow and Clyde, Department of Radiology, Royal Hospital for Children, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, United Kingdom
| | - Greg Irwin
- NHS Greater Glasgow and Clyde, Department of Radiology, Royal Hospital for Children, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, United Kingdom
| | - Pia Hermanns
- Children's Hospital, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Joachim Pohlenz
- Children's Hospital, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Malcolm David Cairns Donaldson
- University of Glasgow School of Medicine, Section of Child Health, Royal Hospital for Children, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, United Kingdom
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Pediatric thyroid ultrasound: a radiologist's checklist. Pediatr Radiol 2020; 50:563-574. [PMID: 32166365 DOI: 10.1007/s00247-019-04602-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/26/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
Ultrasonography (US) is the imaging method of choice for evaluating the pediatric thyroid gland, complemented by scintigraphy and thyroid function tests, especially when evaluating children with suspected congenital hypothyroidism, goiter, infectious or autoimmune diseases, or neoplasm. Diagnostic considerations in newborns with congenital hypothyroidism mainly include dysgenesis, dyshormonogenesis, transient hypothyroidism and central (hypophyseal) hypothyroidism. The midline of the neck should be scrutinized for thyroid tissue from the floor of the mouth to the thoracic inlet. Cystic and echogenic ultimobranchial remnants should not be misinterpreted as orthotopic thyroid tissue. Diffuse thyroid diseases affect older children; these comprise Hashimoto and Graves diseases and infectious thyroiditis and exhibit features similar to those in adults. It is important to note that the diffuse sclerosing variant of papillary thyroid cancer can complicate thyroiditis and should not be confused with Hashimoto disease. In children with solid nodules the threshold for fine-needle aspiration biopsy or surgery should be lower compared to adults because of a higher likelihood of malignancy compared with adults. Biopsy should be considered in nodules with suspicious ultrasonographic features, even when smaller than 1 cm. Adult classification systems of thyroid nodules, although useful, are not sufficient to safely discriminate the nodules' likelihood of malignancy in children. We describe key sonographic findings and suggest a standard checklist that might be considered while performing and interpreting thyroid US in neonates and children.
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Adaletli I, Bayramoglu Z, Caliskan E, Yilmaz R, Akyol Sari ZN, Bas F, Kardelen AD, Poyrazoglu S, Darendeliler F. Multi-parametric Ultrasound Evaluation of Pediatric Thyroid Dyshormonogenesis. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1644-1653. [PMID: 31031038 DOI: 10.1016/j.ultrasmedbio.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
The aim of this study was to assess the diagnostic contribution of gray-scale ultrasonography, color Doppler, superb microvascular imaging and shear wave elastography in thyroid dyshormonogenesis (TD). From October 2017 to February 2018, the prospective study included 31 patients (13.6 y; 11-14 y) diagnosed with TD based on thyroid scintigraphy and perchlorate discharge tests and 40 healthy pediatric volunteers (12.8 y; 10-16 y). Median resistive indices (RIs), peak systolic and end-diastolic velocities, vascularity indices (VIs) via superb microvascular imaging and shear wave elastography parameters were evaluated. Median VI values were significantly higher and median RI values were significantly lower in the study group than the control group. No significant difference was found between shear wave elastography parameters of the TD and control group. VI was significantly correlated with median total thyroid gland volumes (p = 0.002, r = 0.28), medication dosage (p = 0.03, r = 0.48) and 2-h radioactive iodine uptake values (p = 0.008, r = 0.57). VI is a clinically significant and novel parameter useful for diagnosing TD.
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Affiliation(s)
- Ibrahim Adaletli
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Zuhal Bayramoglu
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey.
| | - Emine Caliskan
- Radiology Department, Seyhan State Hospital, Adana, Turkey
| | - Ravza Yilmaz
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Zeynep Nur Akyol Sari
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Aslı Derya Kardelen
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
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13
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Cerqueira TLDO, Ramos YR, Strappa GB, Jesus MSD, Santos JG, Sousa C, Carvalho G, Fernandes V, Boa-Sorte N, Amorim T, Silva TM, Ladeia AMT, Acosta AX, Ramos HE. Mutation screening in the genes PAX-8, NKX2-5, TSH-R, HES-1 in cohort of 63 Brazilian children with thyroid dysgenesis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:466-471. [PMID: 30304112 PMCID: PMC10118737 DOI: 10.20945/2359-3997000000065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 05/09/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the candidate genes PAX-8, NKX2-5, TSH-R and HES-1 in 63 confirmed cases of thyroid dysgenesis. SUBJECTS AND METHODS Characterization of patients with congenital hypothyroidism into specific subtypes of thyroid dysgenesis with hormone levels (TT4 and TSH), thyroid ultrasound and scintigraphy. DNA was extracted from peripheral blood leukocytes and the genetic analysis was realized by investigating the presence of mutations in the transcription factor genes involved in thyroid development. RESULTS No mutations were detected in any of the candidate genes. In situ thyroid gland represented 71.1% of all cases of permanent primary congenital hypothyroidism, followed by hypoplasia (9.6%), ectopia (78%), hemiagenesis (6.0%) and agenesis (5.5%). The highest neonatal screening TSH levels were in the agenesis group (p < 0.001). CONCLUSIONS Thyroid dysgenesis is possibly a polygenic disorder and epigenetic factors could to be implicated in these pathogeneses.
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Affiliation(s)
- Taíse Lima de Oliveira Cerqueira
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil.,Programa de Pós-Graduação em Biotecnologia em Saúde e Medicina Investigativa, Instituto Gonçalo Moniz (IGM/ Fiocruz), Salvador, BA, Brasil
| | - Yanne Rocha Ramos
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Giorgia Bruna Strappa
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Mariana Souza de Jesus
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Jailciele Gonzaga Santos
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Camila Sousa
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Gildásio Carvalho
- Associação de Pais e Amigos dos Excepcionais (APAE), Salvador, BA, Brasil
| | | | - Ney Boa-Sorte
- Associação de Pais e Amigos dos Excepcionais (APAE), Salvador, BA, Brasil
| | - Tatiana Amorim
- Associação de Pais e Amigos dos Excepcionais (APAE), Salvador, BA, Brasil
| | - Thiago Magalhães Silva
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Ana Marice Teixeira Ladeia
- Programa de Pós-Graduação em Saúde Humana e Medicina, Escola Bahiana de Saúde e Medicina, Salvador, BA, Brasil
| | - Angelina Xavier Acosta
- Programa de Pós-Graduação em Biotecnologia em Saúde e Medicina Investigativa, Instituto Gonçalo Moniz (IGM/ Fiocruz), Salvador, BA, Brasil
| | - Helton Estrela Ramos
- Departamento de Biorregulação, Laboratório de Estudo da Tiroide, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil.,Programa de Pós-Graduação em Biotecnologia em Saúde e Medicina Investigativa, Instituto Gonçalo Moniz (IGM/ Fiocruz), Salvador, BA, Brasil
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14
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Zdraveska N, Zdravkovska M, Anastasovska V, Sukarova-Angelovska E, Kocova M. Diagnostic re-evaluation of congenital hypothyroidism in Macedonia: predictors for transient or permanent hypothyroidism. Endocr Connect 2018; 7:278-285. [PMID: 29335252 PMCID: PMC5801559 DOI: 10.1530/ec-17-0332] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diagnostic re-evaluation is important for all patients with congenital hypothyroidism (CH) for determining the etiology and identifying transient CH cases. Our study is a first thyroxine therapy withdrawal study conducted in Macedonian CH patients for a diagnostic re-evaluation. We aimed to evaluate the etiology of CH, the prevalence of transient CH and identify predictive factors for distinguishing between permanent (PCH) and transient CH (TCH). MATERIALS AND METHODS Patients with CH aged >3 years underwent a trial of treatment withdrawal for 4 weeks period. Thyroid function testing (TFT), ultrasound and Technetium-99m pertechnetate thyroid scan were performed thereafter. TCH was defined when TFT remained within normal limits for at least 6-month follow-up. PCH was diagnosed when TFT was abnormal and classified according the imaging findings. RESULTS 42 (55%) patients had PCH and 34 (45.0%) patients had TCH. Thyroid agenesia was the most prevalent form in the PCH group. Patients with TCH had lower initial thyroid-stimulating hormone (TSH) values (P < 0.0001); higher serum thyroxine levels (P = 0.0023) and lower mean doses of levothyroxine during treatment period (P < 0.0001) than patients with PCH. Initial TSH level <30.5 IU/mL and levothyroxine dose at 3 years of age <2.6 mg/kg/day were a significant predictive factors for TCH; sensitivity 92% and 100%, specificity 75.6% and 76%, respectively. CONCLUSION TCH presents a significant portion of patients with CH. Initial TSH value and levothyroxine dose during treatment period has a predictive role in differentiating TCH from PCH. Earlier re-evaluation, between 2 and 3 years age might be considered in some patients requiring low doses of levothyroxine.
