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Costeira MJ, Costa P, Roque S, Carvalho I, Vilarinho L, Palha JA. History of Neonatal Screening of Congenital Hypothyroidism in Portugal. Int J Neonatal Screen 2024; 10:16. [PMID: 38390980 PMCID: PMC10885029 DOI: 10.3390/ijns10010016] [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: 12/22/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Congenital hypothyroidism (CH) leads to growth and development delays and is preventable with early treatment. Neonatal screening for CH was initiated in Portugal in 1981. This study examines the history of CH screening in the country. Data were obtained from annual reports and from the national database of neonatal screening laboratory. The CH screening strategy primarily relies on the thyroid-stimulating hormone (TSH), followed by total thyroxine measurement as the second tier for confirmation. The TSH cutoff started at 90 mIU/L, decreasing to the actual 10 mIU/L. The coverage of the screening program has increased rapidly; although voluntary, it reached about 90% in 6 years and became universal in 10 years. Guideline and cutoff updates led to the identification of over 200 additional cases, resulting in specific retesting protocols for preterm and very-low-birth-weight babies. The actual decision tree considers CH when TSH levels are above 40 mIU/L. Data from the CH screening also provide an indication of the iodine status of the population, which is presently indicative of iodine insufficiency. The Portuguese neonatal screening for CH is a history of success. It has rapidly and continuously adapted to changes in knowledge and has become a universal voluntary practice within a few years.
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Affiliation(s)
- Maria José Costeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.J.C.); (P.C.)
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
- Department of Neonatology, Unidade Local de Saúde do Alto Ave Rua dos Cutileiros, 4835-044 Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.J.C.); (P.C.)
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
| | - Susana Roque
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.J.C.); (P.C.)
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
| | - Ivone Carvalho
- Neonatal Screening, Metabolism & Genetics—National Institute of Health Dr. Ricardo Jorge, 4000-053 Porto, Portugal; (I.C.); (L.V.)
| | - Laura Vilarinho
- Neonatal Screening, Metabolism & Genetics—National Institute of Health Dr. Ricardo Jorge, 4000-053 Porto, Portugal; (I.C.); (L.V.)
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.J.C.); (P.C.)
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
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Chamot S, Al-Salameh A, Petit P, Bonneterre V, Cancé C, Decocq G, Boullier A, Braun K, Desailloud R. Does prenatal exposure to multiple airborne and tap-water pollutants increase neonatal thyroid-stimulating hormone concentrations? Data from the Picardy region, France. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 905:167089. [PMID: 37717745 DOI: 10.1016/j.scitotenv.2023.167089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Systematic screening for congenital hypothyroidism by heel-stick sampling has revealed unexpected heterogeneity in the geographic distribution of newborn thyroid-stimulating hormone concentrations in Picardy, France. We explored a possible relationship with environmental pollutants. METHODS Zip code geolocation data from mothers of newborns without congenital hypothyroidism born in 2021 were linked to ecological data for a set of airborne (particulate matter with a diameter of 2.5 μm or less [PM2.5] or 10 μm or less [PM10]) and tap-water (nitrate and perchlorate ions and atrazine) pollutants. Statistical associations between mean exposure levels during the third trimester of pregnancy and Thyroid-stimulating hormone (TSH) concentrations in 6249 newborns (51 % male) were investigated using linear regression models. RESULTS Median neonatal TSH concentration (interquartile range, IQR) was 1.7 (1-2.8) mIU/L. An increase of one IQR in prenatal exposure to perchlorate ions (3.6 μg/L), nitrate ions (19.2 mg/L), PM2.5 (3.7 μg/m3) and PM10 (3.4 μg/m3), were associated with increases in TSH concentrations of 2.30 % (95 % CI: 0.95-3.66), 5.84 % (95 % CI: 2.81-8.87), 13.44 % (95 % CI: 9.65-17.28) and 6.26 % (95 % CI: 3.01-9.56), respectively. CONCLUSIONS Prenatal exposure to perchlorate and nitrate ions in tap water and to airborne PM over the third trimester of pregnancy was significantly associated with increased neonatal TSH concentrations.
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Affiliation(s)
- Sylvain Chamot
- Regional Center for Occupational and Environmental Diseases of Hauts-de-France, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80000 Amiens, France; Péritox (UMR_I 01), UPJV/INERIS, University of Picardy Jules Verne, 1 rond point du Pr Christian Cabrol, 80000 Amiens, France.
