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Sobitan A, Gebremedhin B, Yao Q, Xie G, Gu X, Li J, Teng S. A Computational Approach: The Functional Effects of Thyroid Peroxidase Variants in Thyroid Cancer and Genetic Disorders. JCO Clin Cancer Inform 2024; 8:e2300140. [PMID: 38295322 PMCID: PMC10843385 DOI: 10.1200/cci.23.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/16/2023] [Accepted: 10/18/2023] [Indexed: 02/02/2024] Open
Abstract
PURPOSE Thyroid peroxidase (TPO) is essential for the synthesis of thyroid hormones. However, specific mutations render TPO antigenic and prone to autoimmune attacks leading to thyroid cancer, TPO deficiency, and congenital hypothyroidism (CH). Despite technological advancement, most experimental procedures cannot quickly identify the genetic causes of CH nor detect thyroid cancer in the early stages. METHODS We performed saturated computational mutagenesis to calculate the folding energy changes (∆∆G) caused by missense mutations and analyzed the mutations involved in post-translational modifications (PTMs). RESULTS Our results showed that the functional important missense mutations occurred in the heme peroxidase domain. Through computational saturation mutagenesis, we identified the TPO mutations in G393 and G348 affecting protein stability and PTMs. Our folding energy calculations revealed that seven of nine somatic thyroid cancer mutations destabilized TPO. CONCLUSION These findings highlight the impact of these specific mutations on TPO stability, linking them to thyroid cancer and other genetic thyroid-related disorders. Our results show that computational mutagenesis of proteins provides a quick insight into rare mutations causing Mendelian disorders and cancers in humans.
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Affiliation(s)
| | | | - Qiaobin Yao
- Department of Biology, Howard University, Washington, DC
| | - Guiqin Xie
- Department of Oral Pathology, Howard University, Washington, DC
| | - Xinbin Gu
- Department of Oral Pathology, Howard University, Washington, DC
| | - Jiang Li
- Department of Electrical Engineering and Computer Science, Howard University, Washington, DC
| | - Shaolei Teng
- Department of Biology, Howard University, Washington, DC
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Yao Y, Deng K, Zhu J, Xiang L, Yuan X, Li Q, Liu L, Xu W. Increased incidence of congenital hypothyroidism in China: An analysis of 119 million screened newborns. Eur J Pediatr 2023; 182:4477-4486. [PMID: 37491618 DOI: 10.1007/s00431-023-05108-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
Despite the lack of nationwide epidemiological studies, congenital hypothyroidism (CH) incidence in China has increased. We aimed to evaluate the trends of CH and the possible reasons behind them. Data from screened newborns from the Chinese Newborn Screening Information System from 2012 to 2019 was collected. We applied the Bayesian hierarchical Poisson regression model and meta-analysis to estimate incidence or proportion over the years. The estimated CH incidence increased from 4.01 per 10,000 births in 2012 to 5.77 per 10,000 births in 2019. The average annual growth rate (ARG) of CH incidence for all provinces varied from 0.59 to 20.96%. The most rapid rise in incidence was observed in cases with an initial thyroid stimulating hormone (TSH) concentration of < 10 mIU/L. The meta-analysis results showed that the proportion of permanent CH increased by 0.024% (95%CI: 0.011%, 0.037%) annually. Each 1 mIU/L decrease in TSH cutoff value was associated with a 2.96% increase in CH incidence. In the same period, the proportion of premature CH cases increased from 6.60 to 9.10%, which was much higher than the increase in preterm births. A significant relationship was not found between provincial growth rates in screening coverage and provincial baseline incidences of CH. Conclusion: CH incidence has substantially increased in China. The slight adjustment of the TSH cutoff value and increasing preterm birth rate contribute to such a trend; however, the contribution is limited. What is Known: • An uptrend in congenital hypothyroidism (CH) incidence has been reported in many European and American countries in the last two decades; however, no studies have been conducted in China to explain the increased CH incidence. • We provide a detailed epidemiological report on the trends of CH during 2012-2019 in China, with an attempt to explore the reasons behind it. What is New: • This first-ever national-wide epidemiological report in China showed an uptrend in CH incidence with variations over regions and CH subtypes. The mild lowering of TSH cutoff values and the increasing preterm birth rate contributed to this uptrend.
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Affiliation(s)
- Yongna Yao
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zhu
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liangcheng Xiang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuelian Yuan
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Liu
- School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Weijuan Xu
- Editorial Department, West China Second University Hospital, Sichuan University, 20, Section 3, Ren Min South Road, Chengdu, Sichuan, China.