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Affiliation(s)
- Nikolina Zdraveska
- University Children's Hospital SkopjeFaculty of Medicine, Skopje, Republic of Macedonia
| | - Maja Zdravkovska
- Institute of Patophysiology and Nuclear MedicineFaculty of Medicine, Skopje, Republic of Macedonia
| | - Violeta Anastasovska
- University Children's Hospital SkopjeFaculty of Medicine, Skopje, Republic of Macedonia
| | | | - Mirjana Kocova
- University Children's Hospital SkopjeFaculty of Medicine, Skopje, Republic of Macedonia
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15
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Bezen D, Dilek E, Torun N, Tütüncüler F. Etiological evaluation of primary congenital hypothyroidism cases. Turk Arch Pediatr 2017; 52:85-91. [PMID: 28747839 DOI: 10.5152/turkpediatriars.2017.3989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/22/2017] [Indexed: 11/22/2022]
Abstract
AIM Primary congenital hypothyroidism is frequently seen endocrine disorder and one of the preventable cause of mental retardation. Aim of study was to evaluate the frequency of permanent/transient hypothyrodism, and to detect underlying reason to identfy any marker which carries potential to discriminate permanent/transient form. MATERIAL AND METHODS Forty eight cases older than 3 years of age, diagnosed as primary congenital hypothyroidism and started thyroxin therapy in newborn-period, and followed up between January 2007-June 2013 were included in the study. Thyroid hormon levels were evaluated and thyroid ultrasonography was performed in cases who are at the end of their 3 years of age, after 6 weeks of thyroxine free period. Thyroid sintigraphy was performed if serum thyroid-stimulating hormone was high (≥ 5 mIU/mL) and perchlorate discharge test was performed if uptake was normal or increased on sintigraphy. Cases with thyroid-stimulating hormone levels ≥ 5 mIU/mL were defined as permanent primary congenital hypothyroidism group and as transient primary congenital hypothyroidism group with normal thyroid hormones during 6 months. RESULTS The mean age was 3.8±0.7 years. Mean diagnosis age was 16.6±6.5 days and 14 cases (29.2%) were diagnosed by screening program of Ministry of Health. There were 23 cases (14F, 9M) in permanent primary congenital hypothyroidism group and 12 (52.2%) of them were dysgenesis (8 hypoplasia, 4 ectopia), and 11 (47.8%) dyshormonogenesis. In transient primary congenital hypothyroidism group, there were 25 cases (17M, 8F). The mean thyroid-stimulating hormone levels at diagnosis were similar in two groups. The mean thyroxin dose in permanent primary congenital hypothyroidism group was significantly higher than transient group at the time of thyroxin cessation (2.1±0.7, 1.5±0.5 mg/kg/d, respectively, p=0.004). Thyroxin dose ≥1.6 mcg/kg/d was 72% sensitive and 69.6% specific for predicting permenant primary congenital hypothyroidism. CONCLUSIONS Transient primary congenital hypothyroidism is more frequent than expected and found often in males in the primary congenital hypothyroidism cases, started thyroxin therapy in neonatal period. While fT4, thyroid-stimulating hormone, Tg levels at diagnosis do not predict transient/permenant primary congenital hypothyroidism, thyroxin dose before the therapy cessation at the age of 3 may make the distinction between transient/permenant primary congenital hypothyroidism.
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Affiliation(s)
- Diğdem Bezen
- Department of Pediatrics, Division of Pediatric Endocrinology, Trakya University School of Medicine, Edirne, Turkey
| | - Emine Dilek
- Department of Pediatrics, Division of Pediatric Endocrinology, Trakya University School of Medicine, Edirne, Turkey
| | - Neşe Torun
- Department of Nuclear Medicine, Trakya University School of Medicine, Edirne, Turkey
| | - Filiz Tütüncüler
- Department of Pediatrics, Division of Pediatric Endocrinology, Trakya University School of Medicine, Edirne, Turkey
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Kocova M, Zdraveska N, Zdravkovska M, Anastasovska V, Pop Gjorceva D. Submental thyroid ectopy might cause subclinical hypothyroidism in early childhood. SAGE Open Med Case Rep 2016; 4:2050313X16683623. [PMID: 27994873 PMCID: PMC5153024 DOI: 10.1177/2050313x16683623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022] Open
Abstract
Objective: Thyroid ectopy is a rare condition resulting from abnormal embryologic development and migration of the gland. Sublingual is the most common thyroid ectopy; all other ectopic thyroid locations occur very rare. There are no reports in the literature that describe the clinical course of patients with congenital hypothyroidism due to thyroid ectopy. Methods and Results: We present a child with congenital hypothyroidism detected on neonatal screening which had a subclinical course during follow-up. Scintigraphy revealed submental thyroid ectopy, a rare ectopic location and no orthotopic thyroid gland. Conclusion: Our case is unique because of the rare ectopic thyroid location but also of the unexpected clinical course; however, further thyroid monitoring is required for the therapy adjustment and detection of any changes in the ectopic tissue.
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Affiliation(s)
- Mirjana Kocova
- Department for Endocrinology and Genetics, University Children's Hospital, Skopje, Republic of Macedonia
| | - Nikolina Zdraveska
- Department for Endocrinology and Genetics, University Children's Hospital, Skopje, Republic of Macedonia
| | - Maja Zdravkovska
- Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of Macedonia
| | - Violeta Anastasovska
- Department for Endocrinology and Genetics, University Children's Hospital, Skopje, Republic of Macedonia
| | - Daniela Pop Gjorceva
- Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of Macedonia
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Keller-Petrot I, Leger J, Sergent-Alaoui A, de Labriolle-Vaylet C. Congenital Hypothyroidism: Role of Nuclear Medicine. Semin Nucl Med 2016; 47:135-142. [PMID: 28237002 DOI: 10.1053/j.semnuclmed.2016.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Thyroid scintigraphy holds a key place in the etiologic workup of neonatal hypothyroidism. Routine screening for this disorder in maternity hospitals in industrialized countries, for nearly 40 years, has permitted early treatment and thereby helped to prevent its physical and mental complications. Neonatal hypothyroidism affects approximately 1 in 3000 births. The most common causes are abnormal thyroid gland development and defective hormone synthesis by an eutopic thyroid gland. The incidence of the latter has risen in recent years, for reasons that remain unclear. A thorough etiologic workup helps to determine the disease type. Current guidelines recommend thyroid imaging by means of ultrasound and scintigraphy. Ultrasound should be done by a practitioner trained to examine the cervical region of newborns, as the thyroid is very small and must be distinguished from the particular aspect of the "thyroid empty lodge." Ultrasound lacks sensitivity for detecting small ectopic glands but is the gold standard for measuring thyroid dimensions. Scintigraphy provides an etiologic diagnosis in most cases. The two isotopes used in this setting are technetium-99m and iodine-123. The latter isotope gives more contrast and allows the perchlorate discharge test to be performed to detect abnormal iodide organification in the neonate with an eutopic thyroid. If scintigraphy cannot be performed during the neonatal period, a postponed procedure can be achieved after 3 years of age. Close cooperation between the nuclear medicine physician and the pediatric endocrinologist is crucial for timely and optimized scintigraphy.
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Affiliation(s)
- Isabelle Keller-Petrot
- Service de Médecine Nucléaire Pédiatrique, Hôpital d'Enfants Armand Trousseau, Paris, France
| | - Juliane Leger
- Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1141, DHU Protect, Paris, France
| | - Aline Sergent-Alaoui
- Service de Médecine Nucléaire Pédiatrique, Hôpital d'Enfants Armand Trousseau, Paris, France
| | - Claire de Labriolle-Vaylet
- Service de Médecine Nucléaire Pédiatrique, Hôpital d'Enfants Armand Trousseau, Paris, France; UPMC Univ Paris 06, Biophysique, Paris, France.
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18
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Deeb A, Elkadry I, Attia S, Al Suwaidi H, Obaid L, Schoenmakers NA. Biochemical, radiological, and genetic characterization of congenital hypothyroidism in Abu Dhabi, United Arab Emirates. J Pediatr Endocrinol Metab 2016; 29:801-6. [PMID: 27060741 DOI: 10.1515/jpem-2015-0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 02/11/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH) is caused by thyroid gland (TG) dysgenesis or inadequate thyroid hormone biosynthesis in a structurally normal gland. Different etiologies are known to be associated with various clinical, biochemical and imaging markers and a subset of cases have an underlying genetic basis. Despite the presence of neonatal screening programs in the UAE, there is a lack of data on the disease etiology in the area. We aim to study the etiology of CH in our center and examine its relationship with the clinical, biochemical, genetic and radiological features. METHODS Patients with CH who were followed in our center between 2011 and 2014 are enrolled in the study. Data collected included gender, gestational age, history of CH in a first-degree relative, initial thyroid stimulating hormone (TSH) and thyroxine (T4) levels, imaging findings, associated disease/malformation and treatment details. Selected patients with associated systemic disease or familial CH underwent genetic testing. RESULTS Sixty-five patients were enrolled. Ten patients underwent genetic study: seven patients with associated congenital disease/malformation, one with a sibling and two with cousins with CH. Forty-nine subjects had technetium99 and/or ultrasound scans. Dyshormonogenesis was diagnosed in two-thirds of the patients. Three patients of 10 tested had likely causative genetic mutations; two homozygous thyroid peroxidase (TPO) and one heterozygous thyroid stimulating hormone receptor (TSHR) missense mutations. CONCLUSIONS Dyshormonogenesis is the commonest etiology in CH in the studied group. It is expected that genetic mutations are more prevalent in our region due to the nature of the CH etiology and the rate of high consanguinity rate.
