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Sheikhi S, Aghazadeh R, Sayyadi H, Pourheydar B, Saboory E, Bagheri M, Derafshpour L. The effects of choline supplementation in mothers with hypothyroidism on the alteration of cognitive-behavioral, long-term potentiation, morphology, and apoptosis in the hippocampus of pre-pubertal offspring rats. Int J Dev Neurosci 2024; 84:109-121. [PMID: 38311365 DOI: 10.1002/jdn.10312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 12/10/2023] [Accepted: 12/24/2023] [Indexed: 02/10/2024] Open
Abstract
The mother's thyroid hormone status during gestation and the first few months after delivery can play a crucial role in maturation during the brain development of the child. Transient abnormalities in thyroid function at birth indicate developmental and cognitive disorders in adulthood. Choline supplementation during gestation and the perinatal period in rats causes long-lasting memory improvement in the offspring. However, it remains unclear whether choline is able to restore the deficits in rats with maternal hypothyroidism. The aim of this study was to evaluate the effects of choline supplementation on the alteration of cognitive-behavioral function, long-term potentiation (LTP), and morphological changes as well as apoptosis in pre-pubertal offspring rats. To induce hypothyroidism, 6-propyl-2-thiouracil was added to the drinking water from the 6th day of gestation to the 21st postnatal day (PND). Choline treatment was started twice a day on the first day of the gestation until PND 21 via gavage. LTP recording and Morris water maze (MWM) test were conducted at PND 28. Then, the rats were sacrificed to assess their brains. The results revealed that developmental thyroid hormone deficiency impaired spatial learning and memory and reduced LTP (both: P < 0.001). Choline treatment alleviated LTP (P < 0.001), as well as learning and memory deficits (P < 0.01) in both male and female hypothyroid rats. However, no significant changes were observed in the number of caspase-3 stained cells in choline-receiving hypothyroid groups. The results revealed that developmental thyroid hormone deficiency impaired spatial learning and memory and reduced LTP. Choline treatment alleviated LTP, as well as learning and memory deficits in both male and female hypothyroid rats.
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Affiliation(s)
- Siamak Sheikhi
- Department of Psychiatry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Razieh Aghazadeh
- Department of Physiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hojjat Sayyadi
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Bagher Pourheydar
- Neurophysiology Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Ehsan Saboory
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Morteza Bagheri
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Leila Derafshpour
- Neurophysiology Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
- Ottawa Hospital Research Institute, Ottawa, Canada
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Joshi JS, Shanoo A, Patel N, Gupta A. From Conception to Delivery: A Comprehensive Review of Thyroid Disorders and Their Far-Reaching Impact on Feto-Maternal Health. Cureus 2024; 16:e53362. [PMID: 38435202 PMCID: PMC10907906 DOI: 10.7759/cureus.53362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
This comprehensive review delves into the multifaceted landscape of thyroid disorders during pregnancy, exploring their impact from conception to postpartum considerations. Key findings highlight the intricate interplay between maternal thyroid health and fetal development, emphasizing the critical importance of timely screening and targeted interventions. The evolving landscape of research and technology suggests a paradigm shift toward personalized approaches in clinical practice, emphasizing integrated care models and the integration of telehealth platforms. Postpartum considerations, including postpartum thyroiditis, underscore the necessity for ongoing monitoring and intervention for maternal well-being. Implications for clinical practice encompass healthcare provider education, public awareness campaigns, and policy advocacy for standardized screening guidelines. The call to action resonates for increased research funding to advance understanding and improve outcomes. By fostering awareness, education, and collaborative efforts, this review aims to navigate the complexities of thyroid disorders during pregnancy, ensuring a healthier start for both mothers and their infants.
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Affiliation(s)
- Jalormy S Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amardeep Shanoo
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nainita Patel
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Gómez-Lavín Fernández L, Comas Rovira M, Pina Pérez S, Moreno Baró A, Corripio Collado R, Zamora Lapiedra M, Lesmes Heredia C, Albert Fabregas L. Management of foetal hyperthyroidism in a mother with autoimmune hypothyroidism: A case report. ENDOCRINOL DIAB NUTR 2023; 70:511-516. [PMID: 37596010 DOI: 10.1016/j.endien.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 08/20/2023]
Abstract
Foetal hyperthyroidism is mediated by transplacental passage of thyroid stimulating antibodies (TSAbs) and affects mothers with autoimmune (AI) thyroid disease. We report a case of a 33-year-old woman with a history of AI hypothyroidism and raised TSI after 2 stillbirths with suspect foetal hyperthyroidism. At 20.5 gestational weeks (GW) of her third pregnancy, foetal tachycardia and goitre were detected. TSI levels were 30.9mUI/mL. Methimazole (MMI) was started and adjusted based on ultrasound signs (foetal heart rate and thyroid gland vascularisation). The neonate was born at 35GW and cord blood revealed decreased TSH and normal free T4. MMI was started in the neonate at 2 days of life due to the appearance of asymptomatic hyperthyroidism. This case illustrates a rare recurrence of foetal hyperthyroidism in a mother with AI hypothyroidism. Pregestational thyroidectomy, TSAbs determination, early ultrasound diagnosis and foetal therapy helped us to improve obstetric outcomes.
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Affiliation(s)
- Lucía Gómez-Lavín Fernández
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Montserrat Comas Rovira
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain.