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Liu L, He W, Zhu J, Deng K, Tan H, Xiang L, Yuan X, Li Q, Huang M, Guo Y, Yao Y, Li X. Global prevalence of congenital hypothyroidism among neonates from 1969 to 2020: a systematic review and meta-analysis. Eur J Pediatr 2023:10.1007/s00431-023-04932-2. [PMID: 37071175 DOI: 10.1007/s00431-023-04932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/13/2023] [Accepted: 03/11/2023] [Indexed: 04/19/2023]
Abstract
Little is known about the global prevalence of congenital hypothyroidism (CH), though it is known to vary across countries and time periods. This meta-analysis aims to estimate the global and regional prevalence of CH among births between 1969 and 2020. PubMed, Web of Sciences, and Embase databases were searched for relevant studies between January 1, 1975, and March 2, 2020. Pooled prevalence was calculated using a generalized linear mixed model, and expressed as a rate per 10,000 neonates. The meta-analysis involved 116 studies, which analyzed 330,210,785 neonates, among whom 174,543 were diagnosed with CH. The pooled global prevalence of CH from 1969 to 2020 was 4.25 (95% confidence interval (CI) 3.96-4.57). The geographic region with highest prevalence was the Eastern Mediterranean (7.91, 95% CI 6.09-10.26), where the prevalence was 2.48-fold (95% CI 2.04-3.01) that in Europe. The national income level with the highest prevalence was upper-middle (6.76, 95% CI 5.66-8.06), which was 1.91-fold (95% CI 1.65-2.22) that in high-income countries. Global prevalence of CH was 52% (95% CI 4-122%) higher in 2011-2020 than in 1969-1980, after adjusting for geographic region, national income level, and screening strategy. Conclusion: The global prevalence of CH increased from 1969 to 2020, which may reflect the implementation of national neonatal screening, neonatal testing for thyroid-stimulating hormone, and a lowering of the diagnostic level of this hormone. Additional factors are likely to be driving the increase, which should be identified in future research. What is Known: • Cumulated evidence had suggested that the occurrences of congenital hypothyroidism (CH) among newborns were varied in different countries.. • Up-trends of the birth prevalence of CH were observed in many European and American countries. What is New: • This is the first meta-analysis to estimate global and regional prevalence of CH among newborns. • The global prevalence of CH has increased by 127% since 1969. The Eastern Mediterranean has the highest prevalence and stands out with the most pronounced escalation in the prevalence of CH.
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Affiliation(s)
- Lei Liu
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Wenchong He
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Jun Zhu
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance, West China Second Hospital, Sichuan University, Chengdu, 610041, China
| | - Huiwen Tan
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Liangcheng Xiang
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xuelian Yuan
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qi Li
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
| | - Menglan Huang
- School of Resource and Environmental Engineering, Mianyang Teachers' College, Mianyang, 621000, China
| | - Yingkun Guo
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Yongna Yao
- National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Xiaohong Li
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, 20 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China.
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Mehran L, Azizi F, Mousapour P, Cheraghi L, Yarahmadi S, Amirshekari G, Khalili D. Development of a risk prediction model for early discrimination between permanent and transient congenital hypothyroidism. Endocrine 2021; 73:374-383. [PMID: 33616836 DOI: 10.1007/s12020-021-02641-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop a risk prediction model for early discrimination between transient and permanent congenital hypothyroidism (CH). DESIGN AND SETTING In a retrospective cohort, 1047 confirmed CH neonates, from 15 randomly selected provinces in Iran, were entered to the study. Clinical and biochemical information of transient and permanent cases, distinct at the age of 3 years were retrospectively gathered. RESULTS Among CH neonates, the overall prevalence of permanent CH was 57.1%. Using forward stepwise multivariable logistic regression analysis, confirmatory venous TSH, total T4 < 8.2 ng/dl, requiring levothyroxine dosage increase, venous TSH ≥ 10 mU/l between 6 and 12 months of age, parental consanguinity and family history of thyroid diseases were associated with increased risk of permanent CH. The prediction model achieved a very good power in discriminating patients with transient and permanent CH with an optimism-corrected area under the ROC curve of 0.86 (95% CI:0.84-0.88) with a very good calibration. Integrated discrimination improvement (IDI) test indicated significantly greater diagnostic performance of the model compared to serum TSH alone. CONCLUSIONS Using several potential predictors for permanent CH, we developed a relatively powerful risk prediction model as a cost-saving screening tool in order to avoid unnecessary long-term treatment of transient cases which might empower clinicians for prognostication of the CH course and tailoring treatment up to 1 year of age.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouria Mousapour
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yarahmadi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golshan Amirshekari
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Iodine nutrition status of women after 10 years of Lipiodol supplementation: a cross-sectional study in Xinjiang, China. Br J Nutr 2021; 126:9-21. [PMID: 33028431 DOI: 10.1017/s0007114520003918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study examined the contribution of long-term use of Lipiodol capsules, as a supplement to iodised salt to the control of iodine deficiency disorders among women in Xinjiang of China. A total of 1220 women across Kashgar, Aksu, Turpan and Yili Prefectures were surveyed in 2017. Lipiodol capsules were administered twice yearly in Kashgar and once yearly in Aksu and Turpan, but not in Yili. Urinary iodine concentration (UIC), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroglobulin antibody, thyroid peroxidase antibody and thyroid volume values were assessed. All the women in the four areas were in a state of non-iodine deficiency by UIC. The UIC were higher than adequate in Kashgar and Aksu (619·4 v. 278·6 μg/l). Thyroid hormone levels differed significantly in Turpan and Yili (FT3: 4·4 v. 4·6 pmol/l, FT4: 13·8 v. 14·2 pmol/l, TSH: 2·0 v. 2·7 mIU/l), but did not differ significantly in Kashgar, Aksu and Yili. The four areas did not differ significantly with regard to thyroid nodules, autoimmune thyroiditis or goitre. However, the detection rates of subclinical hypothyroidism (16·6 %) and total thyroid dysfunction (25·4 %) were higher among women in Yili. The supplementation with Lipiodol capsules had improved the iodine nutrition status of women in iodine-deficient areas of Xinjiang since 2006. To avoid negative effects of excess iodine, we suggest a gradual discontinuation of Lipiodol capsules in women with special needs based on the existing iodine nutrition level of local women.
