Introduction: Congenital hypothyroidism is the most common causes of preventable mental retardation. It is associated with other births defects like cardiac malformations. Descriptions in Sub Saharan Africa are rare, ...Introduction: Congenital hypothyroidism is the most common causes of preventable mental retardation. It is associated with other births defects like cardiac malformations. Descriptions in Sub Saharan Africa are rare, justifying the present report. Case Report: We reported the cases of 3 female patients, diagnosed with hypothyroidism, presenting in addition pulmonary stenosis. The diagnosis was late in all the patients and we noticed clinical improvement under levothyroxine. Conclusion: Association congenital hypothyroidism and cardiac defect is not rare. Our patients are female with no history of consanguinity, presenting congenital hypothyroidism with a gland in situ associated with pulmonary stenosis. Systematic screening of other births defects is thus recommended in affected patients.展开更多
Objective: To study the clinical therapy and prognosis in children with transient congenital hypothyroidism (CH).Methods: Fifty-seven children with CH diagnosed after neonatal screening were treated with low-dosage le...Objective: To study the clinical therapy and prognosis in children with transient congenital hypothyroidism (CH).Methods: Fifty-seven children with CH diagnosed after neonatal screening were treated with low-dosage levothyroxine (L-T4).Follow-up evaluation included the determination of TT3, TT4 and TSH serum levels and the assessment of thyroid gland morphology, bone age, growth development and development quotients (DQ). A full check-up was performed at age 2, when the affected children first discontinued the L-T4 treatment for 1 month, and one year later. Development quotients were compared (16.25±3.87) μg/d. Mean duration of therapy was (28.09±9.56) months. No significant difference was found between study group and control group in the DQ test (average score (106.58± 14.40) vs (102.4±8.6), P＞0.05) and 96.49% of the CH children achieved a test score above 85. Bone age, 99mTc scans and ultrasonographic findings were all normal, and evaluation of physical development was normal too, as were the serum levels of TT3, TT4 and TSH after one year of follow-up. Conclusion: A L-T4 dosage of and physical development at age 2. So it is possible for CH children to stop taking medicine if their laboratory findings and physical development are all normal after regular treatment and 2～3 years of follow-up.展开更多
Radiation exposure has been linked to increased risk of congenital hypothyroidism (CH) for decades. CH is a relatively uncommon condition, occurring in about 1 of 2000 US births. Thyroid Stimulating Hormone (TSH) leve...Radiation exposure has been linked to increased risk of congenital hypothyroidism (CH) for decades. CH is a relatively uncommon condition, occurring in about 1 of 2000 US births. Thyroid Stimulating Hormone (TSH) levels for each child born in California permitted an analysis of combined confirmed and borderline CH cases. Borderline/confirmed CH cases are more than seven times greater than just confirmed cases. Airborne levels of gross beta nuclear radiation in the US were elevated in the period starting several days after the Fukushima nuclear meltdown, especially in west coast states like California. The borderline/confirmed CH rate for newborns during the last 9.5 months in 2011 (exposed to Fukushima in utero) vs. births during other periods in 2011 and 2012 (not exposed) was significantly elevated, suggesting that adverse health effects to the newborn thyroid were not restricted to just a small number of confirmed CH cases. The sensitivity of the fetus to radiation exposure, plus the presence of thyroid-seeking radioiodine, suggest further analysis of Fukushima’s potential to cause adverse health effects in newborns is needed.展开更多
Introduction: Down syndrome (DS) is the most common chromosomal abnormality causing mental handicap in humans. Children with DS have significant medical problems and developmental delay which are further impaired by h...Introduction: Down syndrome (DS) is the most common chromosomal abnormality causing mental handicap in humans. Children with DS have significant medical problems and developmental delay which are further impaired by hypothyroidism. Those clinical features are potentially improved by using thyroxine replacement therapy. Objectives: To examine the evidence of effectiveness (motor & mental development) and safety of thyroxine supplementation in the treatment of SH and CH in children with