| | - Silvia Pina Pérez
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Anna Moreno Baró
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Raquel Corripio Collado
- Paediatric Endocrinology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Marc Zamora Lapiedra
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Cristina Lesmes Heredia
- Obstetrics and Gynaecology Department, Maternal-Foetal Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Inovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Lara Albert Fabregas
- Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
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Гусейнова РМ, Просвирнина АА, Корчагина МО, Трухин АА, Шеремета МС. [Thyrotoxicosis in a patient with Turner syndrome: radioactive iodine therapy]. PROBLEMY ENDOKRINOLOGII 2022; 68:49-58. [PMID: 36689711 PMCID: PMC9939966 DOI: 10.14341/probl13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
Turner syndrome (TS) is a chromosomal disorder affecting female and characterized by complete or partial monosomy of the X chromosome. These genetic changes lead to the abnormalities in growth and development and increase the risk of autoimmune diseases, including those affecting the thyroid. Thyroid pathology in TS may include autoimmune thyroiditis, hypothyroidism, thyrotoxicosis (Graves disease, AIT in the hyperthyroid state).Thyrotoxicosis is the clinical syndrome of excess circulating thyroid hormones. One of the main causes of thyrotoxicosis is Graves' disease (GD), an organ-specific autoimmune disease caused by the production of stimulating thyrotropin receptor antibodies. There are three treatment options for thyrotoxicosis: anti-thyroid drugs, radioactive iodine and thyroidectomy. A personalized approach to disease management is especially important in cases of genetic diseases.We present a clinical case of a patient with TS and GD, who has been referred to a radiologist at the Department of Radionuclide Therapy of Endocrinology Research Center. The patient was diagnosed with congenital hypothyroidism at neonatal screening, but thyroid hormones therapy was initiated aged three. Based on the survey, GD was diagnosed aged twenty one. Anti-thyroid drug therapy was started, which resulted in toxic hepatitis. Taking into account intolerance to anti-thyroid drugs, radioiodine therapy has been recommended, which led to hypothyroidism.
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Affiliation(s)
- Р. М. Гусейнова
- Национальный медицинский исследовательский центр эндокринологии
| | | | - М. О. Корчагина
- Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)
| | - А. А. Трухин
- Национальный медицинский исследовательский центр эндокринологии
| | - М. С. Шеремета
- Национальный медицинский исследовательский центр эндокринологии
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Yokomichi H, Mochizuki M, Kojima R, Horiuchi S, Ooka T, Akiyama Y, Miyake K, Kushima M, Otawa S, Shinohara R, Yamagata Z. Mother's iodine exposure and infants' hypothyroidism: the Japan Environment and Children's Study (JECS). Endocr J 2022; 69:9-21. [PMID: 34433732 DOI: 10.1507/endocrj.ej21-0168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this study, we aimed to determine the association of neonatal/post-neonatal hypothyroidism with mother's iodine exposure, especially povidone iodine disinfection, and hysterosalpingography. Participants were mother-child pairs in a Japanese birth cohort (n = 100,286). Risk factors of hypothyroidism were supplement intake, seaweed intake, other daily iodine intake, povidone iodine disinfection at delivery, and maternal history of hysterosalpingography, thyroid disease (Graves' disease and Hashimoto's thyroiditis), and medication (thiamazole and levothyroxine). Congenital hypothyroidism (CH) at age 1 year was assessed using a questionnaire. Transient hypothyroidism was defined as elevated thyroid stimulating hormone level at birth and absence of CH at age 1 year. The incidence of CH at age 1 year per 100 children was 1.1 for those born at 22-30 weeks' gestation, 0.17 following povidone iodine disinfection, and 0.07, 0.95, 0.81, 1.17, and 1.15 with a maternal history of hysterosalpingography, Graves' disease, Hashimoto's thyroiditis, thiamazole use, and levothyroxine use, respectively. Odds ratios (95% confidence intervals) of CH at age 1 year for povidone iodine disinfection, hysterosalpingography history, maternal Graves' disease, and maternal Hashimoto's thyroiditis were 1.13 (0.71-1.79), 0.47 (0.07-3.36), 7.06 (3.70-13.5), and 5.93 (2.90-12.1), respectively. For transient hypothyroidism for povidone iodine disinfection and hysterosalpingography history, these values were 1.99 (1.51-2.62) and 0.63 (0.20-1.96), respectively. Maternal thyroid disease greatly increased neonatal/post-neonatal hypothyroidism risk. Povidone iodine disinfection may increase transient hypothyroidism risk but not the risk at 1 year of age. Hysterosalpingography does not increase hypothyroidism risk from birth to age 1 year.
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Affiliation(s)
- Hiroshi Yokomichi
- Department of Health Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Mie Mochizuki
- Department of Pediatrics, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Reiji Kojima
- Department of Health Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Tadao Ooka
- Department of Health Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yuka Akiyama
- Department of Health Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Kunio Miyake
- Department of Health Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi 409-3898, Japan
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6
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Abstract
Congenital hypothyroidism (CH) is a disorder of thyroid hormone deficiency which develops secondary to incomplete thyroid development or inadequate thyroid hormone production. State-mandated newborn screening throughout the United States has increased the detection rate of CH, allowing for early intervention. Although the overall mortality rate of CH is low, delayed or omitted treatment can lead to devastating neurocognitive outcomes. As such, CH is regarded as the leading cause of preventable intellectual disability in children. Early identification, facilitated by astute neonatal nursing and medical care, is contingent upon an active working knowledge of the disease process and awareness of the limitations of the newborn screen.
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7
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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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Rashidy-Pour A, Derafshpour L, Vafaei AA, Bandegi AR, Kashefi A, Sameni HR, Jashire-Nezhad N, Saboory E, Panahi Y. Effects of treadmill exercise and sex hormones on learning, memory and hippocampal brain-derived neurotrophic factor levels in transient congenital hypothyroid rats. Behav Pharmacol 2021; 31:641-651. [PMID: 32826427 DOI: 10.1097/fbp.0000000000000572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Transient thyroid function abnormalities at birth exhibit intellectual developmental and cognitive disorders in adulthood. Given the well-known effects of physical activity and sex hormones on cognitive functions and brain-derived neurotrophic factor (BDNF), the present study examined the effects of treadmill exercise, sex hormones, and the combined treatment on learning and memory and hippocampal BDNF levels in transient congenital hypothyroid rats. To induce hypothyroidism, 6-propyl-2-thiouracil was added to the drinking water from the 6th day of gestation to the 21st postnatal day (PND). From PNDs 28 to 47, female and male pup rats received 17β-estradiol and testosterone, respectively, and about 30 min later, they were forced to run on the treadmill for 30 min once a day. On PNDs 48-55, spatial learning and memory of all rats tested in the water maze, which followed by measurement of BDNF in the hippocampus. Results showed that developmental hypothyroidism induced significant deficits in spatial learning and memory and hippocampal BDNF in both male and female rats. In both male and female hypothyroid rats, exercise and exercise plus sex hormones, but not sex hormones alone alleviated learning and memory deficits and all treatments (exercise, sex hormones, and the combined treatment) increased hippocampal BDNF. These disconnects in the effects of exercise, sex hormones and the combined treatment on behavioral and neurochemical outcomes suggest that a neurochemical mechanism other than hippocampal BDNF might contribute in the ameliorating effects of exercise on learning and memory deficits induced by developmental thyroid hormone insufficiency.