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McMahon R, DeMartino L, Sowizral M, Powers D, Tracy M, Caggana M, Tavakoli NP. The Impact of Seasonal Changes on Thyroxine and Thyroid-Stimulating Hormone in Newborns. Int J Neonatal Screen 2021; 7:ijns7010008. [PMID: 33546274 PMCID: PMC7930942 DOI: 10.3390/ijns7010008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 11/18/2022] Open
Abstract
Newborn screening for congenital hypothyroidism (CH) is performed by measuring the concentration of thyroxine (T4) and/or thyroid-stimulating hormone (TSH) in dried blood spots. Unfortunately, the levels of T4 and TSH vary due to multiple factors, and therefore the false-positive rate for the test is a challenge. We analyzed screening data from 2008 to 2017 to determine the effect of seasonal changes and manufacturer kit lot changes on T4 and TSH values and on numbers of infants referred. Over a 10-year period, we screened 2.4 million infants using commercially available fluoroimmunoassays to measure T4 and TSH concentrations in dried blood spots. During colder months, daily mean T4 and TSH values were higher and referral rates and false-positive rates were higher. However, there was no significant difference between the number of confirmed CH cases. Furthermore, in rare instances, we observed differences in T4 daily mean values during the 10-year period when manufacturer kit lot changes were made. Seasonal temperature variations influence measured T4 and TSH values and consequently lower the positive predictive value for CH testing in colder months. Newborn screening (NBS) programs should be aware that manufacturer kit lot changes may also influence T4 values.
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Affiliation(s)
- Rebecca McMahon
- Wadsworth Center, Division of Genetics, New York State Department of Health, Albany, NY 12208, USA; (R.M.); (L.D.); (M.C.)
| | - Lenore DeMartino
- Wadsworth Center, Division of Genetics, New York State Department of Health, Albany, NY 12208, USA; (R.M.); (L.D.); (M.C.)
| | - Mycroft Sowizral
- Scientific Core, Wadsworth Center, New York State Department of Health, Albany, NY 12208, USA;
| | - Diana Powers
- Mathematics Department, West Virginia University Institute of Technology, Beckley, WV 25801, USA;
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, State University of New York, Rensselaer, NY 12144, USA;
| | - Michele Caggana
- Wadsworth Center, Division of Genetics, New York State Department of Health, Albany, NY 12208, USA; (R.M.); (L.D.); (M.C.)
| | - Norma P. Tavakoli
- Wadsworth Center, Division of Genetics, New York State Department of Health, Albany, NY 12208, USA; (R.M.); (L.D.); (M.C.)
- Department of Biomedical Sciences, State University of New York, Albany, NY 12208, USA
- Correspondence: ; Tel.: +1-518-486-2569
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Salas-Lucia F, Pacheco-Torres J, González-Granero S, García-Verdugo JM, Berbel P. Transient Hypothyroidism During Lactation Alters the Development of the Corpus Callosum in Rats. An in vivo Magnetic Resonance Image and Electron Microscopy Study. Front Neuroanat 2020; 14:33. [PMID: 32676012 PMCID: PMC7333461 DOI: 10.3389/fnana.2020.00033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 05/28/2020] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging (MRI) data of children with late diagnosed congenital hypothyroidism and cognitive alterations such as abnormal verbal memory processing suggest altered telencephalic commissural connections. The corpus callosum (CC) is the major inter-hemispheric commissure that contra-laterally connects neocortical areas. However, in late diagnosed neonates with congenital hypothyroidism, the possible effect of early transient and chronic postnatal hypothyroidism still remains unknown. We have studied the development of the anterior, middle and posterior CC, using in vivo MRI and electron microscopy in hypothyroid and control male rats. Four groups of methimazole (MMI) treated rats were studied. One group, as a model for early transient hypothyroidism, was MMI-treated from postnatal day (P) 0 to P21; some of these rats were also treated with L-thyroxine (T4) from P15 to 21. Another group modeling chronic hypothyroid, were treated with MMI from P0 to 150 and from embryonic day 10 to P170. The results obtained from these groups were compared with same age control rats. The normalized T2 signal obtained using MRI was higher in MMI-treated rats and correlated with a low number and percentage of myelinated axons. The number and density of myelinated axons decreased in transient and chronic hypothyroid rats at P150. The g-ratio (inner to outer diameter ratio) and the estimated conduction velocity of myelinated axons were similar between MMI-treated and controls, but the conduction delay decreased in the posterior CC of MMI-treated rats compared to controls. These data show that early postnatal transient and chronic hypothyroidism alters CC maturation in a way that may affect the callosal transfer of information. These alterations cannot be reversed after delayed T4-treatment. Our data support the findings of neurocognitive delay in late T4-treated children with congenital hypothyroidism.