DS. Methods: Several medical data bases (MEDLINE, EMBASE, CINAHL, Cochrane, Clinical Trials Gov, Essential Evidence and Google) were searched until 20 October, 2011, for randomized control trials (RCTs) that had examined thyroxine’s effectiveness and safety in the treatment of SH or CH in children with DS. Results: There were two high quality RCTs that examined thyroxine in the treatment of CH in children with DS, and no RCTs were found to have examined the effectiveness of thyroxine for SH in children with DS. Conclusion: The RCT which met our inclusion criteria provides the reliable evidence in recommending thyroxine for the treatment of CH in children with DS which is similar to the guidelines for general population. The absence of RCTs examining the treatment of SH in Children with DS indicates the need to conduct such trials.展开更多
Aim:To evaluate the hearing of children with congenital hypothyroidism(CH)and to analyze the knowledge that parents’have on the possible auditory impacts of the disease.Methods:A total of 263 parents/guardians were i...Aim:To evaluate the hearing of children with congenital hypothyroidism(CH)and to analyze the knowledge that parents’have on the possible auditory impacts of the disease.Methods:A total of 263 parents/guardians were interviewed about aspects of CH and hearing.Audiological evaluation was performed on 80 participants,divided into two groups:with CH(n?50)and without CH(n紏30).Clinical and laboratory CH data were obtained from medical records,pure tone auditory thresholds and acoustic reflexes were analyzed.The auditory data was compared between groups.Student’s t-test and Chi-square were used for statistical analysis at a significance level of 5%(p<0.05).Results:The majority(78%),of the parents were unaware that CH when not treated early is a potential risk to hearing.There was no correlation between socioeconomic class and level of information about CH and hearing(p>0,05;p=0.026).There was a statistically significant difference between the auditory tone thresholds of the groups and between the levels of intensity necessary for the triggering of the acoustic reflex.The group with CH presented the worst results(p<0.05)and absence of acoustic reflex in a normal tympanometric condition.Conclusions:Children with CH are more likely to develop damage to the auditory system involving retrocochlear structures when compared to healthy children,and that the disease may have been a risk factor for functional deficits without deteriorating hearing sensitivity.The possible impacts of CH on hearing,when not treated early,should be more publicized among the parents/guardians of this population.展开更多
BACKGROUND Congenital hepatic fibrosis(CHF)is a rare autosomal recessive disorder characterized by variable degrees of periportal fibrosis and malformation of bile ducts.CHF is generally accompanied by a variety of co...BACKGROUND Congenital hepatic fibrosis(CHF)is a rare autosomal recessive disorder characterized by variable degrees of periportal fibrosis and malformation of bile ducts.CHF is generally accompanied by a variety of conditions or syndromes with other organ involvement.CASE SUMMARY We report a 5-year-4-month-old Chinese boy with congenital hypothyroidism(CH)diagnosed with CHF.The patient was diagnosed with CH by a newborn screening test and has since been taking levothyroxine.He has developed normally without neurocognitive deficits.Abnormal liver function was observed in the patient at the age of 4 years and 11 mo,and elevated levels of liver function indices were persistent for 5 mo.Radiological imaging indicated hepatosplenomegaly without narrowing of the portal vein but dilated splenic vein.A liver biopsy confirmed the pathological features of CHF.Genetic testing revealed two novel homozygous mutations,namely,c.2141-3T>C variant in PKHD1 related to CHF and c.2921G>A(p.R974H)in DUOX2 related to CH.The patient was treated with compound glycyrrhizin tablet,ursodeoxycholic acid,and levothyroxine after diagnosis.The patient achieved a favorable clinical outcome during a follow-up period of over 2 years.CONCLUSION Herein,we report the first case of a Chinese boy with comorbidity of CHF and CH,carrying both PKHD1 gene and DUOX2 gene novel mutations.Liver biopsy and genetic testing should be considered for the diagnosis of coexistent liver disease in CH patients with unexplained abnormal liver function.展开更多