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Affiliation(s)
- Ali Rashidy-Pour
- Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan
| | - Leila Derafshpour
- Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia
| | - Abbas Ali Vafaei
- Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan
| | - Ahmad Reza Bandegi
- Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan.,Department of Biochemistry, Faculty of Medicine, Semnan University of Medical Sciences
| | - Adel Kashefi
- Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan
| | - Hamid Reza Sameni
- Research Center of Nervous System Stem Cell, Semnan University of Medical sciences, Semnan
| | - Nahid Jashire-Nezhad
- Research Center of Nervous System Stem Cell, Semnan University of Medical sciences, Semnan
| | - Ehsan Saboory
- Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia
| | - Yosef Panahi
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
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Changes in nitric oxide synthase levels are associated with impaired cardiac function and tolerance to ischemia-reperfusion injury in male rats with transient congenital hypothyroidism. Naunyn Schmiedebergs Arch Pharmacol 2020; 393:1103-1111. [PMID: 31940052 DOI: 10.1007/s00210-020-01812-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/04/2020] [Indexed: 12/14/2022]
Abstract
Transient congenital hypothyroidism (TCH) has long-lasting consequences on the cardiovascular system during adulthood. The aim of this study was to determine whether nitric oxide (NO) and NO-producing enzymes are involved in impaired cardiac function as well as decreased tolerance to ischemia-reperfusion (IR) injury in adult male rats with TCH. Pregnant rats were divided into control and hypothyroid groups. Male offspring rats were categorized in control and hypothyroid (TCH) groups at week 16. Levels of NOx (nitrate+nitrite) and neuronal NOS (nNOS), inducible NOS (iNOS), and endothelial NOS (eNOS) were measured in hearts of rats and isolated perfused hearts from both groups were subjected to IR. Levels of NOx and NOSs were also measured in both groups after ischemia. Compared with controls, heart NOx levels were higher at baseline (48.0 ± 4.9 vs. 35.0 ± 2.6 μmol/L; P = 0.034) and following IR (103.6 ± 4.2 vs. 70.2 ± 2.7 μmol/L; P < 0.001) in rat with TCH. At baseline, compared with controls, heart iNOS and nNOS levels were significantly higher in rats with TCH (6.12 ± 0.34 vs. 4.78 ± 0.27 ng/mg protein; P = 0.008 for iNOS and 4.87 ± 0.28 vs. 3.55 ± 0.23 ng/mg protein; P = 0.003 for nNOS). Following IR, in rats with TCH, heart iNOS levels increased (11.75 ± 2.02 vs. 6.12 ± 0.34, ng/mg protein; P = 0.015) whereas nNOS level decreased (4.10 ± 0.25 vs. 4.87 ± 0.28 ng/mg protein; P = 0.063). Adverse effects of TCH on cardiac function are associated with increased ratio of iNOS/eNOS; in addition, increased heart nNOS levels are involved in impaired cardiac function while its decrease is associated with decreased tolerance to IR injury.
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Delivery of Euthyroid Baby following Hyperthyroidism in Twin Gestation with Coexisting Complete Hydatidiform Mole. Case Rep Endocrinol 2019; 2019:2941501. [PMID: 31949957 PMCID: PMC6944968 DOI: 10.1155/2019/2941501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/13/2019] [Indexed: 01/22/2023] Open
Abstract
Context Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Twin pregnancies with GTD and coexisting normal fetus are extremely rare with an estimated incidence of 1 case per 22,000–100,000 pregnancies. Molecular mimicry between human chorionic gonadotrophin (hCG) and thyroid-stimulating hormone (TSH) leads to gestational trophoblastic hyperthyroidism (GTH) which is further associated with increased maternal and fetal complications. This is the first reported case in literature describing the delivery of a baby with biochemical euthyroid status following a twin pregnancy with hydatidiform mole (HM) associated with gestational trophoblastic hyperthyroidism (GTH). Case Description A 24-year-old G4 P3 Caucasian female with twin gestation was admitted to hospital for gestation trophoblastic hyperthyroidism. She was later diagnosed to have twin pregnancy with complete mole and coexisting normal fetus complicated by gestational trophoblastic hyperthyroidism (GTH). Despite the risk associated with the continuation of molar pregnancy, per patient request, pregnancy was continued till viability of the fetus. The patient underwent cesarean section due to worsening preeclampsia and delivered a euthyroid baby at the 24th week of gestation. Conclusions Twin pregnancy with gestational trophoblastic disease and coexisting normal fetus is associated with high risk of hyperthyroidism, and careful monitoring of the thyroid function test along with dose titration of thionamides is of utmost importance throughout the gestation. If normal thyroid hormone levels are maintained during the pregnancy, euthyroidism could be successfully achieved in the baby.
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Themelin C, Pierron C, Calafat JF, de Beaufort C. Transient neonatal hypothyroidism secondary to postnatal maternal exposure to contrast medium. BMJ Case Rep 2019; 12:12/10/e230854. [PMID: 31619400 DOI: 10.1136/bcr-2019-230854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a preterm breastfed infant who developed a transient hypothyroidism after his lactating mother had a CT scan with iodinated contrast medium, despite the advised 24 hours' pause in breast feeding. The aetiological assessment did not show any other cause for this hypothyroidism. Transient neonatal hypothyroidism after the use of topical iodine is well known, but it has not been described as a complication of intravenous contrast medium administration to a lactating mother. This case highlights the possibility of transient neonatal hypothyroidism secondary to contrast medium exposure to a lactating mother. When imaging is needed in the lactating mother, a longer break in breast feeding might be needed to prevent transient hypothyroidism in the preterm infant.
