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First Experiences with Newborn Screening for Congenital Hypothyroidism in Ulaanbaatar, Mongolia. Int J Neonatal Screen 2021; 7:ijns7020029. [PMID: 34200138 PMCID: PMC8293200 DOI: 10.3390/ijns7020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022] Open
Abstract
Congenital hypothyroidism (CH) is among the most common conditions leading to intellectual disability, which can be prevented by early detection through newborn screening (NBS). In Mongolia, a regional screening program for CH was launched in 2000, which was supported by the International Atomic Energy Agency (IAEA) for the Asia Pacific Region. In our present study, a total of 23,002 newborns from nine districts in Ulaanbaatar were screened between 2012 and 2020, by the measurement of the thyroid-stimulating hormone (TSH) from dried blood spots, sampled 24 to 72 h after birth. The level of TSH was measured by the DELFIA assay. The overall CH prevalence confirmed at birth was 1/2091. The female-to-male ratio for CH cases was 1.8:1. The majority of patients were asymptomatic (72.7% of CH cases); umbilical hernia and cold or mottled skin were reported symptoms in patients with CH (27.3%). Thyroid dysgenesis (hypoplasia and agenesis) was the most common etiology, with a total of nine cases (81.8%) out of the eleven patients. The lapse between the birth date and the initiation of L-thyroxine treatment in CH-positive children was lower than 15 days in 63.64% of cases or 15 to 30 days in 36.36% of children. Further research is required to expand the screening coverage for CH in Mongolia.
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Zhang J, Li Y. [Risk factors for neonatal congenital hypothyroidism: a Meta analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23. [PMID: 34020742 PMCID: PMC8140347 DOI: 10.7499/j.issn.1008-8830.2011121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To investigate the risk factors for congenital hypothyroidism (CH) in neonates, and to provide a reference for the prevention of CH. METHODS The databases including China Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang Data, and Weipu Periodical Database, PubMed, Web of Science, Embase, SpringerLink, and Elsevier/ScienceDirect were searched for studies on the risk factors for CH in neonates published up to August 1, 2020. R 3.6.2 and RevMan 5.3 software were used to perform a Meta analysis. RESULTS A total of 20 studies were included, with 13 case-control studies and 7 cross-sectional studies. There were 11 564 neonates in total, with 3 579 neonates in the case group and 7 985 neonates in the control group. The Meta analysis showed that advanced maternal age (OR=2.111, 95%CI: 1.275-3.493), thyroid disease during pregnancy (OR=3.365, 95%CI: 1.743-6.500), gestational diabetes mellitus (OR=2.158, 95%CI: 1.545-3.015), anxiety (OR=3.375, 95%CI: 2.133-5.340), medication during pregnancy (OR=2.774, 95%CI: 1.344-5.725), radiation exposure during pregnancy (OR=3.262, 95%CI: 1.950-5.455), family history of thyroid disease (OR=8.706, 95%CI: 5.991-12.653), low birth weight (OR=2.674, 95%CI: 1.895-3.772), fetal macrosomia (OR=1.657, 95%CI: 1.187-2.315), preterm birth (OR=2.567, 95%CI: 2.070-3.183), post-term birth (OR=2.083, 95%CI: 1.404-3.091), twin pregnancy or multiple birth (OR=3.455, 95%CI: 1.958-6.096), and birth defects (OR=6.038, 95%CI: 3.827-9.525) were risk factors for CH in neonates. CONCLUSIONS Advanced maternal age, gestational thyroid disease, gestational diabetes mellitus, anxiety, medication during pregnancy, radiation exposure during pregnancy, family history of thyroid disease, low birth weight, fetal macrosomia, preterm birth, post-term birth, twin pregnancy or multiple pregnancy, and birth defects may increase the risk of CH in neonates.