Background:Congenital hypothyroidism is a disorder of thyroid gland morphogenesis.It is the commonest endocrine disorder in newborns occurring in 1:4,000 to 1:3,000 live births.The incidence in Nigeria has not been we...Background:Congenital hypothyroidism is a disorder of thyroid gland morphogenesis.It is the commonest endocrine disorder in newborns occurring in 1:4,000 to 1:3,000 live births.The incidence in Nigeria has not been well documented probably due to lack of neonatal screening.Aim/objectives:To raise awareness of physicians to have a high index of suspicion for this treatable cause of mental retardation in children presenting with unusual symptoms.Case presentation:Case 1 presented to our hospital at 18 months of age with a respiratory tract infection.She had delayed developmental milestones and coarse facies among other features.This prompted a work up for hypothyroidism.Thyroid function tests done showed a profoundly hypothyroid picture and she was commenced on levothyroxine.Case 2 was referred to our facility at ninth week of age on suspicion of a congenital heart disease.The parents had complained of dry skin to the referring physician.She had a hypothyroid profile on laboratory evaluation.Conclusion:Congenital hypothyroidism should be suspected in children with unusual symptoms as it is a treatable cause of short stature and mental retardation.The introduction of newborn screening will go a long way in identifying the children in need of urgent thyroid replacement to prevent the negative consequences of untreated hypothyroidism.展开更多
Juvenile hypothyroidism is an unfrequent form of hypothyroidism that affects children. If not diagnosed and treated properly, it may cause severe neurological disorders during growth. The most frequent difficulties ar...Juvenile hypothyroidism is an unfrequent form of hypothyroidism that affects children. If not diagnosed and treated properly, it may cause severe neurological disorders during growth. The most frequent difficulties are found in school performance, difficulties in concentration, hyperactivity or fatigue and damage on the onset of puberty. Starting levothyroxine as a drug of choice is essential, and it should be made according to the age and weight of the child. Laboratory tests for control should be requested periodically, along with a strict control of the child’s development and growth. The family-doctor relationship, along with a clear guidance on the importance of treatment, is critical to achieve a successful treatment. This article is a review about the main clinical features of hypothyroidism in childhood, especially in developing countries, providing key aspects of adherence and characteristics of its follow-up.展开更多
Various reports indicate that the incidence of congenital hypothyroidism is increasing in developed nations, and that improved detection and more inclusive criteria for the disease do not explain this trend entirely. ...Various reports indicate that the incidence of congenital hypothyroidism is increasing in developed nations, and that improved detection and more inclusive criteria for the disease do not explain this trend entirely. One risk factor documented in numerous studies is exposure to radioactive iodine found in nuclear weapons test fallout and nuclear reactor emissions. Large amounts of fallout disseminated worldwide from the meltdowns in four reactors at the Fukushima-Dai-ichi plant in Japan beginning March 11, 2011 included radioiodine isotopes. Just days after the meltdowns, I-131 concentrations in US precipitation was measured up to 211 times above normal. Highest levels of I-131 and airborne gross beta were documented in the five US States on the Pacific Ocean. The number of congenital hypothyroid cases in these five states from March 17-December 31, 2011 was 16% greater than for the same period in 2010, compared to a 3% decline in 36 other US States展开更多
Objective To identify mutations of the thyroglobulin(TG)gene and inheritance patterns in Chinese patients with congenital hypothyroidism.Methods Clinical data of 235 children with congenital hypothyroidism and some of...Objective To identify mutations of the thyroglobulin(TG)gene and inheritance patterns in Chinese patients with congenital hypothyroidism.Methods Clinical data of 235 children with congenital hypothyroidism and some of their families were collected from 2014 to 2018,and peripheral blood samples were collected for DNA extraction.展开更多