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Affiliation(s)
- Céline Themelin
- Pediatrics, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
| | - Charlotte Pierron
- Pediatrics, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
| | | | - Carine de Beaufort
- Pediatrics, Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg .,Pediatrics, Universitair Ziekenhuis Brussel, Brussel, Belgium
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12
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Hemati Z, Hashemipour M, Hovsepian S, Mansourian M, Zandieh M, Ahmadian M, Dalvi M, Arefnia S, Kelishadi R. Congenital hypothyroidism in different cities of the Isfahan province: A descriptive retrospective study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:137. [PMID: 31463322 PMCID: PMC6691614 DOI: 10.4103/jehp.jehp_219_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 03/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Considering the high prevalence rate of congenital hypothyroidism CH in Iran, an epidemiological study in each region would be helpful in understanding the etiology of the disorder and providing preventative strategies in this field. This study aims to determine the prevalence of CH in different cities of the Isfahan province. MATERIALS AND METHODS This descriptive and retrospective study was conducted among 918 primarily diagnosed CH neonates, who have been identified through the neonatal screening program from 2009 to 2015. At the age of ≥3 years, treatment was discontinued for 4 weeks, and T4 and thyroid-stimulating hormone were measured. Permanent (PCH) or transient (TCH) was determined from the results of the thyroid function tests. RESULTS From 389,101 screened neonates, 918 were diagnosed with primary CH. The overall prevalence rate of CH was 2.36 in 1000 live birth (ranged 1.58-7.22 in 1000 live birth in different cities). The highest prevalence rate of CH was reported in Ardestan, Khansar, Golpaygan, and Nain cities with prevalence rate of 4.86-7.22 in 1000 live birth and lowest prevalence occurring in Fereydan, Shahreza, Isfahan, and Mobarakeh cities with prevalence rate of 1.58-1.89 in 1000 live birth. In 392 cases which reached to 3 years of age, the rate of TCH was 47.45%. In Chadegan, Natanz, Fereydunshahr, Shahinshahr, Najafabad, Dehaghan, Borkhar, and Mobarakeh, the prevalence of PCH was <50%. CONCLUSION The current findings indicate that the incidence rate of both PCH and TCH are high in Isfahan province with significant variability in different cities which could be due to the role of different genetic, prenatal, and different environmental factors. These epidemiological data could be used as baseline date to design more etiological studies.
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Affiliation(s)
- Zeinab Hemati
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | - Mahin Hashemipour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Silva Hovsepian
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Pediatrics, Emam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Zandieh
- Isfahan Health Center, Colleague of Congenital Hypothyroidism Screening Program, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahshid Ahmadian
- Isfahan Health Center, Colleague of Congenital Hypothyroidism Screening Program, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzie Dalvi
- Isfahan Health Center, Colleague of Congenital Hypothyroidism Screening Program, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Serajoddin Arefnia
- Department of Pediatrics, Emam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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An Optimal Capillary Screen Cut-off of Thyroid Stimulating Hormone for Diagnosing Congenital Hypothyroidism: Data from a Pilot Newborn Screening Program in Delhi. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Derafshpour L, Saboory E, Vafaei AA, Rashidy-Pour A, Roshan-Milani S, Rasmi Y, Panahi Y, Sameni H. Interactive Effects of Exercise, Sex Hormones, and Transient Congenital Hypothyroidism on Long-Term Potentiation in Hippocampal Slices of Rat Offspring. Basic Clin Neurosci 2019; 10:119-135. [PMID: 31031899 PMCID: PMC6484195 DOI: 10.32598/bcn.9.10.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/25/2017] [Accepted: 04/30/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction: The long-term adverse effects of transient thyroid function abnormalities at birth on intellectual development are proven. The effect of exercise increases in the presence of sex hormones. The current study aimed at investigating the possibility that a combination of sex hormones and exercise has synergistic effects on neural plasticity in Transient Congenital Hypothyroidism (TCH) rats. Methods: To induce hypothyroidism in the mothers, Propylthiouracil (PTU) was added to drinking water (100 mg/L) on the 6th day of gestation and continued until the 21st Postnatal Day. From Postnatal Day (PND) 28 to 47, the female and male pups received 17β-estradiol and testosterone, respectively. The mild treadmill exercise began 30 minutes after the sex hormones or vehicle administration. On PND 48, electrophysiological experiments were performed on brain slices. Results: Increase of Long-Term Potentiation (LTP) was observed in sedentary-non-hormone female rats of TCH group, compared with that of the control. The exercise enhanced LTP in control rats, but the hormones showed no significant effect. The effect of exercise and sex hormone was not significant in the TCH group. The combination of exercise and testosterone enhanced LTP in TCH male rats, while the combination of exercise and estradiol or each of them individually did not produce such an effect on LTP in TCH female rats. Conclusion: The study findings showed an increase in excitatory transmission despite the returning of thyroid hormone levels to normal range in TCH female rats. Also a combination treatment including exercise and testosterone enhanced LTP in male rats of TCH group, which was a gender-specific event.
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Affiliation(s)
- Leila Derafshpour
- Laboratory of Learning and Memory, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran.,Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Ehsan Saboory
- Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Abbas Ali Vafaei
- Laboratory of Learning and Memory, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Rashidy-Pour
- Laboratory of Learning and Memory, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Shiva Roshan-Milani
- Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Yousef Rasmi
- Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Yousef Panahi
- Department of Basic Science, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Hamidreza Sameni
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Razavi Z, Dalili S, Sabzehei MK, Yousefi A, Nouri S, Abedi M, Bazmamoun H. Developmental Screening of Children with Congenital Hypothyroidism Using Ages and Stages Questionnaires Test. IRANIAN JOURNAL OF CHILD NEUROLOGY 2019; 13:145-154. [PMID: 31037087 PMCID: PMC6451860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 06/27/2018] [Accepted: 11/05/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Congenital hypothyroidism (CH) is one of the most common causes of mental retardation in children. We investigated the developmental status of children with CH screened by Ages & Stages Questionnaires (ASQ) measurement scores. MATERIALS & METHODS In this retrospective study, neurodevelopmental status of 78 children diagnosed with CH followed up at the Outpatient Pediatric Endocrinology Clinic of Besat Hospital, Hamadan, Iran from May 2006 to Mar 2013, was evaluated by ASQ method. Data on age, sex, birth weight, birth length, head circumference, residency location, parental education level, primary venous TSH and T4 levels, age at diagnosis, treatment start age and initial levothyroxine dosage were extracted from medical records. Data were analyzed using statistical software SPSS. P-value less than 0.05 was considered statistically significant. RESULTS Of the 78 patients, 34 (43.6%) were female, 32 (41%) had developmental disorder, and 56 (71.8%) were living in urban areas. Types of developmental impairments included: global motor delay in 13 (40.6%) patients, problem-solving in 11 (34.3%), impaired communication skills in 5 (15.6%), impaired fine motor skills in 2 (6.2%), and impairment of personal social skills in 1 (3.1%). The average ages for diagnosis and treatment were 25.65 days in patients with developmental impairment and 17.99 days in those without developmental delay. ASQ results showed significant statistical correlation with initial dose of levothyroxine (P=0.017), age of hypothyroidism diagnosis (P=0.002) and age of treatment initiation (P=0.018). CONCLUSION Early diagnosis and treatment along with initial levothyroxine dose were most important factors of ASQ scores of children with CH. Higher dose of the levothyroxine is required at onset.