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Affiliation(s)
- Ji Zhang
- Institute of Endemic Disease, Guizhou Provincial Center for Disease Prevention and Control, Guiyang 550004, China
| | - Yang Li
- Institute of Endemic Disease, Guizhou Provincial Center for Disease Prevention and Control, Guiyang 550004, China
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张 骥, 李 杨. [Risk factors for neonatal congenital hypothyroidism: a Meta analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:505-512. [PMID: 34020742 PMCID: PMC8140347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/11/2021] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To investigate the risk factors for congenital hypothyroidism (CH) in neonates, and to provide a reference for the prevention of CH. METHODS The databases including China Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang Data, and Weipu Periodical Database, PubMed, Web of Science, Embase, SpringerLink, and Elsevier/ScienceDirect were searched for studies on the risk factors for CH in neonates published up to August 1, 2020. R 3.6.2 and RevMan 5.3 software were used to perform a Meta analysis. RESULTS A total of 20 studies were included, with 13 case-control studies and 7 cross-sectional studies. There were 11 564 neonates in total, with 3 579 neonates in the case group and 7 985 neonates in the control group. The Meta analysis showed that advanced maternal age (OR=2.111, 95%CI: 1.275-3.493), thyroid disease during pregnancy (OR=3.365, 95%CI: 1.743-6.500), gestational diabetes mellitus (OR=2.158, 95%CI: 1.545-3.015), anxiety (OR=3.375, 95%CI: 2.133-5.340), medication during pregnancy (OR=2.774, 95%CI: 1.344-5.725), radiation exposure during pregnancy (OR=3.262, 95%CI: 1.950-5.455), family history of thyroid disease (OR=8.706, 95%CI: 5.991-12.653), low birth weight (OR=2.674, 95%CI: 1.895-3.772), fetal macrosomia (OR=1.657, 95%CI: 1.187-2.315), preterm birth (OR=2.567, 95%CI: 2.070-3.183), post-term birth (OR=2.083, 95%CI: 1.404-3.091), twin pregnancy or multiple birth (OR=3.455, 95%CI: 1.958-6.096), and birth defects (OR=6.038, 95%CI: 3.827-9.525) were risk factors for CH in neonates. CONCLUSIONS Advanced maternal age, gestational thyroid disease, gestational diabetes mellitus, anxiety, medication during pregnancy, radiation exposure during pregnancy, family history of thyroid disease, low birth weight, fetal macrosomia, preterm birth, post-term birth, twin pregnancy or multiple pregnancy, and birth defects may increase the risk of CH in neonates.
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Affiliation(s)
- 骥 张
- />贵州省疾病预防控制中心地方病防治研究所, 贵州贵阳 550004Institute of Endemic Disease, Guizhou Provincial Center for Disease Prevention and Control, Guiyang 550004, China
| | - 杨 李
- />贵州省疾病预防控制中心地方病防治研究所, 贵州贵阳 550004Institute of Endemic Disease, Guizhou Provincial Center for Disease Prevention and Control, Guiyang 550004, China
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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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Nanu M, Ardeleanu IS, Brezan F, Nanu I, Apostol A, Moldovanu F, Lazarescu H, Gheorghiu ML, Kozma A. NEONATAL SCREENING FOR CONGENITAL HYPOTHYROIDISM IN ROMANIA: DATA FROM MEDILOG MEDICAL INFORMATION REGISTRY. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:209-214. [PMID: 31508178 DOI: 10.4183/aeb.2019.209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective Congenital hypothyroidism (CH) is one of the common preventable causes of intellectual disability in neonates, by early detection through neonatal screening. We present the 8-year experience of the National Institute for Mother and Child Health (INSMC) in using MEDILOG national registry for the neonatal screening of CH. Methods Neonatal screening for CH, done by TSH measurement in dried blood spot, is organized in 5 regional centers, each with a reference laboratory. Results In 2018 80% of all the newborns, from 80% of the maternity hospitals, were registered in MEDILOG. After re-testing of TSH and T4/FT4 from venous blood in positive cases, the incidence of confirmed CH in 2018 was 1/3576 - 1/ 4746. In INSMC center (which includes 26 counties and Bucharest, out of 41 counties), in 2018 the incidence of positive CH cases at screening was 1/2094 (TSH cut-off ≥17 mIU/L) and of confirmed CH cases 1/3576 newborns. For positive screening cases, the median duration from birth to the INSMC laboratory result was 19 days: median of 9 days between screening and laboratory registration and 6 days between registration and test result. Conclusion MEDILOG registry is a practical instrument for monitoring the steps of neonatal CH screening, the incidence of CH, the evolution of the diagnosed cases, for evaluation of iodine deficiency (by neonatal TSH), and also for research, with the aim of improving early disease detection and treatment.