Background:Although congenital hypothyroidism(CH)has been widely studied in Western countries,CH incidence at different administrative levels in China during the past decade remains unknown.This study aimed to update ...Background:Although congenital hypothyroidism(CH)has been widely studied in Western countries,CH incidence at different administrative levels in China during the past decade remains unknown.This study aimed to update the incidence and revealed the spatial pattern of CH incidence in the mainland of China,which could be helpful in the planning and implementation of preventative measures.Methods:The data used in our study were derived from 245 newborns screening centers that cover 30 provinces of the Chinese Newborn Screening Information System.Spatial auto-correlation was analyzed by Global Moran I and Getis-Ord Gi statistics at the provincial level.Kriging interpolation methods were applied to estimate a further detailed spatial distribution of CH incidence at city level throughout the mainland of China,and Kulldorff space scanning statistical methods were used to identify the spatial clusters of CH cases at the city level.Results:A total of 91,921,334 neonates were screened from 2013 to 2018 and 42,861 cases of primary CH were identified,yielding an incidence of 4.66 per 10,000 newborns screened(95%confidence interval[CI]:4.62–4.71).Neonates in central(risk ratio[RR]=0.84,95%CI:0.82–0.85)and western districts(RR=0.71,95%CI:0.69–0.73)had lower probability of CH cases compared with the eastern region.The CH incidence indicated a moderate positive global spatial autocorrelation(Global Moran I value=0.394,P<0.05),and the CH cases were significantly clustered in spatial distribution.A most likely city-cluster(log-likelihood ratio[LLR]=588.82,RR=2.36,P<0.01)and 25 secondary city-clusters of high incidence were scanned.The incidence of each province and each city in the mainland of China was estimated by kriging interpolation,revealing the most affected province and city to be Zhejiang Province and Hangzhou city,respectively.Conclusion:This study offers an insight into the space clustering of CH incidence at provincial and city scales.Future work on environmental factors need to focus on the effects of CH occurrence.展开更多
Background:The transcription factor paired box 8 (PAX8) was associated with type 2 congenital non-goitrous hypothyroidism (CHNG2), a clinical phenotype of congenital hypothyroidism (CH). Though studied in a few region...Background:The transcription factor paired box 8 (PAX8) was associated with type 2 congenital non-goitrous hypothyroidism (CHNG2), a clinical phenotype of congenital hypothyroidism (CH). Though studied in a few regions with different ethnicities, the incidence of PAX8 mutations varied, even among Chinese cohorts in different regions. This study aimed to identify and characterize PAX8 mutations and explore the prevalence of its mutations in another cohort of CH. Methods: The 105 unrelated Chinese patients with CH were collected from four major hospitals. Exomes of the 105 samples were sequenced by Hiseq 2000 platform to identify mutations of PAX8 on genomic DNAs extracted from peripheral blood samples. Luciferase reporter assays were used to assess the effects of mutations on the transcription of thyroid peroxidase (TPO). Results: Three PAX8 mutations in four subjects were identified in 105 samples. One variant, rsl 89229644, was detected in two subjects, and categorized as uncertain significance. The other two missense mutations (275T>C/Ile92Thr and 398G>A/Argl33Gln) were not detected in three large-scale genotyping projects, namely 1000 Genome Project, Exome Aggregation Consortium and GO Exome Sequencing Project. Functional studies for the two mutations revealed that they could impair the transcription ability of PAX8 on one of its target genes, TPO. Therefore, the two mutations were causative for the pathogenesis of CHNG2. After combining the studies of PAX8 mutations, an average frequency of 1.74%(21/1209) could be obtained in Chinese patients with CH. Conclusion: The study specifically demonstrates the role of two mutations in impairing the transcription ability of PAX8, which should be considered as pathogenic variants for CH.展开更多
文摘Introduction: Congenital hypothyroidism is the most common causes of preventable mental retardation. It is associated with other births defects like cardiac malformations. Descriptions in Sub Saharan Africa are rare, justifying the present report. Case Report: We reported the cases of 3 female patients, diagnosed with hypothyroidism, presenting in addition pulmonary stenosis. The diagnosis was late in all the patients and we noticed clinical improvement under levothyroxine. Conclusion: Association congenital hypothyroidism and cardiac defect is not rare. Our patients are female with no history of consanguinity, presenting congenital hypothyroidism with a gland in situ associated with pulmonary stenosis. Systematic screening of other births defects is thus recommended in affected patients.