| | - Abdallah Al-Salameh
- Péritox (UMR_I 01), UPJV/INERIS, University of Picardy Jules Verne, 1 rond point du Pr Christian Cabrol, 80000 Amiens, France; Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80054 Amiens, France
| | - Pascal Petit
- CHU Grenoble Alpes, Centre Régional de Pathologies Professionnelles et Environnementales, 38000 Grenoble, France; Univ. Grenoble Alpes, AGEIS, 38000 Grenoble, France
| | - Vincent Bonneterre
- CHU Grenoble Alpes, Centre Régional de Pathologies Professionnelles et Environnementales, 38000 Grenoble, France; Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC, 38000 Grenoble, France
| | - Christophe Cancé
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC, 38000 Grenoble, France
| | - Guillaume Decocq
- UF PRiMAX (Prévention des Risques liés aux Médicaments et Autres Xénobiotiques), Service de Pharmacologie clinique, Centre hospitalier universitaire d'Amiens - Picardie, 1 rond point du Pr Christian Cabrol, F-80054 Amiens Cedex 1, France; Ecologie et Dynamique des Systèmes Anthropisés (EDYSAN, UMR CNRS 7058), Jules Verne University of Picardy, 1 rue des Louvels, 80037 Amiens Cedex 1, France
| | - Agnès Boullier
- Department of Biochemistry, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80054 Amiens, France; Regional Center of Newborn Screening of Picardy, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80054 Amiens, France
| | - Karine Braun
- Regional Center of Newborn Screening of Picardy, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80054 Amiens, France; Department of Paediatrics, Amiens University Hospital, 80054 Amiens, France
| | - Rachel Desailloud
- Péritox (UMR_I 01), UPJV/INERIS, University of Picardy Jules Verne, 1 rond point du Pr Christian Cabrol, 80000 Amiens, France; Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80054 Amiens, France
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Chiesa AE, Tellechea ML. Update on Neonatal Isolated Hyperthyrotropinemia: A Systematic Review. Front Endocrinol (Lausanne) 2021; 12:643307. [PMID: 34484109 PMCID: PMC8416274 DOI: 10.3389/fendo.2021.643307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/26/2021] [Indexed: 01/17/2023] Open
Abstract
The purpose of this paper was to systematically summarize the published literature on neonatal isolated hyperthyrotropinemia (HTT), with a focus on prevalence, L-T4 management, re-evaluation of thyroid function during infancy or childhood, etiology including genetic variation, thyroid imaging tests, and developmental outcome. Electronic and manual searches were conducted for relevant publications, and a total of 46 articles were included in this systematic review. The overall prevalence of neonatal HTT was estimated at 0.06%. The occurrence of abnormal imaging tests was found to be higher in the persistent than in the transient condition. A continuous spectrum of thyroid impairment severity can occur because of genetic factors, environmental factors, or a combination of the two. Excessive or insufficient iodine levels were found in 46% and 16% of infants, respectively. Thirty-five different genetic variants have been found in three genes in 37 patients with neonatal HTT of different ethnic backgrounds extracted from studies with variable design. In general, genetic variants reported in the TSHR gene, the most auspicious candidate gene for HTT, may explain the phenotype of the patients. Many practitioners elect to treat infants with HTT to prevent any possible adverse developmental effects. Most patients with thyroid abnormalities and/or carrying monoallelic or biallelic genetic variants have received L-T4 treatment. For all those neonates on treatment with L-T4, it is essential to ensure follow-up until 2 or 3 years of age and to conduct medically supervised trial-off therapy when warranted. TSH levels were found to be elevated following cessation of therapy in 44% of children. Withdrawal of treatment was judged as unsuccessful, and medication was restarted, in 78% of cases. Finally, data extracted from nine studies showed that none of the 94 included patients proved to have a poor developmental outcome (0/94). Among subjects presenting with normal cognitive performance, 82% of cases have received L-T4 therapy. Until now, the precise neurodevelopmental risks posed by mild disease remain uncertain.
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Mikołajczak A, Borszewska-Kornacka MK, Romejko-Wolniewicz E, Bokiniec R. Comparison of the offspring ultrasound thyroid volume in hypothyroid mothers treated with different levothyroxine doses: A cohort study. Adv Med Sci 2020; 65:332-337. [PMID: 32580143 DOI: 10.1016/j.advms.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/09/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE We aimed to determine the volume of the thyroid gland in full-term neonates born to hypothyroid mothers as compared with full-term infants born to healthy mothers and to investigate the association between levothyroxine doses and the thyroid volume of neonates. MATERIALS AND METHODS This is single center prospective observational study of 245 full-term neonates (96 from hypothyroid and 149 from healthy mothers). Ultrasound examination in both longitudinal and transverse projections was used to calculate the thyroid volume applying the ellipsoid formula. RESULTS Median (interquartile range) thyroid volume of newborns from hypothyroid mothers was significantly smaller compared to the control group with regard to the total thyroid volume and the left lobe (p < 0.05). We found no statistically significant difference for the right lobe (p > 0.05) and inverse correlation between the thyroid volume and levothyroxine doses taken by mothers. CONCLUSION Results of the present study indicate that maternal thyroid hormone levels may interfere with the fetal hypothalamic-pituitary axis.
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Affiliation(s)
| | | | - Ewa Romejko-Wolniewicz
- Second Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Renata Bokiniec
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland.
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