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19
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Pokrovska T, Jones J, Shaikh MG, Smith S, Donaldson MDC. How well does the capillary thyroid-stimulating hormone test for newborn thyroid screening predict the venous free thyroxine level? Arch Dis Child 2016; 101:539-545. [PMID: 26966265 PMCID: PMC4893081 DOI: 10.1136/archdischild-2015-309529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/15/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To determine, in newborn infants referred with elevated capillary thyroid-stimulating hormone (TSH), a threshold below which a frankly subnormal venous free thyroxine (fT4) level of <10 pmol/L is unlikely, so that treatment with levo-thyroxine (L-T4) might be deferred until venous thyroid function tests (TFTs) become available. SUBJECTS AND METHODS All infants referred in Scotland since 1979 with capillary TSH elevation were studied, with particular focus on infants screened using the AutoDELFIA assay between 2002 and 2013. RESULTS Of the 321 infants referred with capillary TSH elevation using AutoDELFIA, 35 were excluded (fT4/TSH unavailable (12), venous sample either preceding or >10 days after capillary sampling (13, 10)), leaving 286 eligible for analysis (208 definite/probable hypothyroidism, 61 transient TSH elevation, 17 of uncertain thyroid status). Capillary TSH and venous T4 were strongly correlated (Spearman's rank correlation coefficient -0.707355). The optimal capillary TSH threshold for predicting a venous fT4 of <10 pmol/L was found to be >40 mU/L (90.3% sensitivity and 65.9% specificity compared with 90.25% and 59.1% for >35 mU/L and 88.3% and 68.2% for >45 mU/L). 93 infants (32.5%) had capillary TSH ≤40 mU/L at referral of whom 15 (9.7%) had venous fT4 <10 pmol/L, comprising seven with true congenital hypothyroidism, five with transient TSH elevation and three with uncertain status, two of whom died. CONCLUSION For infants in whom capillary TSH is ≤40 mU/L, it is reasonable to defer L-T4 treatment until venous TFT results are known provided that the latter become available quickly.
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Affiliation(s)
- Tzveta Pokrovska
- Section of Child Health, University of Glasgow School of Medicine, Royal Hospital for Children, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jeremy Jones
- NHS Greater Glasgow and Clyde, Royal Hospital for Children, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Guftar Shaikh
- NHS Greater Glasgow and Clyde, Royal Hospital for Children, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sarah Smith
- Newborn Screening Laboratory, West of Scotland Genetic Services, Queen Elizabeth University Hospital, Glasgow, UK
| | - Malcolm D C Donaldson
- Section of Child Health, University of Glasgow School of Medicine, Royal Hospital for Children, Queen Elizabeth University Hospital, Glasgow, UK
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20
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Goldis M, Waldman L, Marginean O, Rosenberg HK, Rapaport R. Thyroid Imaging in Infants. Endocrinol Metab Clin North Am 2016; 45:255-66. [PMID: 27241963 DOI: 10.1016/j.ecl.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Congenital hypothyroidism is the most common preventable cause of mental retardation. It is important to know the cause of each patient's thyroid dysfunction to foresee the course of therapy and outcomes. Imaging methods, such as ultrasound and thyroid scan, help determine the anatomy and function of the thyroid gland. Although thyroid scan is considered superior in detecting ectopic thyroid tissue, ultrasound is able to detect the presence of thyroid tissue not otherwise visualized in 15% of patients.
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Affiliation(s)
- Marina Goldis
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Lindsey Waldman
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Otilia Marginean
- 1st Paediatric Clinic of Victor Babes, University of Medicine and Pharmacy, 300011 Iosif Nemoianu, nr 2-3, Timisoara, Romania; Paediatric Endocrinology Department of Louis Turcanu, Children Clinical Hospital, Timisoara, Romania
| | - Henrietta Kotlus Rosenberg
- Radiology and Pediatrics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Kravis Children's Hospital at Mount Sinai; Mount Sinai Hospital, New York, USA
| | - Robert Rapaport
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Radiology and Pediatrics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Kravis Children's Hospital at Mount Sinai
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Sindhuja L, Dayal D, Sodhi KS, Sachdeva N, Bhattacharya A. Thyroid dysfunction and developmental anomalies in first degree relatives of children with thyroid dysgenesis. World J Pediatr 2016; 12:215-8. [PMID: 26684308 DOI: 10.1007/s12519-015-0061-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Familial clustering in patients with permanent congenital hypothyroidism (CH) caused by thyroid dysgenesis (TD) has been reported in developed countries. There is no information on familial TD from developing countries. METHODS A total of 312 first degree relatives belonging to 80 families of children with TD (group 1) and 40 families of age-matched normal children (group 2) were screened by thyroid ultrasonography, serum total thyroxine (T4) and thyroid stimulating hormone (TSH). RESULTS Thyroid scintigraphy revealed agenesis in 78.7% of the patients, ectopic gland in 15%, and hypoplasia in 6.2%. The mean thyroid volumes were similar in parents and siblings of both groups. Eight (10.6%) mothers in group 1 were identified to have thyroid hypoplasia as compared with none in group 2 (P=0.03). Serum TSH was significantly higher in group 1 than in group 2 (P=0.004). Sixteen (7.8%) subjects (6 mothers, 5 fathers, and 5 siblings) in group 1 were found to have subclinical hypothyroidism as compared to none in group 2 (P<0.05). Four families were identified to have thyroid developmental anomalies and abnormal thyroid functions accounting for 5% of cases of familial TD in our cohort. CONCLUSION Thyroid developmental anomalies and thyroid function abnormalities are more frequent in first degree relatives of children with TD as compared with a control population. These findings suggest that possibly there is a genetic component of TD in Indian patients.
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Affiliation(s)
- Lakshminarasimhan Sindhuja
- Pediatric Endocrinology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Dayal
- Pediatric Endocrinology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. .,Pediatric Endocrinology & Diabetes Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Graber E, Regelmann MO, Annunziato R, Machac J, Rapaport R. The role of ¹²³I imaging in the evaluation of infants with mild congenital hypothyroidism. Horm Res Paediatr 2015; 83:94-101. [PMID: 25531155 DOI: 10.1159/000367992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Controversy exists regarding the diagnosis and treatment of mild congenital hypothyroidism (MCH). We studied the value of (123)I imaging in patients with MCH. METHODS Retrospective chart review of infants and children <4 years of age who underwent (123)I imaging: group 1 = MCH [thyroid-stimulating hormone (TSH) <25 µIU/ml, normal free T4/T3], group 2 = severe congenital hypothyroidism (TSH ≥25 µIU/ml), and group 3 = MCH in infancy imaged after treatment withdrawal at age 3 years. Data collected included 4- and 24-hour (123)I uptake, TSH, free T4/total T3 at imaging, age at imaging, and levothyroxine (L-T4) dose at 1 year of. RESULTS Thirty-six patients underwent (123)I imaging. In group 1 (n = 20, median TSH: 8.49 µIU/ml), 85% had abnormal imaging consistent with dyshormonogenesis. Two patients were referred after 1 year of age. The median age at imaging for the remaining 18 patients was 54 days. Median L-T4 dose at 1 year of age for these 18 patients was 2.8 μg/kg, which is consistent with dyshormonogenesis. Ninety-one percent of group 2 (n = 11, median TSH: 428.03 µIU/ml) had abnormal imaging. The median age at imaging was 13 days. Four patients in group 3 had abnormal (123)I imaging and restarted treatment. CONCLUSION (123)I imaging is a valuable tool for evaluation, diagnosis, and treatment of MCH.
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Affiliation(s)
- Evan Graber
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Nagasaki K, Minamitani K, Anzo M, Adachi M, Ishii T, Onigata K, Kusuda S, Harada S, Horikawa R, Minagawa M, Mizuno H, Yamakami Y, Fukushi M, Tajima T. Guidelines for Mass Screening of Congenital Hypothyroidism (2014 revision). Clin Pediatr Endocrinol 2015; 24:107-33. [PMID: 26594093 PMCID: PMC4639532 DOI: 10.1297/cpe.24.107] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 03/24/2015] [Indexed: 12/31/2022] Open
Abstract
Purpose of developing the guidelines: Mass screening for congenital hypothyroidism
started in 1979 in Japan, and the prognosis for intelligence has been improved by early
diagnosis and treatment. The incidence was about 1/4000 of the birth population, but it
has increased due to diagnosis of subclinical congenital hypothyroidism. The disease
requires continuous treatment, and specialized medical facilities should make a
differential diagnosis and treat subjects who are positive in mass screening 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, new findings on prognosis and problems in
the adult phase have emerged. Based on these new findings, the 1998 guidelines were
revised in the current document (hereinafter referred to as the Guidelines). Target
disease/conditions: Primary congenital hypothyroidism. Users of the Guidelines: Physician
specialists in pediatric endocrinology, pediatric specialists, physicians referring
patients to pediatric practitioners, general physicians, laboratory technicians in charge
of mass screening, and patients.