文摘Objective: To study the clinical therapy and prognosis in children with transient congenital hypothyroidism (CH).Methods: Fifty-seven children with CH diagnosed after neonatal screening were treated with low-dosage levothyroxine (L-T4).Follow-up evaluation included the determination of TT3, TT4 and TSH serum levels and the assessment of thyroid gland morphology, bone age, growth development and development quotients (DQ). A full check-up was performed at age 2, when the affected children first discontinued the L-T4 treatment for 1 month, and one year later. Development quotients were compared (16.25±3.87) μg/d. Mean duration of therapy was (28.09±9.56) months. No significant difference was found between study group and control group in the DQ test (average score (106.58± 14.40) vs (102.4±8.6), P＞0.05) and 96.49% of the CH children achieved a test score above 85. Bone age, 99mTc scans and ultrasonographic findings were all normal, and evaluation of physical development was normal too, as were the serum levels of TT3, TT4 and TSH after one year of follow-up. Conclusion: A L-T4 dosage of and physical development at age 2. So it is possible for CH children to stop taking medicine if their laboratory findings and physical development are all normal after regular treatment and 2～3 years of follow-up.
文摘Radiation exposure has been linked to increased risk of congenital hypothyroidism (CH) for decades. CH is a relatively uncommon condition, occurring in about 1 of 2000 US births. Thyroid Stimulating Hormone (TSH) levels for each child born in California permitted an analysis of combined confirmed and borderline CH cases. Borderline/confirmed CH cases are more than seven times greater than just confirmed cases. Airborne levels of gross beta nuclear radiation in the US were elevated in the period starting several days after the Fukushima nuclear meltdown, especially in west coast states like California. The borderline/confirmed CH rate for newborns during the last 9.5 months in 2011 (exposed to Fukushima in utero) vs. births during other periods in 2011 and 2012 (not exposed) was significantly elevated, suggesting that adverse health effects to the newborn thyroid were not restricted to just a small number of confirmed CH cases. The sensitivity of the fetus to radiation exposure, plus the presence of thyroid-seeking radioiodine, suggest further analysis of Fukushima’s potential to cause adverse health effects in newborns is needed.
文摘Introduction: Down syndrome (DS) is the most common chromosomal abnormality causing mental handicap in humans. Children with DS have significant medical problems and developmental delay which are further impaired by hypothyroidism. Those clinical features are potentially improved by using thyroxine replacement therapy. Objectives: To examine the evidence of effectiveness (motor & mental development) and safety of thyroxine supplementation in the treatment of SH and CH in children with DS. Methods: Several medical data bases (MEDLINE, EMBASE, CINAHL, Cochrane, Clinical Trials Gov, Essential Evidence and Google) were searched until 20 October, 2011, for randomized control trials (RCTs) that had examined thyroxine’s effectiveness and safety in the treatment of SH or CH in children with DS. Results: There were two high quality RCTs that examined thyroxine in the treatment of CH in children with DS, and no RCTs were found to have examined the effectiveness of thyroxine for SH in children with DS. Conclusion: The RCT which met our inclusion criteria provides the reliable evidence in recommending thyroxine for the treatment of CH in children with DS which is similar to the guidelines for general population. The absence of RCTs examining the treatment of SH in Children with DS indicates the need to conduct such trials.
文摘Aim:To evaluate the hearing of children with congenital hypothyroidism(CH)and to analyze the knowledge that parents’have on the possible auditory impacts of the disease.Methods:A total of 263 parents/guardians were interviewed about aspects of CH and hearing.Audiological evaluation was performed on 80 participants,divided into two groups:with CH(n?50)and without CH(n紏30).Clinical and laboratory CH data were obtained from medical records,pure tone auditory thresholds and acoustic reflexes were analyzed.The auditory data was compared between groups.Student’s t-test and Chi-square were used for statistical analysis at a significance level of 5%(p<0.05).Results:The majority(78%),of the parents were unaware that CH when not treated early is a potential risk to hearing.There was no correlation between socioeconomic class and level of information about CH and hearing(p>0,05;p=0.026).There was a statistically significant difference between the auditory tone thresholds of the groups and between the levels of intensity necessary for the triggering of the acoustic reflex.The group with CH presented the worst results(p<0.05)and absence of acoustic reflex in a normal tympanometric condition.Conclusions:Children with CH are more likely to develop damage to the auditory system involving retrocochlear structures when compared to healthy children,and that the disease may have been a risk factor for functional deficits without deteriorating hearing sensitivity.The possible impacts of CH on hearing,when not treated early,should be more publicized among the parents/guardians of this population.