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Affiliation(s)
- Federico Salas-Lucia
- Departamento de Histología y Anatomía, Facultad de Medicina, Universidad Miguel Hernández (UMH), Sant Joan d’Alacant, Spain
| | - Jesús Pacheco-Torres
- Instituto de Neurociencias de Alicante, UMH – Consejo Superior de Investigaciones Científicas, Sant Joan d’Alacant, Spain
| | - Susana González-Granero
- Laboratorio de Neurobiología Comparada, Instituto Cavanilles de Biodiversidad y Biología Evolutiva, Universitat de València - Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Valencia, Spain
| | - José Manuel García-Verdugo
- Laboratorio de Neurobiología Comparada, Instituto Cavanilles de Biodiversidad y Biología Evolutiva, Universitat de València - Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Valencia, Spain
| | - Pere Berbel
- Departamento de Histología y Anatomía, Facultad de Medicina, Universidad Miguel Hernández (UMH), Sant Joan d’Alacant, Spain
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Mullan K, Patterson C, Doolan K, Cundick J, Hamill L, McKeeman G, McMullan P, Smyth P, Young I, Woodside JV. Neonatal TSH levels in Northern Ireland from 2003 to 2014 as a measure of population iodine status. Clin Endocrinol (Oxf) 2018; 89:849-855. [PMID: 30184261 DOI: 10.1111/cen.13849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/01/2018] [Accepted: 09/01/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The re-emergence of iodine deficiency in the UK has recently been reported in a large cohort of teenage girls including from Northern Ireland (NI) using the gold standard spot urinary iodine concentration. We wished to explore and confirm this by analysing neonatal thyroid-stimulating hormone (nTSH) levels in the NI population. DESIGN We analysed the nTSH heel prick tests results from the NI national screening database between 2003 and 2014. The WHO proposes a definition for population iodine sufficiency at <3% of the population with nTSH results >5 mIU/L. METHODS Anonymized results from 288 491 nTSH tests were retrieved, and prevalence rates of results at increasing cut-offs including >2 mIU/L and >5 mIU/L calculated. We also assessed for possible seasonal variation in nTSH results. RESULTS An overall population prevalence of 0.49% with TSH >5 mIU/L was found, indicating population iodine sufficiency with no year attaining a prevalence >3%. The prevalence of nTSH >2 mIU/L decreased to 4.1% in 2007 and subsequently increased to 9.8% in 2014. Modest seasonal variation was also detected, with higher levels among April/May births. CONCLUSIONS The neonatal TSH database suggests iodine sufficiency in the NI population. However, the rising frequency of results >2 mIU/L may indicate an emerging mild iodine deficiency. This is one of the largest and longest studies of its kind in the UK and the first carried out in NI. The summer months may be a time of increased risk of iodine deficiency in our pregnant women whose requirements are increased and who are not currently targeted by any iodine fortification programme in the UK.
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Affiliation(s)
- Karen Mullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| | - Chris Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Katy Doolan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Jennifer Cundick
- Regional Biochemistry Laboratory, Royal Victoria Hospital Belfast, Belfast, UK
| | - Lesley Hamill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Gareth McKeeman
- Regional Biochemistry Laboratory, Royal Victoria Hospital Belfast, Belfast, UK
| | - Paul McMullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| | | | - Ian Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
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9
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LaFranchi SH. Congenital Hypothyroidism: Inside Ireland's Incline. Pediatrics 2018; 142:peds.2018-2262. [PMID: 30242076 DOI: 10.1542/peds.2018-2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stephen H LaFranchi
- Doernbecher Children's Hospital, Portland, Oregon and Department of Pediatrics, Oregon Health and Sciences University, Portland, Oregon
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10
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Deng K, He C, Zhu J, Liang J, Li X, Xie X, Yu P, Li N, Li Q, Wang Y. Incidence of congenital hypothyroidism in China: data from the national newborn screening program, 2013-2015. J Pediatr Endocrinol Metab 2018; 31:601-608. [PMID: 29715190 DOI: 10.1515/jpem-2017-0361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/03/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH) is one of the most frequent, preventable causes of mental retardation. Little has been reported on the epidemiological characteristics of CH in China. We aimed to estimate the incidence of CH in China and investigate its geographical variation. METHODS We analyzed data from the nationwide newborn screening program for CH between 2013 and 2015. Poisson regression was used to generate the odds ratios (ORs) and 95% confidence intervals (CIs) between the rates of CH and selected demographic characteristics and assess the potential association between CH incidence and geographical locations. RESULTS A total of 18,666 patients with CH were identified from 45.2 million newborns, yielding an overall incidence rate of 4.13 per 10,000 live births. Compared with those in the remote area, regardless of infant sex, a higher incidence risk for CH was present in newborns in coastal areas and inland areas (females: OR=2.00, 95% CI: 1.86-2.16 and OR=1.74, 95% CI: 1.61-1.87, respectively; males: OR=1.70, 95% CI: 1.59-1.83 and OR=1.52, 95% CI: 1.42-1.63, respectively). Additionally, the highest risk of CH for thyroid-stimulating hormone (TSH) screening values <40 mU/L was observed among neonates in the coastal areas, while TSH screening values of 70-100 mU/L were observed among those in the inland areas. CONCLUSIONS The overall incidence of CH is high in China. The significant geographical variations of CH incidence are presented in this study.
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Affiliation(s)
- Kui Deng
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
| | - Chunhua He
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jun Zhu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Juan Liang
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xiaohong Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xiaoyan Xie
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Ping Yu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Nana Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Qi Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.,Department of Pediatrics, West China Second University Hospital, Sichuan University, 20, Section 3, Ren Min South Road, Chengdu, Sichuan, P.R. China, Phone: 86-028-85501363, Fax: 86-028-85501386
| | - Yanping Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China.,National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, 17, Section 3, Ren Min South Road, Chengdu, Sichuan, P.R. China, Phone: 86-028-85501189, Fax: 86-028-85501386
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Lucia FS, Pacheco-Torres J, González-Granero S, Canals S, Obregón MJ, García-Verdugo JM, Berbel P. Transient Hypothyroidism During Lactation Arrests Myelination in the Anterior Commissure of Rats. A Magnetic Resonance Image and Electron Microscope Study. Front Neuroanat 2018; 12:31. [PMID: 29755326 PMCID: PMC5935182 DOI: 10.3389/fnana.2018.00031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022] Open
Abstract
Thyroid hormone deficiency at early postnatal ages affects the cytoarchitecture and function of neocortical and telencephalic limbic areas, leading to impaired associative memory and in a wide spectrum of neurological and mental diseases. Neocortical areas project interhemispheric axons mostly through the corpus callosum and to a lesser extent through the anterior commissure (AC), while limbic areas mostly project through the AC and hippocampal commissures. Functional magnetic resonance data from children with late diagnosed congenital hypothyroidism and abnormal verbal memory processing, suggest altered ipsilateral and contralateral telencephalic connections. Gestational hypothyroidism affects AC development but the possible effect of transient and chronic postnatal hypothyroidism, as occurs in late diagnosed neonates with congenital hypothyroidism and in children growing up in iodine deficient areas, still remains unknown. We studied AC development using in vivo magnetic resonance imaging and electron microscopy in hypothyroid and control male rats. Four groups of methimazole (MMI) treated rats were studied. One group was MMI-treated from postnatal day (P) 0 to P21; some of these rats were also treated with L-thyroxine (T4) from P15 to P21, as a model for early transient hypothyroidism. Other rats were MMI-treated from P0 to P150 and from embryonic day (E) 10 to P170, as a chronic hypothyroidism group. The results were compared with age paired control rats. The normalized T2 signal using magnetic resonance image was higher in MMI-treated rats and correlated with the number and percentage of myelinated axons. Using electron microscopy, we observed decreased myelinated axon number and density in transient and chronic hypothyroid rats at P150, unmyelinated axon number increased slightly in chronic hypothyroid rats. In MMI-treated rats, the myelinated axon g-ratio and conduction velocity was similar to control rats, but with a decrease in conduction delays. These data show that early postnatal transient and chronic hypothyroidism alters AC maturation that may affect the transfer of information through the AC. The alterations cannot be recovered after delayed T4-treatment. Our data support the neurocognitive delay found in late T4-treated children with congenital hypothyroidism.