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Affiliation(s)
| | | | | | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kanshi Minamitani
- Department of Pediatrics, Teikyo University Chiba Medical Center, Chiba, Japa
| | - Makoto Anzo
- Department of Pediatrics, Kawasaki City Hospital, Kawasaki, Japan
| | - Masanori Adachi
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Tomohiro Ishii
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kazumichi Onigata
- Shimane University Hospital Postgraduate Clinical Training Center, Shimane, Japan
| | - Satoshi Kusuda
- Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Shohei Harada
- Division of Neonatal Screening, National Center for Child Health and Development, Tokyo, Japan
| | - Reiko Horikawa
- Department of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Masanori Minagawa
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Haruo Mizuno
- Departments of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuji Yamakami
- Kanagawa Health Service Association, Kanagawa, Japan
| | | | - Toshihiro Tajima
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan
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Acute neonatal respiratory distress caused by a lingual thyroid: the role of nasendoscopy and medical treatment. The Journal of Laryngology & Otology 2015; 129:403-5. [PMID: 25720918 DOI: 10.1017/s002221511500002x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A lingual thyroid is a known cause of oropharyngeal obstruction in the neonate. It can be asymptomatic, or present as stridor, dysphonia, dysphagia or dyspnoea with faltering growth. The therapeutic options include surgical resection. CASE REPORT A 6-day-old female neonate, born at 36 weeks gestation, presented with stridulous breathing and poor feeding. Although the cause was initially thought to be laryngomalacia, nasendoscopy revealed a lingual thyroid. The baby had deranged thyroid function, as detected on neonatal screening, but this result was not available until a later date. Despite being symptomatic, the patient was managed medically; thyroxine therapy was associated with resolution of the respiratory symptoms. CONCLUSION Nasendoscopy provides valuable information about an ectopic thyroid gland. Thyroid replacement therapy may help to suppress the size of the ectopic gland and ultimately prevent an unnecessary surgical procedure.
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Hong HS, Lee EH, Jeong SH, Park J, Lee H. Ultrasonography of various thyroid diseases in children and adolescents: a pictorial essay. Korean J Radiol 2015; 16:419-29. [PMID: 25741204 PMCID: PMC4347278 DOI: 10.3348/kjr.2015.16.2.419] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 01/05/2015] [Indexed: 12/20/2022] Open
Abstract
Thyroid imaging is indicated to evaluate congenital hypothyroidism during newborn screening or in cases of a palpable thyroid mass in children and adolescents. This pictorial essay reviews the ultrasonography (US) of thyroid diseases in children and adolescents, including normal thyroid gland development, imaging features of congenital thyroid disorders (dysgenesis, [aplasia, ectopy, hypoplasia], dyshormonogenesis, transient hypothyroidism, thyroglossal duct cyst), diffuse thyroid disease (Grave's disease, Hashimoto's thyroiditis, and suppurative thyroiditis), and thyroid nodules. The primary imaging modalities for evaluating thyroid diseases are US and radionuclide scintigraphy. Additionally, US can be used to guide aspiration of detected nodules.
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Affiliation(s)
- Hyun Sook Hong
- Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 420-767, Korea
| | - Eun Hye Lee
- Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 420-767, Korea
| | - Sun Hye Jeong
- Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 420-767, Korea
| | - Jisang Park
- Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 420-767, Korea
| | - Heon Lee
- Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 420-767, Korea
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Dayal D, Sindhuja L, Bhattacharya A, Sodhi KS, Sachdeva N. Agenesis and not ectopia is common in North Indian children with thyroid dysgenesis. Indian J Endocrinol Metab 2014; 18:S97-S99. [PMID: 25538886 PMCID: PMC4266877 DOI: 10.4103/2230-8210.145080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Ectopic Thyroid Gland (ETG) is known to be the most common form of thyroid dysgenesis in children with permanent congenital hypothyroidism (CH). Recent reports indicate that agenesis or hypoplasia of thyroid gland may be commoner as compared to ETG in thyroid dysgenesis (TD). There is limited information available on the proportion of different variants of TD in Indian children. AIM To characterize the different TD variants in a cohort of North Indian children with TD. SETTINGS AND DESIGN Endocrinology Unit of a large Multispecialty Pediatrics Center located in North India. Retrospective review of clinical records of children with CH due to TD diagnosed between April 2004 and March 2014. RESULTS Diagnoses of TD in 94 children (48 boys and 46 girls) were based on combined scanning with high-resolution ultrasonography, and technetium-99m pertechnetate thyroid scintigraphy. Thyroid agenesis, ectopia and hypoplasia were diagnosed in 74 (78.7%), 14 (14.8%) and 6 (6.4%) patients respectively. The mean initial serum total T4 and thyroid stimulating hormone concentrations at diagnosis were 3.03 ± 2.88 μg/dL (range 0.01-8.9) and 284.52 ± 300.67 mIU/L (range 10.03-1159.0) respectively. Patients with ETG were older at the time of diagnosis as compared to patients with hypoplasia or ectopia. The mean duration of follow-up was 3.7 ± 2.85 years (range 3 months-10 years). CONCLUSIONS Thyroid agenesis was the most common form of TD in our children with permanent CH. Hypoplasia and ectopia were uncommon. Female preponderance, noted in many previous reports, was not seen in our patients with TD.
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Affiliation(s)
- Devi Dayal
- Department of Pediatrics, Pediatric Endocrinology and Diabetes Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - L. Sindhuja
- Pediatric Endocrinology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lucas-Herald A, Jones J, Attaie M, Maroo S, Neumann D, Bradley T, Hermanns P, Pohlenz J, Donaldson M. Diagnostic and predictive value of ultrasound and isotope thyroid scanning, alone and in combination, in infants referred with thyroid-stimulating hormone elevation on newborn screening. J Pediatr 2014; 164:846-54. [PMID: 24412140 DOI: 10.1016/j.jpeds.2013.11.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/16/2013] [Accepted: 11/20/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the diagnostic and predictive value of ultrasound and radioisotope scans of the thyroid, alone and in combination, during a single visit after initial referral by the screening laboratory with thyroid-stimulating hormone (TSH) elevation. STUDY DESIGN Retrospective blind review of ultrasound and radioisotope images followed by final diagnosis based on clinical features, biochemistry, imaging, and molecular genetic study. RESULTS Infants (n = 97; 61 female) with median birthweight 3.38 kg (range 2.04-4.86) and gestation 40 weeks (range 33-42), underwent successful dual thyroid ultrasound and technetium-99m pertechnetate radioisotope scan in a single center. Combined scanning at the initial visit resulted in a correct final diagnosis in 79 of 97 (81%) cases. One patient was misdiagnosed initially as having athyreosis as the result of delayed radioisotope scan and the diagnosis of ectopia made later on diagnostic challenge. The specificity/sensitivity for radioisotope scan and for ultrasound was as follows: 100%/97% and 100%/55% for ectopia (n = 39); 81%/100% and 54%/100% for athyreosis (n = 18); and 89%/90% and 80%/95% for dyshormonogenesis (n = 20). Neither modality, alone or in combination, predicted final diagnosis in eutopic glands due to hypoplasia (n = 4), transient TSH elevation (n = 12), and status still uncertain (n = 4). CONCLUSION More than 80% of newborn infants with TSH elevation can be diagnosed correctly on initial imaging with combined radioisotope scan and ultrasound. Ultrasound cannot reliably detect thyroid ectopia. Radioisotope scan, especially if performed late, may show no uptake despite the presence of a eutopic gland.
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Affiliation(s)
- Angela Lucas-Herald
- Child Health Unit, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom
| | - Jeremy Jones
- Child Health Unit, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom
| | - Morag Attaie
- Department of Radiology, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom
| | - Sanjay Maroo
- Department of Radiology, British Columbia Children's Hospital, Vancouver, Canada
| | - David Neumann
- Department of Pediatrics, University Hospital, Hradec Králové, Czech Republic
| | - Therese Bradley
- West of Scotland Medical Genetic Service, Southern General Hospital, Glasgow, United Kingdom
| | - Pia Hermanns
- Children's Hospital, University of Mainz, Mainz, Germany
| | | | - Malcolm Donaldson
- Child Health Unit, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom.