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Affiliation(s)
- Zahra Razavi
- Department of Pediatric Endocrinology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Setila Dalili
- Department of Pediatric Endocrinology, Pediatric Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Guilan, Iran
| | - Mohammad Kazem Sabzehei
- Department of Neonatology, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arman Yousefi
- Department of Pediatrics, Hamadan University of Medical Sciences
| | - Shahla Nouri
- Department of population and family health, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Mahbubeh Abedi
- Family Health Center, Hamadan University of Medical Sciences, Hamadan
| | - Hassan Bazmamoun
- Department of Pediatric Gastroenterology, Hamadan University of Medical Sciences, Hamadan, Iran
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Abstract
Extracellular hydrogen peroxide is required for thyroperoxidase-mediated thyroid hormone synthesis in the follicular lumen of the thyroid gland. Among the NADPH oxidases, dual oxidases, DUOX1 and DUOX2, constitute a distinct subfamily initially identified as thyroid oxidases, based on their level of expression in the thyroid. Despite their high sequence similarity, the two isoforms present distinct regulations, tissue expression, and catalytic functions. Inactivating mutations in many of the genes involved in thyroid hormone synthesis cause thyroid dyshormonogenesis associated with iodide organification defect. This chapter provides an overview of the genetic alterations in DUOX2 and its maturation factor, DUOXA2, causing inherited severe hypothyroidism that clearly demonstrate the physiological implication of this oxidase in thyroid hormonogenesis. Mutations in the DUOX2 gene have been described in permanent but also in transient forms of congenital hypothyroidism. Moreover, accumulating evidence demonstrates that the high phenotypic variability associated with altered DUOX2 function is not directly related to the number of inactivated DUOX2 alleles, suggesting the existence of other pathophysiological factors. The presence of two DUOX isoforms and their corresponding maturation factors in the same organ could certainly constitute an efficient redundant mechanism to maintain sufficient H2O2 supply for iodide organification. Many of the reported DUOX2 missense variants have not been functionally characterized, their clinical impact in the observed phenotype remaining unresolved, especially in mild transient congenital hypothyroidism. DUOX2 function should be carefully evaluated using an in vitro assay wherein (1) DUOXA2 is co-expressed, (2) H2O2 production is activated, (3) and DUOX2 membrane expression is precisely analyzed.
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Affiliation(s)
- Xavier De Deken
- Faculté de Médecine, Université Libre de Bruxelles (ULB), Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Brussels, Belgium.
| | - Françoise Miot
- Faculté de Médecine, Université Libre de Bruxelles (ULB), Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Brussels, Belgium
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Ybarra M, Dos Santos TJ, Pinheiro CTC, Dichtchekenian V, Damiani D. Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study. Pediatrics 2018; 142:peds.2017-3317. [PMID: 30002138 DOI: 10.1542/peds.2017-3317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/24/2022] Open
Abstract
Transient hypothyroidism can present itself as clinically asymptomatic or with few symptoms. Early treatment with levothyroxine (L-T4) prevents complications related to this disorder. We report a case of a male infant with concomitant short bowel syndrome and transient hypothyroidism treated with rectal L-T4. A 4-month-and-10-day-old boy with previous gastroschisis underwent multiple surgical approaches for small bowel resection and developed short bowel syndrome. We suspected hypothyroidism because of jaundice (direct bilirubin up to 59 mg/dL), the absence of evacuation, oral diet intolerance, and intestinal dysmotility. Because of a thyrotropin level of 34.45 μIU/mL and a free thyroxine level of 0.64 ng/dL, the diagnosis was confirmed. Because fasting was demanding, we started the patient on rectal diluted L-T4. After 4 weeks, the patient had spontaneous peristalsis, improvement of jaundice (direct bilirubin: 4.6 mg/dL), and normalized free thyroxine and thyrotropin values. In the present case, the patient was diagnosed with hypothyroidism and was on absolute fasting. An alternative route of drug administration was warranted. We empirically prescribed rectal diluted L-T4 when intravenous and suppository L-T4 were not available. This method was proven to be safe and effective in improving the patient's clinical and biochemical status. Rectal L-T4 is a possible alternative route of administration to treat hypothyroidism in patients who are unable to take the medication orally.