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Affiliation(s)
- Federico S. Lucia
- Departamento de Histología y Anatomía, Facultad de Medicina, Universidad Miguel Hernández, Sant Joan d’Alacant, Alicante, Spain
| | - Jesús Pacheco-Torres
- Instituto de Neurociencias de Alicante, Consejo Superior de Investigaciones Científicas, Universidad Miguel Hernández, Alicante, Spain
| | - Susana González-Granero
- Laboratorio de Neurobiología Comparada, Instituto Cavanilles de Biodiversidad y Biología Evolutiva, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat de València, Valencia, Spain
| | - Santiago Canals
- Instituto de Neurociencias de Alicante, Consejo Superior de Investigaciones Científicas, Universidad Miguel Hernández, Alicante, Spain
| | - María-Jesús Obregón
- Instituto de Investigaciones Biomédicas Alberto Sols, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - José M. García-Verdugo
- Laboratorio de Neurobiología Comparada, Instituto Cavanilles de Biodiversidad y Biología Evolutiva, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat de València, Valencia, Spain
| | - Pere Berbel
- Departamento de Histología y Anatomía, Facultad de Medicina, Universidad Miguel Hernández, Sant Joan d’Alacant, Alicante, Spain
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Khammarnia M, Siakhulak FR, Ansari H, Peyvand M. Risk factors associated with congenital hypothyroidism: a case-control study in southeast Iran. Electron Physician 2018; 10:6286-6291. [PMID: 29629049 PMCID: PMC5878020 DOI: 10.19082/6286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/27/2017] [Indexed: 01/26/2023] Open
Abstract
Background and aim Congenital hypothyroidism (CH) is known as one of the most common preventable cause of mental retardation. This study aimed to determine factors associated with CH in Iran. Methods This case-control study was conducted on 160 children under one year old in Zahedan in southeast Iran in 2016. The neonates who were born from March 1, 2015 to March 19, 2016 and had undergone a screening program for CH were the study population. The neonates with serum TSH > 10mIu/L and T4 < 6.5 or TSH > 30 mIu/L were considered as a case group. Each case was individually matched for sex, age at birth and place of residence with three neonates with normal TSH and T4 titers as a control group. Data was gathered using a standard checklist and analyzed using SPSS 20 and statistical tests, such as Chi-square and Fisher’s exact tests. Multivariable logistic regression analysis was also used to identify independent predictors of CH. Results About 25 of the 40 patients with CH (62.5%) were male who, in the univariate analysis, the following explanatory factors had no significant association with CH: history of parental consanguinity, type of delivery, weight at birth, height at birth, age of mother, sampling time, nationality, and birth season (p>0.05). Although, multivariate analysis showed no significant association between the studied factors and risk of CH (p>0.05), the likelihood of CH was greater among neonates born to consanguineous parents (AOR: 1.78, 95% CI: 0.82–3.89), those who were born to lower height at birth (AOR: 1.82, 95% CI: 0.85–3.91), neonates born to mothers younger than 18 years (AOR: 2.43, 95% CI: 0.57–10.29) and those who were born in the summer (AOR: 1.76, 95% CI: 0.57–5.44). Conclusion None of the studied factors were predictors for CH. Since consanguineous marriages are frequent in the province, and it may be a major contributory factor, future studies should be conducted on the genetic causes.