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De Silva A, Jong I, McLean G, Bergman P, Rodda C, Brown J, Nandurkar D. The role of scintigraphy and ultrasound in the imaging of neonatal hypothyroidism: 5-year retrospective review of single-centre experience. J Med Imaging Radiat Oncol 2014; 58:422-30. [PMID: 24649899 DOI: 10.1111/1754-9485.12166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/22/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Congenital hypothyroidism (CH), as indicated by an elevation of capillary thyroid-stimulating hormone (TSH) at newborn screening, is a preventable cause of mental retardation with varying aetiology; it can be transient or permanent. Radionuclide assessment is currently the gold standard for imaging CH. This study aimed to (i) review the different scintigraphic patterns and correlate them with TSH levels/patient outcomes, (ii) assess the role of sonography in neonates with apparent agenesis as indicated by scintigraphy and (iii) develop a diagnostic investigative algorithm. METHODS The technetium thyroid scans of 83 consecutive patients (49 females, average age 32 days) with CH scanned between 2005 and 2009 were retrospectively reviewed. Two nuclear medicine physicians blinded to the clinical details interpreted the scans in consensus. Scintigram appearances were categorised into five groups. Patients scintigraphically diagnosed with thyroid agenesis were evaluated with ultrasound. TSH values and scintigraphic and sonographic findings were correlated with patients' final diagnosis. RESULTS Based on scintigraphy, 14, 13 and 19 patients out of 83 were assessed as having normal thyroid sites with normal, increased and decreased uptake, respectively. Twenty-two of 83 patients had no uptake, and 15 of 83 patients had ectopic uptake. Higher median TSH levels were seen in no-uptake and ectopic uptake subgroups. Eighteen of 22 patients with no uptake were evaluated with ultrasound. Three of the 18 patients had a normal thyroid gland, and three of 18 patients had a hypoplastic thyroid. CONCLUSION Scintigram findings in patients with congenital hypothyroidism fall into five major categories, which have therapeutic implications (lifelong thyroxine in agenesis versus trial of stopping thyroxine in other subgroups). Sonographic demonstration of thyroid tissue in patients scintigraphically diagnosed with thyroid agenesis has major management implications.
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Affiliation(s)
- Ami De Silva
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
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Abstract
Color Doppler Ultrasounds (CDU) and Thyroid Scanning (TS) have much improved in recent years and offer a likely diagnosis of the disorder and its main subtypes. This especially applies when diagnosing permanent or transient causes of congenital hypothyroidism (CH), where dual imaging has proven to be more informative than single scanning. Though both isotopes have acceptable performances, the use of (123)I appears more advisable, since it more accurately identifies the various aetiologies of CH and probably has better dosimetric characteristics than (99m)Tc. Detailed dual imaging patterns are presented in connection with most of the underlying mechanisms explaining CH, thyroid dysgenesis (75%) and dyshormonogenesis (20%). Imaging of thyroid autoimmunity, of immunogenic thyrotoxicosis and of thyroid autonomy, is helped by CDU but most often requires a quantified (123)I-TS (molecular imaging). We finally show the interest of CDU to sort suspicious nodule and present the new TIRADS scoring system.
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Affiliation(s)
- Jérôme Clerc
- Université Paris Descartes and Assistance Publique-Hôpitaux de Paris, Department of Nuclear Medicine, Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75679 Paris Cedex 14, France.
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Lucas-Herald A, Bradley T, Hermanns P, Jones J, Attaie M, Thompson E, Pohlenz J, Donaldson M. Novel heterozygous thyrotropin receptor mutation presenting with neonatal hyperthyrotropinaemia, mild thyroid hypoplasia and absent uptake on radioisotope scan. J Pediatr Endocrinol Metab 2013; 26:583-6. [PMID: 23412867 DOI: 10.1515/jpem-2012-0308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/16/2013] [Indexed: 11/15/2022]
Abstract
Hyperthyrotropinaemia [mildly elevated thyrotropin (TSH) with normal thyroxine (T4) levels] demands a full assessment, including clinical examination, thyroid imaging and, where indicated, molecular genetic investigations. A male infant, both of whose parents were on T4 treatment, was referred at age 57 days with mild but persistent TSH elevation (12.7 mU/L) and normal free T4 (19.6 pmol/L), following notification by the screening laboratory of a capillary TSH of 10.7 mU/L (reference range, 1.7-9.1 mU/L) on day 8. Assessment showed a venous free T4 level of 15 pmol/L, venous TSH of 20.9 mU/L, serum thyroglobulin of 63 μg/L (reference range, <50 μg/L), and negative thyroglobulin and thyroid peroxidase antibodies. Thyroid ultrasound showed a eutopic, slightly small gland with heterogeneous texture; however, there was no uptake on radioisotope scan. Molecular genetic studies demonstrated a novel missense heterozygous mutation in the TSH receptor (TSHR) gene (c.1169G>T;p.Cys390Phe) in the child, mother and maternal grandmother, but not in the father. The infant was treated with T4 but this was discontinued at age 3 years when repeat testing showed a free T4 of 16.7 pmol/L (reference range, 9-23 pmol/L) and TSH of 8.5 mU/L (reference range, 0.3-5.5 mU/L). A heterozygous TSHR mutation should be considered in the context of hyperthyrotropinaemia and reduced/absent uptake on radioisotope scan. Detection of this mutation has allowed our patient to discontinue T4 treatment for the moment, with a view to staying off treatment in the long-term.
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Affiliation(s)
- Angela Lucas-Herald
- Child Health Unit, School of Medicine, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK
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Abstract
OBJECTIVE The purpose of this study was to retrospectively evaluate the use of sonography as the primary imaging modality for congenital hypothyroidism (CH). MATERIALS AND METHODS From our regional registry, we reviewed the cases of patients for whom either sonography or (99m)Tc-pertechnetate scanning was performed for CH between 2003 and 2010. Ultrasound studies were reviewed for presence, size, echotexture, vascularity, and location of the thyroid gland. Technetium-99m-pertechnetate scans were evaluated for the presence and location of the thyroid gland. The ultrasound studies were compared with the (99m)Tc-pertechnetate scans. We assessed the use of ultrasound as the primary imaging modality for the evaluation of CH. RESULTS We identified the cases of 124 patients (89 girls, 35 boys). Ultrasound studies were available for 121 patients, and (99m)Tc-pertechnetate studies for 62 patients. Three patients were examined only by (99m)Tc-pertechnetate scanning. The final imaging results were normal location with normal size or diffuse enlargement of the thyroid gland (n = 47), sublingual thyroid gland (n = 49), agenesis (n = 18), hypoplasia (n = 8), and hemiagenesis (n = 2). Compared with (99m)Tc-pertechnetate scanning, ultrasound had high (100%) specificity and low (44%) sensitivity for detection of sublingual thyroid gland. CONCLUSION We suggest using ultrasound as the primary imaging modality for guiding the treatment of children with CH, potentially decreasing radiation exposure and cost.
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Karakoc-Aydiner E, Turan S, Akpinar I, Dede F, Isguven P, Adal E, Guran T, Akcay T, Bereket A. Pitfalls in the diagnosis of thyroid dysgenesis by thyroid ultrasonography and scintigraphy. Eur J Endocrinol 2012; 166:43-8. [PMID: 22004907 DOI: 10.1530/eje-11-0140] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We aimed to investigate the reliability of thyroid ultrasonography (US) and scintigraphy in determining the type of thyroid dysgenesis (TD). METHODS The study included 82 children (8.0±5.6 years) with a diagnosis of TD by thyroid scintigraphy with (99m)Tc and/or US. The patients were re-evaluated 6.0±5.1 years after the diagnosis. Thyroid US was performed in all cases, regardless of the previous US imaging. Scintigraphy images performed at the time of diagnoses (n=60) were re-evaluated during the study. Those who had no scintigraphy at the time of diagnosis (n=22) or had discordant findings with US (n=6) underwent a new scintigraphy. RESULTS Scintigraphies revealed no uptake in 37, ectopia in 35, and hypoplasia in 10 cases. The sensitivity vs specificity for US to detect athyreosis, ectopia, and hypoplasia at the time of initial diagnoses was 90.5 vs 47.8, 10 vs 100, and 100 vs 80.4% respectively. The sensitivity vs specificity for scintigraphy at the time of initial diagnoses was 96.2 vs 100, 92 vs 97.1, and 100 vs 96%, respectively, for each diagnosis. Re-scintigraphy at the time of the study led to a change in the initial diagnosis of 3/6 cases. Repeated US showed disappearance of previously reported hypoplastic thyroid tissues in eight patients. CONCLUSION US alone could not differentiate ectopia and athyreosis, whereas scintigraphy alone is also prone to mistakes in newborns and young ages. Dual thyroid imaging is important for precise structural definition of TD.