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Affiliation(s)
- Marina Ybarra
- Pediatric Endocrinology Unit, Children's Institute, University of São Paulo, São Paulo, Brazil
| | | | | | - Vaê Dichtchekenian
- Pediatric Endocrinology Unit, Children's Institute, University of São Paulo, São Paulo, Brazil
| | - Durval Damiani
- Pediatric Endocrinology Unit, Children's Institute, University of São Paulo, São Paulo, Brazil
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18
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Beheshti Z, Rezaei R, Alipour A, Kosarian M, Saatsaz S. A 7-year study on the prevalence of congenital hypothyroidism in northern Iran. Electron Physician 2018; 10:6689-6696. [PMID: 29881532 PMCID: PMC5984024 DOI: 10.19082/6689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 09/18/2017] [Indexed: 11/30/2022] Open
Abstract
Background Congenital hypothyroidism (CH) is one of the most common congenital endocrine disorders. The present study determined the prevalence and demographic characteristics of congenital hypothyroidism in the north of Iran. Objective To determine the prevalence of congenital hypothyroidism based on transient and permanent types with demographic characteristics in Mazandaran province in northern Iran. Methods This retrospective descriptive survey analyzed the medical records of children with primary diagnosis of CH in health centers in all cities of Mazandaran Province between June 2009 and March 2016. To compare the study groups (CH type) in terms of quantitative and qualitative variables, the t-test and Chi-square test were used, respectively using the SPSS22. P-value <0.05 was considered as significant. Results Of 269,088 infants screened during the study period, 548 infants with primary congenital hypothyroidism were identified (a prevalence of 1 per 491 births) and congenital hypothyroidism was definitively diagnosed in 389 children (a prevalence of 1 per 453 births); of them, 169 had permanent CH (a prevalence of 1 per 1043 births) and 220 had transient CH (a prevalence of 1 per 801 births). The female to male ratio in the permanent congenital hypothyroidism group was higher than that in the transient congenital hypothyroidism group (p=0.08). The family relationship between mother and father was stronger in the permanent congenital hypothyroidism group than in the transient congenital hypothyroidism group (p=0.03). Conclusion These findings show that congenital hypothyroidism is more prevalent in the north of Iran than in other areas of Iran; the prevalence of transient CH is particularly higher than permanent CH.
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Affiliation(s)
- Zahra Beheshti
- Department of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rozita Rezaei
- Department of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Social Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehrnoosh Kosarian
- Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sussan Saatsaz
- Department of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
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Jung JM, Jin HY, Chung ML. Feasibility of an Early Discontinuation of Thyroid Hormone Treatment in Very-Low-Birth-Weight Infants at Risk for Transient or Permanent Congenital Hypothyroidism. Horm Res Paediatr 2016; 85:131-9. [PMID: 26812645 DOI: 10.1159/000443399] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS This prospective study was conducted to investigate the feasibility of an early discontinuation of thyroid hormone treatment in very-low-birth-weight (VLBW) infants with congenital hypothyroidism (CH). METHODS We enrolled VLBW infants between January 2011 and December 2012. The infants were divided into the hypothyroid and normal thyroid function groups according to the results of a thyroid function test. We performed an early off-therapy trial at 24 months of age. RESULTS Of the 182 VLBW infants enrolled, 15 were lost to follow-up and 167 were finally enrolled. In total, 24 infants (14.4%) were assigned to the hypothyroid function group and were treated with thyroid hormone. Younger gestational age and a lower birth weight were associated with hypothyroid function. In the hypothyroid function group, hypothyroidism (HT) and hyperthyrotropinemia (HTT) were observed in 13 and 11 infants, respectively. There were no differences in the clinical characteristics between the HT and HTT groups. Overall, 24 infants discontinued thyroxine medication at 24 months of age after normal results had been confirmed by radiologic work-ups, including thyroid ultrasonography and technetium-99m scans. All infants were successfully weaned off thyroxine and maintained euthyroid function. CONCLUSION Early discontinuation of thyroid hormone replacement therapy is possible in the majority of VLBW infants with CH.
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Razavi Z, Mohammadi L. Permanent and Transient Congenital Hypothyroidism in Hamadan West Province of Iran. Int J Endocrinol Metab 2016; 14:e38256. [PMID: 28144251 PMCID: PMC5253200 DOI: 10.5812/ijem.38256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 09/25/2016] [Accepted: 10/09/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Primary congenital hypothyroidism (CH) is the most common treatable cause of mental retardation and can be classified into permanent and transient types. The purpose of this study was to determine the prevalence of permanent and transient congenital hypothyroidism (CH) in Hamadan, West province of Iran. METHODS The study population included all cases with primary congenital hypothyroidism, which were confirmed by thyroid function tests (TSH levels ≥ 10 mIU/L). All these patients had been followed up at the outpatient pediatric endocrine clinic of Besat hospital (Hamadan, Iran) for a period of time between May 2006 and March 2013. Biochemical findings at diagnosis and detailed medical records were collected. Patients were considered as permanent hypothyroidism if their TSH level was 10 (mIU/l) during 6 - 12 months of treatment. Also three years old patients with TSH level > 10 mU/L during one or three months after discontinuation of levothyroxine treatment were considered as permanent hypothyroidism. RESULTS A total of 164 children (49.9% male and 50.6% female) diagnosed with CH completed the study. Female/male ratio was 1.02/1. The incidence of CH was about 1/1250 in Hamadan, West province of Iran. Of the 164 patients, 105 cases (64 %) were diagnosed as permanent CH and other 59 cases (36%) were proven to have transient hypothyroidism. Female to male ratio was 1.14 in patients suffering from permanent CH and 0.8 in patients with transient CH. The initial TSH level was found to be significantly higher in cases with permanent CH compared to the patients with transient CH (P = 0.001). Mean TSH level during the first year of treatment was higher in permanent CH cases compared to transient cases (P = 0.001). Children with transient CH had a lower TSH serum level during the three years of treatment (P = 0.000). A significant statistical difference was not found between the genders and permanent or transient CH (P = 0.352). Co-occurring congenital anomalies and birth order were significantly different between two groups (P = 0.028 and P = 0.024, respectively). CONCLUSIONS Our regional follow-up data showed that about 40% of newborns with primary CH had transient thyroid dysfunction. Our results further clarify our previous research by providing evidences on the incidence rate of CH. The incidence rates of CH as well as transient type of CH in our region were higher than those reported by other studies which have been conducted in other regions of the world. The initial TSH level was the strongest predictor of treatment cessation. Given the high incidence of transient CH in our region, further studies are needed to confirm the etiology and to provide considerable insight into preventive and/or the treatment strategies.