基金Supported by National Natural Science Foundation of China,No.81870373Shanghai Hospital Development Center New Frontier Technology Joint Research Project,No.SHDC12017115and 2019 Shanghai“Innovative Action Plan of Science and Technology”Animal Research Project Guide,No.19140904301.
文摘BACKGROUND Congenital hepatic fibrosis(CHF)is a rare autosomal recessive disorder characterized by variable degrees of periportal fibrosis and malformation of bile ducts.CHF is generally accompanied by a variety of conditions or syndromes with other organ involvement.CASE SUMMARY We report a 5-year-4-month-old Chinese boy with congenital hypothyroidism(CH)diagnosed with CHF.The patient was diagnosed with CH by a newborn screening test and has since been taking levothyroxine.He has developed normally without neurocognitive deficits.Abnormal liver function was observed in the patient at the age of 4 years and 11 mo,and elevated levels of liver function indices were persistent for 5 mo.Radiological imaging indicated hepatosplenomegaly without narrowing of the portal vein but dilated splenic vein.A liver biopsy confirmed the pathological features of CHF.Genetic testing revealed two novel homozygous mutations,namely,c.2141-3T>C variant in PKHD1 related to CHF and c.2921G>A(p.R974H)in DUOX2 related to CH.The patient was treated with compound glycyrrhizin tablet,ursodeoxycholic acid,and levothyroxine after diagnosis.The patient achieved a favorable clinical outcome during a follow-up period of over 2 years.CONCLUSION Herein,we report the first case of a Chinese boy with comorbidity of CHF and CH,carrying both PKHD1 gene and DUOX2 gene novel mutations.Liver biopsy and genetic testing should be considered for the diagnosis of coexistent liver disease in CH patients with unexplained abnormal liver function.
文摘Background:Congenital hypothyroidism is a disorder of thyroid gland morphogenesis.It is the commonest endocrine disorder in newborns occurring in 1:4,000 to 1:3,000 live births.The incidence in Nigeria has not been well documented probably due to lack of neonatal screening.Aim/objectives:To raise awareness of physicians to have a high index of suspicion for this treatable cause of mental retardation in children presenting with unusual symptoms.Case presentation:Case 1 presented to our hospital at 18 months of age with a respiratory tract infection.She had delayed developmental milestones and coarse facies among other features.This prompted a work up for hypothyroidism.Thyroid function tests done showed a profoundly hypothyroid picture and she was commenced on levothyroxine.Case 2 was referred to our facility at ninth week of age on suspicion of a congenital heart disease.The parents had complained of dry skin to the referring physician.She had a hypothyroid profile on laboratory evaluation.Conclusion:Congenital hypothyroidism should be suspected in children with unusual symptoms as it is a treatable cause of short stature and mental retardation.The introduction of newborn screening will go a long way in identifying the children in need of urgent thyroid replacement to prevent the negative consequences of untreated hypothyroidism.
文摘Juvenile hypothyroidism is an unfrequent form of hypothyroidism that affects children. If not diagnosed and treated properly, it may cause severe neurological disorders during growth. The most frequent difficulties are found in school performance, difficulties in concentration, hyperactivity or fatigue and damage on the onset of puberty. Starting levothyroxine as a drug of choice is essential, and it should be made according to the age and weight of the child. Laboratory tests for control should be requested periodically, along with a strict control of the child’s development and growth. The family-doctor relationship, along with a clear guidance on the importance of treatment, is critical to achieve a successful treatment. This article is a review about the main clinical features of hypothyroidism in childhood, especially in developing countries, providing key aspects of adherence and characteristics of its follow-up.