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Affiliation(s)
- M Nanu
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Research Department in Social Pediatry and Obstetrics, Bucuresti, Romania.,"Alessandrescu-Rusescu" National Institute for Mother and Child Health - The Technical Assistance and Management Unit of the National Programs PN-VI, Bucuresti, Romania
| | - I S Ardeleanu
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Clinical Pediatrics, Bucuresti, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucuresti, Romania
| | - F Brezan
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Clinical Pediatrics, Bucuresti, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucuresti, Romania
| | - I Nanu
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Research Department in Social Pediatry and Obstetrics, Bucuresti, Romania
| | - A Apostol
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - The Technical Assistance and Management Unit of the National Programs PN-VI, Bucuresti, Romania
| | - F Moldovanu
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Research Department in Social Pediatry and Obstetrics, Bucuresti, Romania
| | - H Lazarescu
- National Institute for Recovery, Physical Medicine and Balneoclimatology, Bucuresti, Romania
| | - M L Gheorghiu
- "Carol Davila" University of Medicine and Pharmacy, Bucuresti, Romania.,"C.I. Parhon" National Institute of Endocrinology, Bucuresti, Romania
| | - A Kozma
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Research Department in Social Pediatry and Obstetrics, Bucuresti, Romania.,National Institute for Recovery, Physical Medicine and Balneoclimatology, Bucuresti, Romania
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Yu B, Long W, Yang Y, Wang Y, Jiang L, Cai Z, Wang H. Newborn Screening and Molecular Profile of Congenital Hypothyroidism in a Chinese Population. Front Genet 2018; 9:509. [PMID: 30420871 PMCID: PMC6216286 DOI: 10.3389/fgene.2018.00509] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/10/2018] [Indexed: 12/12/2022] Open
Abstract
is the most gene mutation in Chinese CH patients.
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Affiliation(s)
- Bin Yu
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Wei Long
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yuqi Yang
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Ying Wang
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Lihua Jiang
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Zhengmao Cai
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Huaiyan Wang
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
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Abstract
Transient congenital hypothyroidism (CH) refers to a temporary deficiency of thyroid hormone identified after birth, with low thyroxine (T4) and elevated thyrotropin (TSH), which later recovers to improved thyroxine production, typically in first few months of infancy. Approximately 17% to 40% of children diagnosed with CH by newborn screening (NBS) programs were later determined to have transient hypothyroidism. Causes of transient CH are prematurity, iodine deficiency, maternal thyrotropin receptor blocking antibodies, maternal intake of anti-thyroid drugs, maternal or neonatal iodine exposure, loss of function mutations and hepatic hemangiomas. The classic clinical symptoms and signs of CH are usually absent immediately after birth in vast majority of infants due to temporary protection from maternal thyroxine. NBS has been largely successful in preventing intellectual disability by early detection of CH by performing thyroid function tests in infants with abnormal screening results. In this review we present the evidence for decision making regarding treatment vs. withholding treatment in infants with transient CH and present a rational approach to identifying transient CH based on American Academy of Pediatrics (AAP) recommendation.
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Affiliation(s)
- Neelakanta Kanike
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ajuah Davis
- Department of Pediatrics, Division of Pediatric Endocrinology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Prem S Shekhawat
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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