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Affiliation(s)
- Zahra Razavi
- Pediatrics Department, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Corresponding author: Zahra Razavi, Pediatrics Department, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Tel: +98-9183122066, Fax: +98-8132640064, E-mail:
| | - Lida Mohammadi
- Medical student, Pediatrics Department, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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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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Kurtoğlu S, Köroğlu Ş, Baştuğ O, Daar G, Yıkılmaz A, Elmalı F. The comparison of thyroxine versus thyroxine plus oral iodine in the treatment of congenital hypothyroidism due to iodine deficiency. Horm Res Paediatr 2015; 81:409-15. [PMID: 24776962 DOI: 10.1159/000358878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/21/2014] [Indexed: 11/19/2022] Open
Abstract
AIM Iodine deficiency is one of the most important causes of congenital hypothyroidism. In addition to thyroid hormone replacement, iodine supplementation is also given to newborns with congenital hypothyroidism due to iodine deficiency. We aimed to determine whether it is beneficial to administer iodine supplementation in addition to the L-thyroxine (L-T4) treatment of newborns with congenital hypothyroidism due to iodine deficiency. MATERIALS AND METHODS Of 51 newborns, 26 who were diagnosed with congenital hypothyroidism due to iodine deficiency were treated with L-T4. The remaining 25 cases were given L-T4 plus 100 μg/day of oral iodine. Free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), thyroglobulin (TG), thyroid volume, urine iodine and breast milk iodine levels were measured in the first and third months of treatment, and the data were compared between the two groups. RESULTS First- and third-month values of fT3, fT4, TSH, TG and thyroid volume for both groups were statistically similar. There was no significant difference between the two groups in respect to falling levels of fT3 and TSH, the rate of increase of fT4 levels or the shrinkage rate of thyroid volume. CONCLUSION In this study, the addition of oral iodine to L-T4 treatment provided no benefit compared to treatment with L-T4 alone.
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Affiliation(s)
- Selim Kurtoğlu
- Department of Neonatology and Pediatric Endocrinology, Erciyes University Medical Faculty, Kayseri, Turkey
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Soto-Rivera CL, Fichorova RN, Allred EN, Van Marter LJ, Shah B, Martin CR, Agus MSD, Leviton A. The relationship between TSH and systemic inflammation in extremely preterm newborns. Endocrine 2015; 48:595-602. [PMID: 24996532 PMCID: PMC4285685 DOI: 10.1007/s12020-014-0329-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/05/2014] [Indexed: 01/06/2023]
Abstract
Elevated thyrotropin (TSH) levels in critically ill extremely premature infants have been attributed to transient hypothyroidism of prematurity or non-thyroidal illness syndrome. We evaluated the hypothesis that relatively high TSH levels in the first 2 postnatal weeks follow recovery from systemic inflammation, similar to non-thyroidal illness syndrome. The study was conducted in 14 Neonatal Intensive Care Units and approved by each individual Institutional Review Board. We measured the concentrations of TSH and 25 inflammation-related proteins in blood spots obtained on postnatal days 1, 7, and 14. We then evaluated the temporal relationships between hyperthyrotropinemia (HTT), defined as a TSH concentration in the highest quartile for gestational age and postnatal day, and elevated levels of inflammation-related proteins. 880 newborns less than 28 weeks of gestation were included. Elevated concentrations of inflammation-related proteins during the first or second week did not precede day-14 HTT. Systemic inflammation on day 7 was associated with day-14 HTT only if inflammation persisted through the end of the 2 week period. HTT frequently accompanied elevated concentrations of inflammation-related proteins on the same day. The hypothesis that HTT follows recovery from severe illness, defined as preceding systemic inflammation, is weakly supported by our study. Our findings more prominently support the hypothesis that TSH conveys information about concomitant inflammation in the extremely premature newborn.
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Affiliation(s)
- Carmen L Soto-Rivera
- Department of Medicine, Divisions of Endocrinology and Medicine Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA,
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Fan X, Chen S, Qian J, Sooranna S, Luo J, Li C, Tang Q, Lin C. Incidence and Interrelated Factors in Patients With Congenital Hypothyroidism as Detected by Newborn Screening in Guangxi, China. Glob Pediatr Health 2015; 2:2333794X14567193. [PMID: 27335934 PMCID: PMC4784601 DOI: 10.1177/2333794x14567193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. A newborn screening program (NSP) for congenital hypothyroidism (CH) was carried out in Guangxi in order to understand the incidence of CH and the factors interrelated to major types of CH in this region of China. Methods. During 2009 to 2013, data from 930 612 newborns attending NSP in Guangxi were collected. Patients were classified with either permanent CH (PCH) or transient CH (TCH) after 2 years of progressive study. Results. A total of 1210 patients were confirmed with CH with an incidence of 1/769, including 68 PCH and 126 TCH cases with incidences of 1/6673 and 1/3385, respectively. The frequency of thyroid stimulating hormone values greater than 5 mIU/L was 7.2%, which, based on WHO guidelines, suggests that the population was mildly iodine deficient. Conclusions. The incidence of CH was high in Guangxi. Approximately two thirds of CH patients were TCH, which may be due to a deficiency in iodine within the population.
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Affiliation(s)
- Xin Fan
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Shaoke Chen
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jiale Qian
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Suren Sooranna
- Imperial College London, London, UK; Chelsea and Westminster Hospital, London, UK
| | - Jingi Luo
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Chuan Li
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qin Tang
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Caijuan Lin
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Cho MS, Cho GS, Park SH, Jung MH, Suh BK, Koh DG. Earlier re-evaluation may be possible in pediatric patients with eutopic congenital hypothyroidism requiring lower L-thyroxine doses. Ann Pediatr Endocrinol Metab 2014; 19:141-5. [PMID: 25346918 PMCID: PMC4208263 DOI: 10.6065/apem.2014.19.3.141] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/15/2014] [Accepted: 09/24/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The incidence of congenital hypothyroidism (CH) has increased in several countries. Lower cut-off in screening programs have led to an increase in the proportion of transient hypothyroidism (TH) cases diagnosed, leading to debate on the associated clinical and economic impact. This study aimed to identify factors that would allow discrimination between TH and permanent CH (PH) in patients with a eutopic thyroid gland. METHODS Sixty-six patients with CH from 3 different hospitals were studied: 26 cases of TH, and 40 cases of PH. Laboratory findings and clinical parameters were analysed in 56 patients with eutopic thyroid gland. RESULTS Initial serum thyroid stimulating hormone levels and L-thyroxine dose at 12 and 24 months of age were significantly higher in PH than TH patients with a eutopic thyroid gland. The area under the curve for the 12-month and 24-month dose for the prediction of TH in eutopic CH was 0.799 (95% confidence interval [CI], 0.678-0.919; P<0.001) and 0.925 (95% CI, 0.837-1.000; P<0.001), respectively. The optimum 12-month and 24-month dose in predicting TH is 3.25 µg/kg (12-month: sensitivity, 87.1%; specificity, 68.0%; 24-month: sensitivity 93.5%, specificity 88%). CONCLUSION Infants with CH requiring lower L-thyroxine doses (<3.25 µg/kg) are likely to have TH, and thus might be re-evaluated at 12 months or 24 months rather than 3 years of age.