文摘Various reports indicate that the incidence of congenital hypothyroidism is increasing in developed nations, and that improved detection and more inclusive criteria for the disease do not explain this trend entirely. One risk factor documented in numerous studies is exposure to radioactive iodine found in nuclear weapons test fallout and nuclear reactor emissions. Large amounts of fallout disseminated worldwide from the meltdowns in four reactors at the Fukushima-Dai-ichi plant in Japan beginning March 11, 2011 included radioiodine isotopes. Just days after the meltdowns, I-131 concentrations in US precipitation was measured up to 211 times above normal. Highest levels of I-131 and airborne gross beta were documented in the five US States on the Pacific Ocean. The number of congenital hypothyroid cases in these five states from March 17-December 31, 2011 was 16% greater than for the same period in 2010, compared to a 3% decline in 36 other US States
文摘Objective To identify mutations of the thyroglobulin(TG)gene and inheritance patterns in Chinese patients with congenital hypothyroidism.Methods Clinical data of 235 children with congenital hypothyroidism and some of their families were collected from 2014 to 2018,and peripheral blood samples were collected for DNA extraction.
基金supported by a grant from the National Key Research and Development Program of China(No.2017YFC1001700).
文摘Background:Although congenital hypothyroidism(CH)has been widely studied in Western countries,CH incidence at different administrative levels in China during the past decade remains unknown.This study aimed to update the incidence and revealed the spatial pattern of CH incidence in the mainland of China,which could be helpful in the planning and implementation of preventative measures.Methods:The data used in our study were derived from 245 newborns screening centers that cover 30 provinces of the Chinese Newborn Screening Information System.Spatial auto-correlation was analyzed by Global Moran I and Getis-Ord Gi statistics at the provincial level.Kriging interpolation methods were applied to estimate a further detailed spatial distribution of CH incidence at city level throughout the mainland of China,and Kulldorff space scanning statistical methods were used to identify the spatial clusters of CH cases at the city level.Results:A total of 91,921,334 neonates were screened from 2013 to 2018 and 42,861 cases of primary CH were identified,yielding an incidence of 4.66 per 10,000 newborns screened(95%confidence interval[CI]:4.62–4.71).Neonates in central(risk ratio[RR]=0.84,95%CI:0.82–0.85)and western districts(RR=0.71,95%CI:0.69–0.73)had lower probability of CH cases compared with the eastern region.The CH incidence indicated a moderate positive global spatial autocorrelation(Global Moran I value=0.394,P<0.05),and the CH cases were significantly clustered in spatial distribution.A most likely city-cluster(log-likelihood ratio[LLR]=588.82,RR=2.36,P<0.01)and 25 secondary city-clusters of high incidence were scanned.The incidence of each province and each city in the mainland of China was estimated by kriging interpolation,revealing the most affected province and city to be Zhejiang Province and Hangzhou city,respectively.Conclusion:This study offers an insight into the space clustering of CH incidence at provincial and city scales.Future work on environmental factors need to focus on the effects of CH occurrence.
基金National Natural Science Foundation of China (No.81101490).
文摘Background:The transcription factor paired box 8 (PAX8) was associated with type 2 congenital non-goitrous hypothyroidism (CHNG2), a clinical phenotype of congenital hypothyroidism (CH). Though studied in a few regions with different ethnicities, the incidence of PAX8 mutations varied, even among Chinese cohorts in different regions. This study aimed to identify and characterize PAX8 mutations and explore the prevalence of its mutations in another cohort of CH. Methods: The 105 unrelated Chinese patients with CH were collected from four major hospitals. Exomes of the 105 samples were sequenced by Hiseq 2000 platform to identify mutations of PAX8 on genomic DNAs extracted from peripheral blood samples. Luciferase reporter assays were used to assess the effects of mutations on the transcription of thyroid peroxidase (TPO). Results: Three PAX8 mutations in four subjects were identified in 105 samples. One variant, rsl 89229644, was detected in two subjects, and categorized as uncertain significance. The other two missense mutations (275T>C/Ile92Thr and 398G>A/Argl33Gln) were not detected in three large-scale genotyping projects, namely 1000 Genome Project, Exome Aggregation Consortium and GO Exome Sequencing Project. Functional studies for the two mutations revealed that they could impair the transcription ability of PAX8 on one of its target genes, TPO. Therefore, the two mutations were causative for the pathogenesis of CHNG2. After combining the studies of PAX8 mutations, an average frequency of 1.74%(21/1209) could be obtained in Chinese patients with CH. Conclusion: The study specifically demonstrates the role of two mutations in impairing the transcription ability of PAX8, which should be considered as pathogenic variants for CH.