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Affiliation(s)
- Elif Karakoc-Aydiner
- Department of Pediatric Endocrinology, Marmara University, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi, No: 41 Ust Kaynarca, Pendik, 34890 Istanbul, Turkey
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The role of ultrasonography in primary congenital hypothyroidism. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2011; 16:1122-8. [PMID: 22973380 PMCID: PMC3430036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 08/29/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to compare the usefulness of ultrasonography and scintigraphy in diagnosing the etiology of primary congenital hypothyroidism (CH). METHODS The newborns that were examined by both thyroid scintigraphy and ultrasonography during CH screening program in Isfahan were included in this study. The ultrasonographic findings were compared with the scintigraphic findings and the sensitivity and specificity of the ultrasonography was determined. RESULTS During this study, 102 CH newborns were studied. According to the ultrasonographic results, 61.8%, 26.5%, 2.9% and 8.8% of them had normal thyroid gland, agenesia, ectopia and hypoplasia, respectively, and according to scintigraphic results, 55.9%, 35.3% and 8.8% of them had normal thyroid gland, agenesia and ectopia, respectively. Ultrasound detected sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio were 77%, 92%, 89%, 84%, 9.6 and 0.25, respectively. The sensitivity and specificity of ultrasonography compared with thyroid scintigraphy in diagnosis of thyroid gland ectopia was 33% and 100%, respectively. CONCLUSIONS Though thyroid ultrasonography failed to diagnose 67% of ectopic cases and nonfunctioning thyroid gland, it had the ability to determine the anatomy of thyroid gland. So, considering some limitations of scintigraphy, we concluded that ultrasonography is a relatively appropriate imaging tool for diagnosing CH etiologies, especially in the initial phase of CH screening.
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Yao D, He X, Yang RL, Jiang GP, Xu YH, Zou CC, Zhao ZY. Sonographic measurement of thyroid volumes in healthy Chinese infants aged 0 to 12 months. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:895-898. [PMID: 21705721 DOI: 10.7863/jum.2011.30.7.895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purposes of this study were to determine thyroid volumes in healthy Chinese infants aged 0 to 12 months and to provide reference data for normal thyroid growth. METHODS A total of 408 healthy infants (229 male and 179 female) were enrolled in the study. The length, breadth, and depth of the thyroid gland were measured with sonography. The volume of each lobe was calculated by the correct ellipsoid formula (volume = length × breadth × depth × 0.479). RESULTS All of the infants' thyroids showed a normal uniform echo texture on sonography. The thyroid volume increased with age (r = 0.519; P < .001). Moreover, positive associations were noted between thyroid volume and height and weight (r = 0.517; P < . 001; r = 0.499; P < .001, respectively). No significant differences based on sex were found (t = 1.784; P = .075). CONCLUSIONS The thyroid volumes in these healthy Chinese infants varied from those reported in the published literature on healthy European infants. It is important to establish local reference ranges for thyroid volumes in healthy infants.
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Affiliation(s)
- Dan Yao
- Department of Pediatric Health Care, Children's Hospital, Zhejiang University School of Medicine, 57 Zhugan Ln, Yanan Road, 310003 Hangzhou, China.
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Chang YW, Lee DH, Hong YH, Hong HS, Choi DL, Seo DY. Congenital hypothyroidism: analysis of discordant US and scintigraphic findings. Radiology 2011; 258:872-9. [PMID: 21339351 DOI: 10.1148/radiol.10100290] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively review discordant cases of congenital hypothyroidism according to a comparison of findings of ultrasonography (US) and scintigraphy. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective study with a waiver of informed consent. Data of 300 pediatric patients (mean age, 4.7 weeks; range, 1-48 weeks; male-to-female ratio, 169:131) with congenital hypothyroidism who underwent technetium 99m radioisotope scintigraphy and US were reviewed. Scintigraphic scans were analyzed for location and range of the radioisotope uptake. US images were analyzed for location and thyroid volume. If a normal thyroid was not detected, ectopic thyroid was evaluated. Detection of focal thyroid abnormalities was recorded. Correlation between radioisotope uptake at scintigraphy and volume of normally located glands measured at US was analyzed by using the Pearson correlation test. Differences between results of thyroid function testing and radiologic data among subtypes of congenital hypothyroidism were analyzed with analysis of variance and Scheffe multiple comparison test. RESULTS Among 55 patients with no radioisotope uptake, the appearance of the thyroid gland on US scans was normal in 42 patients (76%). This finding was attributed to hypopituitarism (n = 3), maternal antibody-induced hypothyroidism (n = 4), transient elevated thyrotropin (n = 5), and unknown causes (n = 30). Ectopic tissue was not detected at US (sensitivity, 78%; specificity, 100%) in six patients with a diagnosis of ectopy based on scintigraphic findings. Correlation between radioisotope uptake and US thyroid volume was statistically significant (P < .001). Correlation of results from thyroid function testing (thyrotropin, thyroxine, thyroglobulin) and radiologic data (radioisotope uptake, US measurement of volume) with subtypes of congenital hypothyroidism was significant (P < .001). Solid thyroid nodules were present in the thyroid gland in 0.7% (two of 300) of cases. CONCLUSION Use of both scintigraphy and US results in a more complete depiction of neonatal congenital hypothyroidism than either test alone.
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Affiliation(s)
- Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Hospital, 22 Daesakwan-gil, Yongsan-ku, Seoul 140-743, Korea.
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Treves ST, Baker A, Fahey FH, Cao X, Davis RT, Drubach LA, Grant FD, Zukotynski K. Nuclear Medicine in the First Year of Life. J Nucl Med 2011; 52:905-25. [DOI: 10.2967/jnumed.110.084202] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Space-time clustering of elevated thyroid stimulating hormone levels. Eur J Epidemiol 2011; 26:405-11. [PMID: 21476081 DOI: 10.1007/s10654-011-9571-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
Abstract
Previous studies of congenital hypothyroidism (CHT) have reported an increasing incidence which may suggest that environmental factors play an aetiological role. If so, then cases may exhibit space-time clustering, where cases occur at similar times and close proximities to other cases. In this study we investigated whether space-time clustering of elevated thyroid stimulating hormone (TSH) in newborns exists. All infants born in the Northern Region of England are screened by measuring levels of circulating TSH using a blood spot assay. Data on 207 cases of elevated TSH values, as a proxy for CHT, in newborns born from 1994 to 2006 inclusive were available and analysed using rigorous space-time clustering statistical methods. Analysis showed statistically significant evidence of space-time clustering. The strength of clustering was most marked for cases born within 0.1-0.7 year (1-8 months) of one another. This is the first study to find significant space-time clustering of cases of elevated TSH levels in newborns, a surrogate for space-time clustering of CHT. Whilst the reasons for the clustering are unclear, it would appear from this analysis that transient environmental exposures are likely to be involved, although environmental determinants of genetic mutations and epigenetic factors cannot be ruled out. Further research is required to a) validate these results in other populations and b) to assess in more detail the potential environmental determinants of increased CHT risk.
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Mutlu M, Karagüzel G, Alıyazicioğlu Y, Eyüpoğlu I, Okten A, Aslan Y. Reference intervals for thyrotropin and thyroid hormones and ultrasonographic thyroid volume during the neonatal period. J Matern Fetal Neonatal Med 2011; 25:120-4. [PMID: 21410423 DOI: 10.3109/14767058.2011.561894] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine thyrotropin (TSH) and thyroid hormones reference ranges in healthy term newborns during the neonatal period and to assess the ranges of thyroid volume in newborns using ultrasound scanning. METHODS Blood samples were collected from 296 healthy newborns at birth (cord; n: 47) and before feeding on the 1st, 3rd, 5th, 7th, 10th, 14th, and 28th days of life. The levels of TSH and thyroid hormones of the newborns were then compared with results from 50 healthy adults. Thyroid ultrasonography (USG) was performed by the same radiologist on 38 newborns aged 10 days. RESULTS TSH and thyroid hormone levels in newborns were statistically higher than those in adults for each day (p < 0.001). Serum TSH concentration on the 1st day of life was higher than at other times (p < 0.001). Mean TSH concentration reverted to the cord level at the 5th or 7th day of life (p > 0.05). TSH levels were no higher than 10 mIU/ml after 2 weeks postnatal age. There was no correlation between hormone levels and Ponderal index (PI), birth weight, gender, or delivery type. Mean thyroid volume was 0.72 ± 0.24 ml (0.36-1.62 ml). CONCLUSIONS We conclude that our results are important for CH screening regarding time-dependent changes of TSH and thyroid hormones besides diagnosis of thyroid hypoplasia or hyperplasia.
