Kara Cengiz, Günindi Figen, Can Yılmaz Gülay, Aydın Murat
Ondokuz Mayıs University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Samsun, Turkey E-mail:
J Clin Res Pediatr Endocrinol. 2016 Jun 5;8(2):170-9. doi: 10.4274/jcrpe.2345. Epub 2016 Apr 18.
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.
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.
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.
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.
据报道，2008 - 2010年土耳其先天性甲状腺功能减退症（CH）的出生患病率高达1:650。由于缺乏随访数据，永久性和暂时性CH的发病率尚不清楚。我们旨在评估暂时性甲状腺功能减退症对CH发病率增加的影响，并确定暂时性CH的自然病程以及临床、生化和影像学特征。
回顾性分析2008 - 2010年期间在黑海地区六个省份筛查出的CH婴儿的基线和随访数据。
在138例病例（48%为女性）中，16例（12%）出现暂时性促甲状腺素血症，未经干预即自行缓解。在接受治疗的122例病例中，63例（52%）患有暂时性CH。随着促甲状腺激素临界值的降低，其发生率在2008年为35%，在2009 - 2010年增至56%。内陆省份的发生率高于沿海省份（67%对43%；p = 0.01）。除男女比例外（1.5:1对0.6:1；p = 0.02），永久性和暂时性病例的临床特征相似。70%的暂时性病例在3岁前停用左甲状腺素，中位年龄为19（2 - 36）个月。早期停药的唯一指征是左甲状腺素剂量低，停药时为1.25±0.27μg/kg/天。
我们的区域随访数据显示，超过一半的原发性CH新生儿存在暂时性甲状腺功能障碍。在大多数情况下，如左甲状腺素治疗停止所示，可在3岁前区分暂时性和永久性CH。
