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Ding X, Liu Z, Zhang B, Yang Y, Wang Y, Yu B, Long W. Permanent vs Transient Congenital Hypothyroidism in Chinese Children: Physical Growth and Predictive Nomogram. J Clin Endocrinol Metab 2024; 109:e1616-e1622. [PMID: 38104243 DOI: 10.1210/clinem/dgad739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
CONTEXT Few reliable markers are available to distinguish transient congenital hypothyroidism (TCH) and permanent congenital hypothyroidism (PCH). Additionally, the differences in growth between TCH and PCH remain unclear. OBJECTIVE To investigate the growth of children with TCH and PCH and develop a nomogram for early differentiation of these forms. METHODS This retrospective study included children with TCH or PCH. The predictive efficacy of the prognostic predictors was analyzed using receiver operating characteristic analysis. Multivariate prediction models were developed. Measurements of growth were compared between groups. RESULTS Patients with TCH had lower initial thyroid-stimulating hormone (TSH) than those with PCH at newborn screening (NBS). The supplementary dose of levothyroxine (L-T4) gradually decreased with age in TCH but not in PCH. The area under the curve (AUC) values of the initial TSH, L-T4 dose at 1 year of age, and L-T4 dose at 2 years of age for distinguishing TCH from PCH were 0.698, 0.71, and 0.879, respectively. The predictive efficacy of the multivariate models at 1 and 2 years of age improved, with AUC values of 0.752 and 0.922, respectively. A nomogram was built based on the multivariate model at 1 year of age. The growth did not differ between children with TCH and those with PCH. However, at 1 year of age, girls with CH exhibited higher z-scores in terms of height and weight than boys with CH. CONCLUSION TSH at NBS and L-T4 doses during treatment can be used to distinguish between PCH and TCH early in life, and the predictive efficacy can be improved using multivariable models with a visualized nomogram. At 3 years of age, patients with TCH and PCH showed similar growth.
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Affiliation(s)
- Xuejing Ding
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Zhiwei Liu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Bin Zhang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Yuqi Yang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Ying Wang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Bin Yu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
| | - Wei Long
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou 213000, China
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Uehara E, Abe K, Tanase-Nakao K, Muroya K, Hattori A, Matsubara K, Fukami M, Narumi S. Molecular and Clinical Features of Congenital Hypothyroidism due to Multiple DUOX2 Variants. Thyroid 2024. [PMID: 38757580 DOI: 10.1089/thy.2024.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background: DUOX2 is one of the major causative genes of congenital hypothyroidism (CH). Still, the mutation spectrum and clinical outcomes of biallelic DUOX2 variants are not fully understood. This study aimed to elucidate the molecular features and long-term clinical manifestations of CH caused by multiple pathogenic DUOX2 variants. Methods: A total of 255 patients with CH were screened for rare variants of 11 known causative genes. DUOX2 variants were classified according to their protein structure and residual activity. In vitro assays were performed for several variants of unknown function. Clinical analyses were conducted for patients with multiple pathogenic variants of DUOX2 but not of other genes. Results: We identified 24 pathogenic variants of DUOX2, together with two benign variants and seven variants of uncertain significance, in 63 patients. The pathogenic variants included three missense substitutions and one frameshift variant that have not been linked to CH. Twenty-one patients carried multiple pathogenic DUOX2 variants without any other pathogenic gene variants. Three of the 21 patients harbored homozygous variants. Family analysis, long-read amplicon sequencing, and haplotype phasing confirmed compound heterozygosity of the DUOX2 variants in 14 patients, whereas the allelic positions of the variants in the remaining four patients could not be determined. Of the 21 patients, 19 were treated with levothyroxine; their ages at drug withdrawal ranged from 9 months to 21.4 years. Three patients required retreatment after drug-free intervals of 6 months, 8 months, and 10 years. There were no differences in the clinical severity among patients with DUOX2 amorphic/amorphic, amorphic/hypomorphic, and hypomorphic/hypomorphic variants. Conclusions: These results broaden the mutation spectrum of DUOX2. Furthermore, our data imply that patients with multiple pathogenic DUOX2 variants typically exhibit transient CH without significant genotype-phenotype correlations. Most importantly, this study demonstrated for the first time that these patients are at risk of developing recurrent hypothyroidism after a long drug-free interval.