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Affiliation(s)
- Mohammad Khammarnia
- Ph.D., Assistant Professor, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fariba Ramezani Siakhulak
- M.Sc., Department of Epidemiology and Biostatistics, School of Public Health, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hossein Ansari
- Ph.D., Department of Epidemiology and Biostatistics, School of Public Health, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mostafa Peyvand
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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13
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Can One Predict Resolution of Neonatal Hyperthyrotropinemia? J Pediatr 2016; 174:71-77.e1. [PMID: 27189684 DOI: 10.1016/j.jpeds.2016.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/21/2016] [Accepted: 04/06/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify predictors of transience vs permanence of neonatal hyperthyrotropinemia. We hypothesized that infants with greater severity of perinatal stress are more likely to have transient thyrotropin elevations. STUDY DESIGN We retrospectively studied infants diagnosed with hyperthyrotropinemia between 2002 and 2014, following them for up to 12 years after diagnosis. Patients were divided into 3 groups: transient hyperthyrotropinemia (treatment was never prescribed), transient congenital hypothyroidism (treatment started but discontinued), and permanent congenital hypothyroidism (withdrawal unsuccessful or not attempted). We performed univariate and multiple logistic regression analyses, including and excluding infants with maternal thyroid disease. RESULTS We included 76 infants, gestational age mean (±SD) 34.2 (±5.7) weeks, evaluated for hyperthyrotropinemia. Thirty-five (46%) were never treated, and 41 (54%) received levothyroxine. Of the treated patients, 16 successfully discontinued levothyroxine, and for 25 withdrawal either failed or was not attempted. We found that male patients were almost 5 times more likely than female patients to have transient neonatal hyperthyrotropinemia (OR 4.85; 95% CI 1.53-15.37). We documented greater maternal age (31.5 ± 5.48 years vs 26 ± 6.76 years, mean ± SD, P = .02), greater rate of cesarean delivery (86.7% vs 54.2%; P = .036), and retinopathy of prematurity (37.5% vs 8%; P = .02) in the group with transient congenital hypothyroidism vs the group with permanent congenital hypothyroidism. CONCLUSION The results show transience of neonatal thyrotropin elevations in a majority of patients and suggest a possible association of hyperthyrotropinemia with maternal and perinatal risk factors.
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Kara C, Günindi F, Can Yılmaz G, Aydın M. Transient Congenital Hypothyroidism in Turkey: An Analysis on Frequency and Natural Course. J Clin Res Pediatr Endocrinol 2016; 8:170-9. [PMID: 27086592 PMCID: PMC5096472 DOI: 10.4274/jcrpe.2345] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Prevalence of congenital hypothyroidism (CH) in Turkey at birth was reported to be as high as 1:650 in 2008-2010. Incidence rates of permanent and transient CH separately are unknown due to lack of follow-up data. We aimed to evaluate the impact of transient hypothyroidism on increasing incidence of CH and to determine the natural course and the clinical, biochemical, and imaging characteristics of transient CH. METHODS Baseline and follow-up data of the infants with CH detected at screening in six provinces in the Black Sea Region were analyzed retrospectively during a time period covering the years 2008-2010. RESULTS Among 138 cases (48% female), 16 (12%) showed transient hyperthyrotropinemia which resolved without intervention. Of the treated 122 cases, 63 (52%) had transient CH. While its frequency was 35% in 2008, it increased to 56% in 2009-2010, following a lowering of the thyroid stimulating hormone cutoff value. The frequency was higher in inland provinces than in coast (67% vs. 43%; p=0.01).Clinical characteristics of permanent and transient cases were similar except female-to-male sex ratios (1.5:1 vs. 0.6:1; p=0.02). L-thyroxine was discontinued in 70% of transient cases before 3 years of age at a median age of 19 (2-36) months. The only indication for early discontinuation of treatment was a low L-thyroxine dose, which was 1.25±0.27 µg/kg/day at withdrawal time. CONCLUSION Our regional follow-up data showed that more than half of newborns with primary CH had transient thyroid dysfunction. In the majority of cases, discrimination between transient and permanent CH can be made before age 3 years, as indicated by cessation of L-thyroxine treatment.
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Affiliation(s)
- Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Samsun, Turkey E-mail:
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Mitrovic K, Vukovic R, Milenkovic T, Todorovic S, Radivojcevic J, Zdravkovic D. Changes in the incidence and etiology of congenital hypothyroidism detected during 30 years of a screening program in central Serbia. Eur J Pediatr 2016; 175:253-9. [PMID: 26346241 DOI: 10.1007/s00431-015-2630-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/26/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Congenital hypothyroidism (CH) is the most frequent congenital endocrine disorder. The purpose of the present study was to determine the incidence of CH in Central Serbia from 1983 to 2013. Newborn screening for CH was based on measuring neonatal thyroid-stimulating hormone (TSH) using a 30 mU/l cutoff (CO) until 12/1987 (P1), 15 mU/l until 12/1997 (P2), 10 mU/l until 12/2006 (P3), and 9 mU/l thereafter (P4). During the study period, there were 1,547,122 live births screened for CH. Primary CH was detected in 434 newborns, with incidence of 1:3728. With gradual lowering of the CO, the incidences of CH increased from 1:5943 in P1 to 1:1872 in P4 (p < 0.001). Incidence of CH with ectopic and enlarged gland doubled (p < 0.001), while prevalence of athyreosis remained relatively constant. The most prominent finding was the increase in the transient CH from none in P1 to 35 % of all CH patients in P4. CONCLUSION The overall incidence of CH in Central Serbia during study period nearly tripled, with a significant increase in almost all etiological categories, and was associated with lowering TSH cutoffs as well as other yet unidentified factors. Further studies are needed to identify other factors associated with increasing incidence of CH. WHAT IS KNOWN Congenital hypothyroidism (CH) is the main cause of preventable mental retardation. Recent reports have indicated a progressive increase in the incidence of primary CH throughout the world, partially explained by lowering of the TSH cutoff values. WHAT IS NEW During the study period associated with lowering of the TSH cutoffs, the overall incidence of CH in Serbia tripled, including transient CH, ectopy, and dyshormonogenesis, while prevalence of athyreosis remained stable during 30 years. Significant increase in the incidence of both permanent and transient CH was observed, associated with lowering of TSH cutoffs as well as other yet unidentified factors.