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Affiliation(s)
- Min Sun Cho
- Department of Pediatrics, The Catholic University of Korea, St. Paul's Hospital, Seoul, Korea
| | - Gyung Sun Cho
- Department of Pediatrics, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - So Hyun Park
- Department of Pediatrics, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Min Ho Jung
- Department of Pediatrics, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea
| | - Byung Kyu Suh
- Department of Pediatrics, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Dae Gyun Koh
- Department of Pediatrics, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
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Ghasemi M, Hashemipour M, Hovsepian S, Heiydari K, Sajadi A, Hadian R, Mansourian M, Mirshahzadeh N, Dalvi M. Prevalence of transient congenital hypothyroidism in central part of Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2013; 18:699-703. [PMID: 24379847 PMCID: PMC3872610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/20/2013] [Accepted: 08/18/2013] [Indexed: 11/01/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH) considered a common endocrine disorder in Iran. We report the epidemiologic findings of CH screening program in Isfahan, seven years after its development, regarding the prevalence of transient CH (TCH) and its screening properties comparing with permanent CH (PCH). MATERIALS AND METHODS In this cross-sectional study, children with primary diagnosis of CH were studied. Considering screening and follow-up lab data and the decision of pediatric endocrinologists, the final diagnosis of TCH was determined. RESULTS A total of 464,648 neonates were screened. The coverage percent of the CH screening and recall rate was 98.9 and 2.1%, respectively. Out of which, 1,990 neonates were diagnosed with primary CH. TCH was diagnosed in 1,580 neonates. The prevalence of TCH was 1 in 294 live births. 79.4% of patients with primary CH had TCH. Mean of screening (54.7 ± 59.0 in PCH vs 21.8 ± 28.9 in TCH), recall (56.5 ± 58.8 in PCH vs 36.6 ± 45.0 in TCH), and thyroid stimulating hormone (TSH) and mean of TSH before (2.0 ± 2.9 in PCH vs 1.6 ± 1.6 in TCH) and after (37.7 ± 29.5 in PCH vs 4.3 ± 1.9 in TCH) discontinuing treatment at 3 years of age was significantly higher in PCH than TCH (P < 0.0000). CONCLUSION The higher rate of CH in Isfahan is mainly due to the transient form of the disease. Further studies for evaluating the role of other environmental, autoimmune and/or genetic factors in the pathophysiology of the disease is warranted.
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Affiliation(s)
- Mahmoud Ghasemi
- Department of Pediatrics, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahin Hashemipour
- Department of Pediatric Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Prof. Mahin Hashemipour, Department of Pediatric Endocrinology, Isfahan Endocrine and Metabolism Research Center, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Silva Hovsepian
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamal Heiydari
- Isfahan Health Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Sajadi
- Isfahan Health Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rezvaneh Hadian
- Isfahan Health Center, Isfahan University of Medical Sciences, Isfahan, Iran,Colleague of Congenital Hypothyroidism Screening Program, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naghme Mirshahzadeh
- Department of Pediatric Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Colleague of Congenital Hypothyroidism Screening Program, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzie Dalvi
- Colleague of Congenital Hypothyroidism Screening Program, Isfahan University of Medical Sciences, Isfahan, Iran
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Bekhit OEM, Yousef RM. Permanent and transient congenital hypothyroidism in Fayoum, Egypt: a descriptive retrospective study. PLoS One 2013; 8:e68048. [PMID: 23840807 PMCID: PMC3695950 DOI: 10.1371/journal.pone.0068048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 05/24/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation. One important challenge in understanding the epidemiology of CH is that some newborns will have transient CH, a temporary depression of thyroid hormone concentrations that can last from several days to several months. Studies from other countries have reported that 10 to 15% of children treated for CH ultimately prove not to need treatment past 3 years of age to maintain normal hormone concentrations, and thus have transient hypothyroidism. The purpose of this study was to determine the prevalence of permanent and transient congenital hypothyroidism in Fayoum, Egypt. METHODS Cases detected by Fayoum neonatal screening program (NSP) between January 2003 and December 2011, and followed up at health insurance center were included. Permanent or transient CH was determined using results of thyroid function tests. RESULTS Of the 248 patients diagnosed primarily with CH by NSP; 204 (82.3%) patients were diagnosed to have permanent CH (prevalence 1/3587 live birth), and 44 (17.7%) patients were diagnosed to have transient CH (prevalence 1/16667 live birth). Initial TSH levels were higher in permanent CH cases than transient cases (p<0.004). Female to male ratio was 0.8 and 0.7 in permanent and transient CH respectively. 161 (65%) patients had thyroid dysgenesis (107 ectopic thyroid gland, 28 athyreosis and 26 thyroid hypoplasia). 87 (35%) patients had intact gland in thyroid scan and were considered to have dyshormonogenesis. Of these 87 patients 44 proved to have transient CH and 43 had permanent CH. CONCLUSION The preliminary data from our study revealed that the incidences of CH as well as the permanent form were similar to worldwide reports. Although the high incidence of transient CH in our study could be explained by iodine deficiency further studies are needed to confirm the etiology and plan the treatment strategies.
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Affiliation(s)
- Osama E M Bekhit
- Pediatrics Department, Fayoum Faculty of Medicine, Fayoum University, Egypt.
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Oxidative Stress, Nox Isoforms and Complications of Diabetes—Potential Targets for Novel Therapies. J Cardiovasc Transl Res 2012; 5:509-18. [DOI: 10.1007/s12265-012-9387-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/06/2012] [Indexed: 01/02/2023]
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