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Affiliation(s)
- Erika Uehara
- National Research Institute for Child Health and Development, Molecular Endocrinology, Tokyo, Tokyo, Japan
- Tohoku University School of Medicine, Advanced Pediatric Medicine, Sendai, Miyagi, Japan;
| | - Kiyomi Abe
- Keio University School of Medicine, Pediatrics, Tokyo, Japan
- Tokyo Saiseikai Central Hospital, Pediatrics, Tokyo, Japan;
| | - Kanako Tanase-Nakao
- National Research Institute for Child Health and Development, Molecular Endocrinology, Tokyo, Japan;
| | - Koji Muroya
- Kanagawa Children's Medical Center, Endocrinology and Metabolism, Yokohama, Kanagawa, Japan;
| | - Atsushi Hattori
- National Research Institute for Child Health and Development, Molecular Endocrinology, Tokyo, Tokyo, Japan
- National Research Institute for Child Health and Development, Division of Diversity Research, Tokyo, Japan;
| | - Keiko Matsubara
- National Research Institute for Child Health and Development, Molecular Endocrinology, Tokyo, Tokyo, Japan
- National Research Institute for Child Health and Development, Division of Diversity Research, Tokyo, Tokyo, Japan;
| | - Maki Fukami
- National Research Institute for Child Health and Development, Molecular Endocrinology, Tokyo, Tokyo, Japan
- National Research Institute for Child Health and Development, Division of Diversity Research, Tokyo, Tokyo, Japan;
| | - Satoshi Narumi
- Keio University School of Medicine, Pediatrics, Tokyo, Japan
- National Research Institute for Child Health and Development, Molecular Endocrinology, Tokyo, Tokyo, Japan;
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Ye L, Yin Y, Chen M, Gong N, Peng Y, Liu H, Miao J. Combined genetic screening and traditional newborn screening to improve the screening efficiency of congenital hypothyroidism. Front Pediatr 2023; 11:1185802. [PMID: 37252044 PMCID: PMC10213735 DOI: 10.3389/fped.2023.1185802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Congenital hypothyroidism (CH) is an neonatal endocrine disorder. Traditional newborn screening is the mainstream method of CH screening, so as to ensure the early detection and treatment of CH. This method is limited as it has high rates of false positives and negatives. Genetic screening can be used to address the shortcomings of traditional newborn Screening (NBS); however, the comprehensive clinical value of genetic screening is yet to be systematically studied. Methods A total of 3,158 newborns who accepted the newborn screening and genetic screening were recruited for this study. Biochemical screening and genetic screening were performed at the same time. The level of TSH with the DBS was detected by time-resolved immunofluorescence assay. High-throughput sequencing technology based on targeted gene capture was used for genetic screening. The suspected neonatal was recalled and tested serum TSH, and FT4. Finally, the effectiveness of traditional NBS and combined screening was compared. Results In this study, 16 cases were diagnosed by traditional NBS. 10 cases of DUOX2 mutation were found in newborn CH-related genetic screening, including 5 homozygous and 5 compound heterozygous variations. We found that the c.1588A > T mutations in DUOX2 constituting the predominant site in the present cohort.Compared with NBS and genetic screening, the sensitivity of combined screening increased by 11.1% and 55.6%, respectively. Compared with NBS and genetic screening, the negative predictive value of combined screening increased by 0.1% and 0.4%, respectively. Conclusions Combined traditional NBS and genetic screening reduces the false negative rate of CH screening and improves the early and accurate identification of neonates with CH. Our research explains the mutation spectrum of CH in this region, and provisionally demonstrates the necessity, feasibility and significance of genetic screening in newborns and provides a solid basis for future clinical developments.