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Affiliation(s)
- Katarina Mitrovic
- Department of Endocrinology, Institute for Mother and Child Healthcare of Serbia "Dr Vukan Čupić", Radoja Dakica 6, 11070, Belgrade, Serbia.
| | - Rade Vukovic
- Department of Endocrinology, Institute for Mother and Child Healthcare of Serbia "Dr Vukan Čupić", Radoja Dakica 6, 11070, Belgrade, Serbia.
| | - Tatjana Milenkovic
- Department of Endocrinology, Institute for Mother and Child Healthcare of Serbia "Dr Vukan Čupić", Radoja Dakica 6, 11070, Belgrade, Serbia.
| | - Sladjana Todorovic
- Department of Endocrinology, Institute for Mother and Child Healthcare of Serbia "Dr Vukan Čupić", Radoja Dakica 6, 11070, Belgrade, Serbia.
| | - Jovana Radivojcevic
- Department of Endocrinology, Institute for Mother and Child Healthcare of Serbia "Dr Vukan Čupić", Radoja Dakica 6, 11070, Belgrade, Serbia.
| | - Dragan Zdravkovic
- Department of Endocrinology, Institute for Mother and Child Healthcare of Serbia "Dr Vukan Čupić", Radoja Dakica 6, 11070, Belgrade, Serbia. .,Medical Faculty, University of Belgrade, Belgrade, 11000, Serbia.
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Castanet M, Goischke A, Léger J, Thalassinos C, Rodrigue D, Cabrol S, Zenaty D, al-Harbi M, Polak M, Czernichow P. Natural history and management of congenital hypothyroidism with in situ thyroid gland. Horm Res Paediatr 2015; 83:102-10. [PMID: 25634148 DOI: 10.1159/000362234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE Normally sited glands account for increasing congenital hypothyroidism (CH). Mechanisms often remain unknown. To report the incidence of CH with in situ thyroid gland (ISTG) and describe the natural history of the disease without known etiology. METHOD Clinical, biochemical and imaging data at diagnosis were retrospectively analyzed in 285 children positively screened for CH in Ile-de-France between 2005 and 2008. If treatment was discontinued, management of hormonal substitution and follow-up of biochemical thyroid function was performed. RESULTS 93 full-term CH neonates displayed ISTG (40.6%), including 50 with unexplained mechanism. Follow-up data were available in 32 of them. Therapy was withdrawn from 20 children at a median age of 23.5 months (6-66), among whom 18 remained still untreated over a median duration of 15.3 months (4.4-29.6). In 11 children, levothyroxine (L-T4) dosage was increased over time to maintain biochemical euthyroidism. No statistical differences in initial TSH or FT4 levels, iodine status or birth weight were found between children with transient and permanent hypothyroidism. CONCLUSION Withdrawal of L-T4 substitution was feasible in 56.2% of full-term children with CH with ISTG but unexplained mechanism, emphasizing the need for systematic therapy withdrawal. However, further studies are warranted to standardize withdrawal protocol.
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Affiliation(s)
- Mireille Castanet
- Service d'Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
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Deladoëy J, Van Vliet G. The changing epidemiology of congenital hypothyroidism: fact or artifact? Expert Rev Endocrinol Metab 2014; 9:387-395. [PMID: 30763998 DOI: 10.1586/17446651.2014.911083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Screening increases prevalence estimates for most diseases and congenital hypothyroidism (CH) is no exception, affecting one in 6700 children by clinical ascertainment and one in 3500 in the first surveys of systematic biochemical screening of newborns. Importantly, screening has resulted in the disappearance of intellectual disability due to CH. A further doubling in prevalence estimates has recently been reported, mostly accounted for by changes in screening algorithms; accordingly, the prevalence of overt CH has remained stable. Population-based registries that distinguish confirmed diagnoses from positive screening results have proved invaluable. These registries should include: etiology of CH based on imaging, ideally technetium scintigraphy; ethnicity; socio-educational data; input from the screening laboratories and pediatric endocrinologists. Efforts should now be directed at increasing the proportion of the world's newborns screened for overt CH (currently 30%) and at determining if neonates with mild hyperthyrotropinemia also benefit from early treatment.
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Affiliation(s)
- Johnny Deladoëy
- a Endocrinology Service and Research Center, Sainte-Justine Hospital, Montreal, Canada
- b Department of Pediatrics, University of Montreal, Montreal, Canada
- c Department of Biochemistry, University of Montreal, Montreal, Canada
| | - Guy Van Vliet
- a Endocrinology Service and Research Center, Sainte-Justine Hospital, Montreal, Canada
- b Department of Pediatrics, University of Montreal, Montreal, Canada
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Rezaeian S, Moghimbeigi A, Esmailnasab N. Gender differences in risk factors of congenital hypothyroidism: an interaction hypothesis examination. Int J Endocrinol Metab 2014; 12:e13946. [PMID: 24790630 PMCID: PMC4005272 DOI: 10.5812/ijem.13946] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 08/12/2013] [Accepted: 01/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies have demonstrated an increased risk of congenital hypothyroidism (CH) in girls in comparison to boys. OBJECTIVES The aim of this study was to determine the potential interactions that are able to change the effect of gender on congenital hypothyroidism. PATIENTS AND METHODS We conducted a matched 1:4 case-control study in Hamadan Province, western of Iran, from 2005 to 2011. Based on screening program data, neonates with TSH ≥ 10 mU/L and T4 ≤ 6.4 μg/dL were considered as congenital hypothyroidism (Cases). Cases and controls were matched regarding the year and place of birth. Data was analyzed using two different approaches including propensity score and multiple conditional logistic regression model. RESULTS A total of 277 cases and 1036 controls were included in the study. Girls accounted for 57.4% of the cases and 51.2% of controls (P = 0.065). Based on the multiple conditional logistic regressions, only the interaction of gender (girl) and birth season (summer) increased the likelihood of CH significantly (OR = 3.09; 95% CI: 1.09-8.74; P = 0.034). On the other hand, the ORs of the interaction of gender and all other factors (except for birth season) were not statistically significant in CH. CONCLUSIONS Birth season might act as an interaction that is able to increase the risk of CH in girls. Accordingly, awareness of the birth season could help policymakers who plan preventive programs to reduce the false negative results among neonates, especially girls.