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Affiliation(s)
- Mehmet Mutlu
- Department of Neonatology, Karadeniz Technical University, Trabzon, Turkey
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Abstract
UNLABELLED The etiology of congenital hypothyroidism (CH) is important in determining its severity, prognosis, genetic counseling and clinical management. AIMS investigate the causes of CH and their severity using serum levels of FreeT4 and TSH. PATIENTS AND METHODS 243 neonates with CH (61% were girls) diagnosed by the Neonatal Screening Program of Minas Gerais between 1996 and 2003. The thyroid function was assessed through serum FreeT4 and TSH by chemilumiscence. CH etiology was evaluated by ultrasonography, scintigraphy, potassium perchlorate discharge test and serum thyroglobulin levels. RESULTS Out of 243 patients, dysgenesis was found in 114 (47%): 3.3% had athyreosis; 0.4% eutopic dysgenetic gland due to maternal use of 131I; 22% ectopic glands (8.6% an isolated ectopic gland and 13% also an eutopic dysgenetic thyroid); 9% eutopic dysgenesis, 8.6% hypoplasia and 3.7% hemiagenesis. Thyroid in situ was found in 129 (52%): 23.5% had iodide organification defect; 3.7% thyroglobulin synthesis defect; 6.2% other 0.4% dyshomonogenesis; iodide transport defect; 1.2% transient CH and 18% a normal gland. Patients with dysgenesis had a more severe CH than those with thyroid in situ (TSH 248.08 vs. 18.17 microIU/mL and FT4 0.32 vs. 0.95 ng/dL, p < 0.001). CONCLUSIONS Some cases had more complex dysgenesis, presenting ectopia associated to a dysgenetic eutopic gland. The ultrasound was the best tool to detect the dysgenetic tissue, but the scintigraphy was the most effective in identifying the functioning tissue. The thyroid hormone synthesis defects were found more frequently than expected, but in some cases they could not be defined.
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Affiliation(s)
- V M A Dias
- Department of Pediatrics, Minas Gerais Federal University, Belo Horizonte, Brazil.
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Heterogeneous tissue in the thyroid fossa on ultrasound in infants with proven thyroid ectopia on isotope scan--a diagnostic trap. Pediatr Radiol 2010; 40:725-31. [PMID: 20066409 DOI: 10.1007/s00247-009-1492-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 10/30/2009] [Accepted: 11/09/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Thyroid imaging is of proven help in establishing a diagnosis of congenital hypothyroidism in infants. US often shows tissue in the thyroid fossa when radionuclide scintigraphy reveals only ectopic uptake. OBJECTIVE Our hypothesis was that the use of US alone could lead to the mistaken diagnosis of normal or dysplastic thyroid in cases of scintigraphy-proven thyroid ectopia. MATERIALS AND METHODS We undertook a detailed retrospective review and analysis of imaging and concurrent biochemistry in infants with thyroid ectopia, confirmed by radionuclide scintigraphy. RESULTS Eighteen infants had thyroid ectopia; ten of the original US reports had suggested that cervical thyroid tissue was present. Review showed bilateral tissue in the thyroid fossa in all that was non-thyroidal in nature since, apart from showing no radionuclide uptake, it exhibited some or all of the following typical features: hyperechogenicity, heterogeneity, small size, poor vascularity, and anechoic and/or hypoechoic cysts. Also, extension of the tissue both around and behind the large cervical blood vessels was a universal finding. CONCLUSION Considerable experience is required to interpret neonatal thyroid US. We caution against diagnosing a dysplastic/hypoplastic thyroid gland in situ on the basis of US alone, particularly if the tissue exhibits any of the non-thyroidal features described.
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Parks JS, Lin M, Grosse SD, Hinton CF, Drummond-Borg M, Borgfeld L, Sullivan KM. The impact of transient hypothyroidism on the increasing rate of congenital hypothyroidism in the United States. Pediatrics 2010; 125 Suppl 2:S54-63. [PMID: 20435718 DOI: 10.1542/peds.2009-1975f] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The reported incidence rate of primary congenital hypothyroidism (CH) has been increasing in the United States over the past 2 decades. We have considered the possibility that the inclusion of cases of transient hypothyroidism has inflated the reported incidence rate of CH. Assessing the effects of cases of transient hypothyroidism on the incidence rate is problematic, because the definitions, diagnostic criteria, and differentiation from transient hyperthyrotropinemia vary widely among state newborn screening programs. Among the 4 etiologies for transient hypothyroidism (maternal thyrotropin receptor-blocking antibodies, exposure to maternal antithyroid medications, iodine deficiency, and iodine excess), there is little evidence of increases in the incidence rate from thyrotropin receptor-blocking antibodies. Exposure to antithyroid drugs could contribute significantly to the incidence rate of transient CH, given the high estimated incidence of active maternal hyperthyroidism. Iodine deficiency or excess in the United States seems unlikely to have contributed significantly to the incidence rate of CH, because the secular trend toward lower iodine intake among women of reproductive age in the 1980s and 1990s seems to have plateaued, and perinatal iodine exposure has presumably declined as a result of recommendations to discontinue using iodine-containing disinfectants. Although the female-to-male sex ratio among newborns with thyroid agenesis or dysgenesis (the most common causes of CH) is typically 2:1, analysis of the sex ratio of newborns diagnosed with presumed CH in the United States suggests that a substantial proportion might have transient hypothyroidism or hyperthyrotropinemia, because the sex ratio has been well below the expected 2:1 ratio. Combined ultrasonography and (123)I scintigraphy of the thyroid gland are effective tools for identifying cases of thyroid agenesis and dysgenesis and can help to differentiate cases of transient hypothyroidism from true CH. Imaging is also a vital component in evaluating children who, at 3 years of age, undergo a trial of discontinuation of levothyroxine treatment to test for persistence of hypothyroidism. Ultimately, thyroid gland imaging, in conjunction with long-term follow-up studies that appropriately assess and report whether there was permanence of hypothyroidism, will be necessary to address the true incidence rate of CH and any contribution to the observed rate by transient cases of hypothyroidism or hyperthyrotropinemia.
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Affiliation(s)
- John S Parks
- Division of Pediatric Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
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Zung A, Tenenbaum-Rakover Y, Barkan S, Hanukoglu A, Hershkovitz E, Pinhas-Hamiel O, Bistritzer T, Zadik Z. Neonatal hyperthyrotropinemia: population characteristics, diagnosis, management and outcome after cessation of therapy. Clin Endocrinol (Oxf) 2010; 72:264-71. [PMID: 19473184 DOI: 10.1111/j.1365-2265.2009.03634.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Neonatal hyperthyrotropinaemia (HT), defined by elevated TSH and normal T(4), is either transient or persistent. The eventual outcome of neonatal HT is unpredictable and the management of HT patients is controversial. We assessed perinatal parameters and diagnostic measures that may distinguish between transient and persistent HT, compared with congenital hypothyroidism (CH). We also aimed to recommend optimal treatment in these forms of thyroid impairment. DESIGN AND PATIENTS A multi-centre, retrospective study was conducted in six paediatric endocrinology units. Forty-three HT patients and 83 CH patients were included in the study. Measurements We evaluated differences in birth weight (BW), gestational age (GA), modes of diagnosis, screening and confirmatory T(4) and TSH levels, thyroid imaging results and optimal thyroxine doses between HT and CH and between the two forms of HT. RESULTS Newborns with HT had lower BW and GA than those with CH. Transient (n = 18) and persistent HT (n = 25) patients were indistinguishable by most parameters, but those with persistent HT had a higher prevalence of abnormal thyroid imaging (69%vs 8%; P = 0.005). During treatment, 79% and 55% of transient and persistent HT patients respectively experienced elevated levels of free T(4.) Although most HT patients were reevaluated after 2.5 years, six transient HT patients stopped therapy and showed full recovery within the first year of life. CONCLUSIONS We recommend obtaining thyroid imaging to distinguish between the two forms of HT. Adherence to recommended doses of thyroxine and probably early cessation of therapy in transient HT can prevent iatrogenic hyperthyroidism in these patients.
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Affiliation(s)
- Amnon Zung
- Pediatric Endocrinology Unit, Kaplan Medical Center, Rehovot, Israel.
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Pearce MS, Korada M, Day J, Turner S, Allison D, Kibirige M, Cheetham TD. Increasing Incidence, but Lack of Seasonality, of Elevated TSH Levels, on Newborn Screening, in the North of England. J Thyroid Res 2010; 2010:101948. [PMID: 21048833 PMCID: PMC2956968 DOI: 10.4061/2010/101948] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 12/15/2009] [Indexed: 12/31/2022] Open
Abstract
Previous studies of congenital hypothyroidism have suggested an increasing incidence and seasonal variation in incidence, which may suggest nongenetic factors involved in aetiology. This study describes the incidence of elevated thyroid stimulating hormone (TSH) values in newborns, a surrogate for congenital hypothyroidism, measured as part of the screening programme for congenital hypothyroidism, over an eleven-year period (1994-2005), and assesses whether seasonal variation exists. All infants born in the Northern Region of England are screened by measuring levels of circulating TSH using a blood spot assay. Data on all 213 cases born from 1994 to 2005 inclusive were available. Annual incidence increased significantly from 37 per 100,000 in 1994 to a peak of 92.8 per 100,000 in 2003. There was no evidence of seasonal variation in incidence. The reasons for the increasing incidence are unclear, but do not appear to involve increasing exposure to seasonally varying factors or changes in measurements methods.