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Affiliation(s)
- Liang Ye
- Department of Pediatrics, Women and Children’ Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yifan Yin
- Department of Pediatrics, Women and Children’ Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Min Chen
- Department of Pediatrics, Women and Children’ Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Nian Gong
- Department of Pediatrics, Women and Children’ Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yong Peng
- Department of Pediatrics, Women and Children’ Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Hao Liu
- Department of Pediatrics, Women and Children’ Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jingkun Miao
- Department of Pediatrics, Women and Children’ Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
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Genetic Factors Causing Thyroid Dyshormonogenesis as the Major Etiologies for Primary Congenital Hypothyroidism: Clinical and Genetic Characterization of 33 Patients. J Clin Med 2022; 11:jcm11247313. [PMID: 36555929 PMCID: PMC9786654 DOI: 10.3390/jcm11247313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Although the significance of primary congenital hypothyroidism (CH) is supported by an increasing amount of evidence, the clinical and genetic characteristics of this condition are still poorly understood. This study aimed to explore the underlying genetic etiologies in a cohort of primary CH patients. SUBJECTS AND METHODS The clinical data of 33 patients with primary CH were collected and analyzed via a cross-sectional study. Genetic analysis was performed by high-throughput sequencing and Sanger verification, and the pathogenicity of the novel missense variants was predicted using a variety of comprehensive bioinformatic tools. RESULTS Among the 33 patients, 22 (22/33, 66.7%) harbored pathogenic variants in the causative genes of thyroid dysgenesis or dyshormonogenesis, with DUOX2 (15/33, 45.5%) topping the list, followed by TG, TPO, DUOXA2 and PAX8. Four novel genetic variants were detected, including a pathogenic frameshift and three likely pathogenic missense variants. Positive neonatal screening for TSH, neonatal jaundice and abnormal thyroid morphology were the main positive findings among all cases. Although 31 of the total 33 CH patients exhibited normal anthropometric and social performance, the other 2 had poor prognosis in this study. CONCLUSIONS This study reported 33 new CH patients bearing four novel genetic variants, which enriched the variant spectrum of CH genes. In this cohort, genetic factors causing thyroid dyshormonogenesis were the main etiologies of CH development. Most patients exhibited a favorable prognosis; however, systematic management remains a challenge in achieving improved clinical outcomes for CH patients.
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Dai C, Chen C, Jiang L, Zhu Y, Wang C. Severe neonatal hyperbilirubinemia secondary to combined RhC hemolytic disease, congenital hypothyroidism and large adrenal hematoma: a case report. BMC Pediatr 2022; 22:539. [PMID: 36089589 PMCID: PMC9465864 DOI: 10.1186/s12887-022-03594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background ABO blood group incompatibility, neonatal sepsis, G-6-PD deficiency, thyroid dysfunction, and hereditary spherocytosis are all probable causes of neonatal hyperbilirubinemia. However, the etiology of some hyperbilirubinemia is extremely complicated, which may be caused by multiple factors, resulting in severe jaundice. We report a case of severe jaundice due to three causes, showing the significance for the investigation of the etiology of neonatal hyperbilirubinemia. Case presentation At 96 h of life, a full-term and vaginal delivery male infant with yellowish discoloration of body was transferred to our hospital. When he entered neonatal intensive care unit on the fourth day after birth, he developed jaundice and the transcutaneous bilirubin was 28 mg/dl. Total bilirubin was 540.2 μmol/L, while the indirect bilirubin was 516.7 μmol/L. Both parents and the baby’s blood types were O Rh(D +), and direct coomb’s test was negative. But mother’s indirect coomb’s test was positive. Investigating for minor blood group revealed that the father’s blood type of Rh was CCDee, the mather’s was ccDEE, and CcDEe for the baby. After intensive phototherapy and double volume exchange transfusion, the total bilirubin remained at 303 μmol/L. At day 10, the bilirubin level was 303.5 μmol/L, intensive phototherapy was continued, and intravenous immunoglobulin was used again. The test for thyroid hormones at day 10, the TSH was 13.334mIU/L. And the screening for congenital hypothyroidism showed the TSH was 33mIU/L. Because of the palpable abdominal mass, ultrasound and MRI was done, showed a huge mass in the right adrenal gland. Brainstem auditory evoked potential was performed at day 7, which indicated hearing impairment (65db for left ear and 70db for the right). Euthyrox and intermittent phototherapy were given as following treatment. The jaundice did not subside until the 12th day. Conclusion Even if their parents' ABO blood group and Rh (d) are consistent, a Coomb test is required for newborns with hyperbilirubinemia since they may have minor blood group incompatibilities. When bilirubin rises rapidly or the clinical treatment effect is inadequate, additional causes should be aggressively screened. Adrenal ultrasound should be performed on newborns with palpable abdominal mass, anemia and jaundice to determine whether there is adrenal hemorrhage.