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Affiliation(s)
- Shahab Rezaeian
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Abbas Moghimbeigi
- Research Center for Health Sciences, Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Nader Esmailnasab
- Kurdistan Research Center for Social Determinants of Health (KRCSDH), School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, IR Iran
- Corresponding author: Nader Esmailnasab, Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, P.O.Box:66177-13446, Sanandaj, IR Iran. Tel: +98-8716131384, Fax: +98-8716664674, E-mail:
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Rabbiosi S, Vigone MC, Cortinovis F, Zamproni I, Fugazzola L, Persani L, Corbetta C, Chiumello G, Weber G. Congenital hypothyroidism with eutopic thyroid gland: analysis of clinical and biochemical features at diagnosis and after re-evaluation. J Clin Endocrinol Metab 2013; 98:1395-402. [PMID: 23426615 DOI: 10.1210/jc.2012-3174] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In recent years changes in screening strategies for congenital hypothyroidism (CH) led to an increased detection of mild forms of CH, associated with eutopic thyroid gland. OBJECTIVES We aimed to determine the clinical evolution of CH with eutopic thyroid gland and to find out prognostic factors at diagnosis and follow-up. PATIENTS AND METHODS We retrospectively analyzed a group of 84 children with CH and eutopic thyroid gland treated at our institution. They all underwent clinical re-evaluation after the age of 3, based on thyroid function testing after l-thyroxine therapy withdrawal, thyroid ultrasonography, and (123)I scintigraphy with perchlorate discharge test. Genetic analysis was performed in selected cases. RESULTS At re-evaluation, 34.5% of patients showed permanent hypothyroidism and needed l-thyroxine reintroduction, 27.4% had persistent hyperthyrotropinemia (TSH 5-10 mU/L), and 38.1% had transient hypothyroidism. Major risk factors for permanent CH were prematurity, first-degree familial history of goiter/nodules, thyroid hypoplasia at diagnosis, and high l-thyroxine requirements at follow-up. Iodine organification defects were found in 29.7% of patients, 30% of whom harbored DUOX2 mutations. TSH receptor gene mutations were found in 8.7% of patients with persistent thyroid dysfunction and negative perchlorate discharge test. CONCLUSIONS Only one-third of patients with CH and eutopic thyroid gland needed to continue l-thyroxine therapy after re-evaluation. A frequent finding was the persistence of mild hyperthyrotropinemia. The evolution of CH remains difficult to predict, although different clinical features might suggest different outcomes. Mutations in the genes commonly linked to mild forms of CH were documented in a minority of cases.
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Affiliation(s)
- Sarah Rabbiosi
- Department of Pediatrics, Vita-Salute San Raffaele University, Scientific Institute San Raffaele Hospital, Milan, Italy.
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20
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Weber G, Rabbiosi S, Zamproni I, Fugazzola L. Genetic defects of hydrogen peroxide generation in the thyroid gland. J Endocrinol Invest 2013; 36:261-6. [PMID: 23404134 DOI: 10.3275/8847] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hydrogen peroxide (H2O2) is a key element in thyroid hormone biosynthesis. It is the substrate used by thyroid peroxidase for oxidation and incorporation of iodine into thyroglobulin, a process known as organification. The main enzymes composing the H2O2-generating system are the dual oxidase 2 (DUOX2) and the recently described DUOX maturation factor 2 (DUOXA2). Defects in these reactions lead to reduced thyroid hormone synthesis and hypothyroidism, with consequent increased TSH secretion and goiter. Since the first report in 2002 of DUOX2 mutations causing congenital hypothryoidism (CH), to date 25 different mutations have been described. Affected patients show a positive perchlorate discharge test and high phenotypic variability, ranging from transient to permanent forms of CH. Up to now, only two cases of CH due to DUOXA2 defects have been published. They also suggest the existence of a great genotype-phenotype variability. The phenotypic expression is probably influenced by genetic background and environmental factors. DUOX and DUOXA constitute a redundant system in which DUOX1/DUOXA1 can at least partially replace the function of DUOX2/DUOXA2. Furthermore, increased nutritional iodide could ensure a better use of H2O2 provided by DUOX1.
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Affiliation(s)
- G Weber
- Department of Pediatric Endocrinology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy.
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Zeinalzadeh AH, Talebi M. Neonatal screening for congenital hypothyroidism in East Azerbaijan, Iran: the first report. J Med Screen 2012; 19:123-6. [DOI: 10.1258/jms.2012.012024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To investigate the prevalence of congenital hypothyroidism (CH) among neonates in East Azerbaijan, Iran. Methods A cross-sectional study conducted from 2009 to 2010. Most heel blood samples were taken between three and seven days of birth. Thyroid stimulating hormone (TSH) was tested using the enzyme-linked immunosorbent assay method. Neonates with abnormal screening results (TSH>20 mIU/L, T4<6.5 mg/dL) were re-examined. Data were analysed using SPSS software. Results A total of 62,459 infants were screened. Of 1562 re-called subjects (re-call rate 2.5%), 94 cases with CH were detected, yielding a CH prevalence of 1:666 (female:male ratio 1:1.4). Conclusion The prevalence of CH in East Azerbaijan province is higher in comparison with worldwide levels. These results emphasize the importance of the neonatal screening programme.
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Affiliation(s)
- Ali Hossein Zeinalzadeh
- Community Medicine Specialist, Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Malihe Talebi
- General Practitioner, Province Health Center, Tabriz University of Medical Sciences, Tabriz, Iran
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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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