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Affiliation(s)
- Mark S Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE1 4LP, UK
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Beltrão CB, Juliano AG, Chammas MC, Watanabe T, Sapienza MT, Marui S. Etiology of congenital hypothyroidism using thyroglobulin and ultrasound combination. Endocr J 2010; 57:587-93. [PMID: 20467163 DOI: 10.1507/endocrj.k10e-009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Methods currently employed to establish the etiology of congenital hypothyroidism include thyroid ultrasound and scintigraphic exams. Thyroglobulin is a protein almost exclusively secreted by thyroid tissue and indirectly reflects the amount of follicular cells. Even though thyroglobulin is easy to measure, it has been not frequently used because of discordant results to distinguish mainly athyreosis and ectopy (dysgenesis). Knowing the differences in inheritance and prognosis of thyroid dysgenesis and dyshormonogenesis, it is important to define the etiology of CH, combining tools that are easy, fast and available in most medical centers. Our objective was to evaluate and compare color Doppler ultrasound and serum thyroglobulin with radionuclide scan to define the etiology of congenital hypothyroidism. We evaluated 38 children above 3 years-old off-treatment that performed serum thyroglobulin by immunofluorometric assay, color Doppler ultrasound and radionuclide study. On color Doppler ultrasound, 11 patients had athyreosis, 5 ectopic glands, being 1 associated to hemiagenesis. Twenty one had topic thyroid (3 goiters, 10 normal, 8 hypoplastic). Hemiagenesis and cystic lesion were not revealed by radionuclide scan. We observed substantial agreement between color Doppler ultrasound and radionuclide scan (kappa=0.745, p<0.0001). Serum thyroglobulin in athyreosis ranged from <1.0 to 18.7 micro g/L. Patients with ectopic glands showed wider thyroglobulin range (4.5 to 123 micro g/L, median 28.4 micro g/L). Only one patient showed thyroglobulin deficiency. By using color Doppler ultrasound and serum thyroglobulin levels as valuable combined tools, we established the etiology of congenital hypothyroidism limiting excessive and harmful exams in children, like radionuclide scan.
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Affiliation(s)
- Cristine B Beltrão
- Laboratório de Endocrinologia Celular e Molecular, LIM 25, Unidade de Tireóide, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Tamam M, Adalet I, Bakir B, Türkmen C, Darendeliler F, Baş F, Sanli Y, Kuyumcu S. Diagnostic spectrum of congenital hypothyroidism in Turkish children. Pediatr Int 2009; 51:464-8. [PMID: 19674358 DOI: 10.1111/j.1442-200x.2008.02790.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH) is classified as transient or permanent. Transient CH can be treated with short-term thyroxine replacement therapy or followed up without therapy, whereas lifelong thyroxine replacement is needed in permanent CH. Determination of the underlying etiology is essential for determination of follow-up strategy. The purpose of the present study was therefore to assess the role of color Doppler ultrasonography (CDU) in etiologic diagnosis of CH together with radionuclide method and grayscale ultrasonography (GSU). METHODS A total of 182 patients (83 female, 99 male) were evaluated. To determine etiologic diagnosis, the patients underwent a free T4 (fT4), thyroid-stimulating hormone (TSH) and urinary iodine level measurement, and thyroid scintigraphy, perchlorate discharge test, CDU, and GSU. RESULTS Fifty-four patients had transient and 97 had permanent CH. Isolated hyperthyrotropinemia was diagnosed in 31 patients. Transient CH was due to iodine deficiency in 22 and excess iodine in 13 patients. In 97 patients with permanent CH, ectopia was present in 32 patients and agenesis of the thyroid gland was found in 22 patients, while 43 were diagnosed with dyshormonogenesis. In the ectopia group, GSU failed to detect ectopic tissues in all cases, whereas CDU was successful in determining the presence of ectopic thyroid in 20 cases. The sensitivity of CDU was 80% in determining ectopic tissue. CONCLUSION To determine etiologic diagnosis, radionuclide methods and sonographic modalities should be assessed together. The gold standard in the diagnosis of ectopic thyroid tissue is thyroid scintigraphy. CDU may be a major supportive diagnostic tool in the evaluation of ectopic thyroid gland.
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Affiliation(s)
- Müge Tamam
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Neonatal screening for congenital hypothyroidism in the Federation of Bosnia and Herzegovina: eight years' experience. Eur J Pediatr 2009; 168:629-31. [PMID: 18668261 DOI: 10.1007/s00431-008-0801-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
This report demonstrates the prevalence of primary congenital hypothyroidism (CH) in the Federation of Bosnia and Herzegovina and summarizes the laboratory data. Neonatal thyroid-stimulating hormone (TSH) was measured in whole blood drawn between the 3rd and 5th days of life and spotted on filter paper using the fluorometric assay. Among the 87,061 neonates, 22 had CH, 13 dysgenetic forms, and nine with thyroids in situ. No differences were found between the two types in terms of TSH and total T4 concentrations. However, thyroglobulin was significantly lower in patients with dysgenetic thyroid tissue (p=0.0023). We conclude that the prevalence of CH in the Federation of Bosnia and Herzegovina is 1:3,957 newborns.
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Ramos HE, Nesi-França S, Boldarine VT, Pereira RM, Chiamolera MI, Camacho CP, Graf H, de Lacerda L, Carvalho GA, Maciel RMB. Clinical and molecular analysis of thyroid hypoplasia: a population-based approach in southern Brazil. Thyroid 2009; 19:61-8. [PMID: 18976153 DOI: 10.1089/thy.2008.0116] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH) is mainly due to developmental abnormalities leading to thyroid dysgenesis (TD). TD encompasses very distinct morphologic subtypes of disease. This study examined and compared the phenotype in TD variants and searched for genetic alterations in sporadic thyroid hypoplasia (TH), the most misdiagnosed form of CH. This was a longitudinal study over a 14-year period (1990-2004). METHODS A continuous series of 353 children with TD was identified using thyroid function tests [thyroxine (T4) and TSH], scintigraphy, and ultrasound as diagnostic tools. Individual phenotypes were analyzed in 253 children with TD. Mutations in the most likely candidate genes were studied in 35 cases of TH. RESULTS The overall birth prevalence of permanent CH was 1:4795. Ectopy represented 37% of all cases of permanent primary CH, dyshormonogenesis 28%, agenesis 24%, hypoplasia 10%, and hemiagenesis 1%. The lowest screening T4 level and the highest TSH level were in the agenetic group, followed by TH. The TH group had an improvement in the thyroid function showing less-severe phenotype with aging. In the molecular analysis, one patient was identified with a mutation in the PAX8 gene (155G>C; R52P); four patients had a heterozygous G>C substitution in position -569; two patients showed a (234C>A; P52T) or (2181C>G; D727E) polymorphic variants of the TSH-R gene; and one patient presented a novel heterozygous nonsynonymous substitution, 293G>A; S98N, in the NKX2.5 gene. CONCLUSIONS The prevalence of CH was within the previously reported range of 1:3000-4000. Ectopy was the most common etiology. Clinical analysis revealed distinct hormonal patterns in TH subgroup when compared with other variants of TD, with genetic abnormalities identified only in few cases in the TSH-R, PAX8, and NKX2.5 genes.
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Affiliation(s)
- Helton E Ramos
- Laboratory of Molecular Endocrinology, Division of Endocrinology, Department of Medicine, Federal University of São Paulo , São Paulo, Brazil
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Perry RJ, Ainine A, Butler S, Donaldson MDC. Hypoechoic thyroid nodules on ultrasound 4 years after prenatal exposure to radioiodine: resolution with thyroxine therapy. Acta Paediatr 2008; 97:509-12. [PMID: 18331366 DOI: 10.1111/j.1651-2227.2008.00725.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED We describe an infant inadvertently exposed to radioiodine at 17 weeks gestation. His mother had received 400 MBq of (131)I for hyperthyroidism (total T4 178 nmol/L, thyroid stimulating hormone (TSH) <0.1 mU/L, 4-h (131)I uptake 16%). Following cordocentesis at 27 weeks (free T4 12.7 pmol/L, TSH 35.4 mU/L) intra-amniotic thyroxine was withheld and a male infant was born at 39 weeks gestation, birthweight 3520 g. Cord TSH was low (0.1 mU/L), total T4 151 nmol/L on day 4, the mother having received no medication during pregnancy. Postnatal follow-up showed mild TSH elevation (11.0-19.4 mU/L) but normal free T4 (9-12.7 pmol/L) during the first 2 years of life following which the child was discharged still untreated. On recall at 4.3 years, TSH elevation persisted (15.4 mU/L) and ultrasound showed several hypoechoic thyroid nodules within the left lobe that disappeared after thyroxine treatment. CONCLUSION In the event of inadvertent exposure to radioiodine in utero, the infant should receive thyroxine therapy from birth in order to protect the thyroid gland from TSH over-stimulation, however mild.
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Affiliation(s)
- Rebecca J Perry
- Department of Child Health, Royal Hospital for Sick Children, Glasgow, UK
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