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Opazo MC, Rivera JC, Gonzalez PA, Bueno SM, Kalergis AM, Riedel CA. Thyroid Gene Mutations in Pregnant and Breastfeeding Women Diagnosed With Transient Congenital Hypothyroidism: Implications for the Offspring's Health. Front Endocrinol (Lausanne) 2021; 12:679002. [PMID: 34721286 PMCID: PMC8551387 DOI: 10.3389/fendo.2021.679002] [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] [Received: 03/10/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022] Open
Abstract
Fetus and infants require appropriate thyroid hormone levels and iodine during pregnancy and lactation. Nature endorses the mother to supply thyroid hormones to the fetus and iodine to the lactating infant. Genetic variations on thyroid proteins that cause dyshormonogenic congenital hypothyroidism could in pregnant and breastfeeding women impair the delivery of thyroid hormones and iodine to the offspring. The review discusses maternal genetic variations in thyroid proteins that, in the context of pregnancy and/or breastfeeding, could trigger thyroid hormone deficiency or iodide transport defect that will affect the proper development of the offspring.
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Affiliation(s)
- Maria C. Opazo
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias de la Vida, Departamento de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
- Instituto de Ciencias Naturales, Facultad de Medicina Veterinaria y Agronomía, Universidad de las Américas, Santiago, Chile
| | - Juan Carlos Rivera
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias de la Vida, Departamento de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
| | - Pablo A. Gonzalez
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia A. Riedel
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias de la Vida, Departamento de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
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Long W, Guo F, Yao R, Wang Y, Wang H, Yu B, Xue P. Genetic and Phenotypic Characteristics of Congenital Hypothyroidism in a Chinese Cohort. Front Endocrinol (Lausanne) 2021; 12:705773. [PMID: 34539567 PMCID: PMC8446595 DOI: 10.3389/fendo.2021.705773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The molecular etiology and the genotype-phenotype correlation of congenital hypothyroidism (CH) remain unclear. METHODS We performed genetic analysis in 42 newborns with CH using whole-exome sequencing. Patients were divided into a single-gene group and a multi-gene group according to the number of affected genes, or divided into a monoallelic group, a biallelic group, and an oligogenic group according to the pattern of the detected variants. The clinical characteristics were compared between groups. RESULTS Thyroid dysgenesis (TD) was observed in 10 patients and goiter in 5 patients, whereas 27 patients had normal-sized gland-in-situ (GIS). We identified 58 variants in five genes in 29 patients. The genes with the most frequent variants were DUOX2 (70.7%), followed by TSHR (12.1%), DUOXA2 (10.3%), and TPO (5.2%). Variants in the genes causing dyshormonogenesis (DH) were more common than those in the genes causing TD (87.9% versus 12.1%). Among the patients with detected variants, 26 (89.7%) were harboring a single gene variant (single-gene group), which include 22 patients harboring biallelic variants (biallelic group) and four patients harboring monoallelic variants (monoallelic group). Three (10.3%) patients harbored variants in two or three genes (multi-gene group or oligogenic group). Compared with the single-gene group, the levothyroxine (L-T4) dose at 1 year of age was higher in the multi-gene group (p = 0.018). A controllable reduction in the L-T4 dose was observed in 25% of patients in the monoallelic group and 59.1% of patients in the biallelic group; however, no patients with such reduction in the L-T4 dose were observed in the oligogenic group. CONCLUSIONS Patients with normal-sized GIS accounted for the majority of our cohort. Genetic defects in the genes causing DH were more common than those in the genes causing TD, with biallelic variants in DUOX2 being dominant. DH might be the leading pathophysiology of CH in Chinese individuals.
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Affiliation(s)
- Wei Long
- Department of Medical Genetics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Fang Guo
- Department of Medical Genetics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Ruen Yao
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Pediatrics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Huaiyan Wang
- Department of Pediatrics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Bin Yu
- Department of Medical Genetics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
- *Correspondence: Bin Yu, ; Peng Xue,
| | - Peng Xue
- Department of Pediatrics, Affiliated Changzhou Children’s Hospital of Nantong University, Changzhou, China
- *Correspondence: Bin Yu, ; Peng Xue,
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