NEONATAL SCREENING FOR CONGENITAL HYPOTHYROIDISM IN DUHOK GOVERNORATE (IRAQ); A PRELIMINARY STUDY

DHIA J. AL-TIMIMI; AVEEN H. MUSTAFA

DHIA J. AL-TIMIMI Professor, Department of Medical Chemistry, College of Medicine, University of Duhok, Kurdistan Region, Iraq
AVEEN H. MUSTAFA Lecturer, Department of Medical Chemistry, College of Medicine, University of Duhok, Kurdistan Region, Iraq.

Keywords: Congenital hypothyroidism, Screening program, TSH, Kurdistan, Iraq

Abstract

https://doi.org/10.31386/dmj.2019.12.1.33

Background: Congenital hypothyroidism is one of the commonest treatable endocrine diseases and can affect he growth and mental development of neonates. The neonatal screening program for congenital hypothyroidism has become a routine procedure in all developed countries and considered a monitoring tool for the early detection and therapy of hypothyroidism. In this study we investigated the prevalence and associated factors of congenital hypothyroidism in Duhok governorate of Kurdistan Region (Iraq).

Methods: A cross-sectional study was conducted during the period from July 2014 to February2015. Capillary blood samples were obtained from 3000 newborn babies by heel prick and tested initially for the thyroid stimulating hormone (TSH) followed by assessing free thyroxine in those with TSH level >10 μIU/ml. Demographic and clinical data such as residency, ethnicity, mother age, newborn age, sex, maturity, birth weight, presence of congenital anomalies as well as related marriage and thyroid diseases of the mother were collected.

Results: The number of neonates having TSH level >10μIU/ml was 88 resulting in a recall rate of 2.9%. Of the88 recalled neonates, 4 were diagnosed with congenital hypothyroidism (4.5%; 1 in 750 live births) and 7 with subclinical hypothyroidism (7.9%, 1 in 428 live births). There was significant association between the occurrence of congenital hypothyroidism and prematurity (p=0.04), congenital anomalies (p=0.03) and thyroid disease of the mother (p=0.03).

Conclusions: The study sample showed a high prevalence of congenital hypothyroidism among neonates of Duhok governorate. Appropriate neonatal screening program and monitoring are essential to reduce the irreversible health consequences of this disorder.

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References

1. Rose SR, Brown RS, Foley T, Kaplowitz PB, Kaye CI, Sundararajan S, et al. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics. 2006; 117(6): 2290-2303.
2. Kaye CI, , Accurso F, La Franchi S, Lane PA, Hope N, Sonya P, et al. Newborn screening fact sheets. Pediatrics. 2006; 118(3): e934-963.
3. Valizadeh M, Mazlomzadeh S, Niksirat A, Shajari Z. High incidence and Recall Rate of Congenital Hypothyroidism in Zanjan Province, a Health Problem or a Study challenge? Int J Endocrinol Metab. 2011; 9(4): 338-342.
4. ŞimşekE, Karabay M, Kocabay K. Neonatal Screening for Congenital Hypothyroidism in West Black Sea Area in Turkey. Int J Clin Pract. 2005; 59(3):336-341.
5. LaFranchi S. Clinical features and detection of congenital hypothyroidism 2015.Available from:
http://www.uptodate.com/contents/cli nical-features-and- detection-of-congenitalhypothyroidism [Accessed March, 2015].
6. Unachak, Dejkhamron P. Primary congenital hypothyroidism: Clinical characteristics and etiological study. J Med Assoc Thai. 2004; 87: 612-617.
7. Malik BA, Butt MA. Is delayed diagnosis of hypothyroidism still a problem in Faisalabad, Pakistan. J Pak Med Assoc. 2008; 58 (10): 545-549.
8. Grüters A, Krude H. Detection and treatment of congenital hypothyroidism. Nature Reviews Endocrinology 2012; 8: 104-113.
9. Shamshiri AR, Yarahmadi S, Forouzanfar MH, Haghdoost AA, Hamzehloo GR, Holakouie K. Evaluation of current Guthrie TSH cut-off point in Iran congenital hypothyroidism screening program: a cost-effectiveness analysis. Arch Iran Med. 2012; 15(3): 136 - 141.
10. Daher R, Beaini M, Mahfouz R, Cortas N, Younis KA. A neonatal screening in Lebanon: Results of five years’ experience. Ann Saudi Med. 2003; 23 (1-2): 16-9.
11. Harris KB, Pass KA: Increase in congenital hypothyroidism in New York Stateand in the United States. Mol Genet Metab. 2007; 91(3): 268277.
12. Gruters A, Krude H. Update on the management of congenital hypothyroidism. Horm Res. 2007; 68 (Suppl. 5): 107-111.
13. Skordis N, Toumba M, Savva SC, Erakleous E, Topouzi M, Vogazianos M, et al.High prevalence of congenital hypothyroidism in the Greek Cypriot population: results of the neonatal screening program 1990-2000. J Pediatr Endocrinol .2005;18 (5): 453461.
14. Gaudino R, Garel C, Czernichow P, Leger J: Proportion of various types ofthyroid disorders among newborns with congenital hypothyroidism and normally located gland: a regional cohort study. Clin Endocrinol. 2005; 62(4): 444-448. 15. Daniel MS, Postellon DC. Emedicine: Congenital hypothyroidism. Medscape Reference 2014. Available from http://emedicine.medscape.com/article /9197-overview. [Accessed March, 2015].
16. Delavari AR, Yarahmadi SH, Birjandi R, Mahdavi AR, Norouzi Nejad A, Dini M. Cost-benefit analysis of the neonatal screening program implementation for congenital hypothyroidism in I. R. Iran. Int J Endocrinol Metab. 2006; 4: 84-87. 17. Najafi M, Khodaee GH, Bahari M, Sabahi M, Farsi MM, Kiani F. Neonatal thyroid screening in a mild iodine deficiency endemic area in Iran. Indian J Med Sci. 2008; 62 (3): 113-115.
18. UNICEF. IRAQ MICS4: Vol. I: Final Report 2011. Available from: www.unicef.org/iraq/ [Accessed March, 2015].
19. Rasheed BA. Ahmed B. Urinary iodine level of primary school children in Duhok governorate. MSc
thesis. Hawler Medical University, College of Medicine. Iraq; 2013.
20. Loeber JG. Neonatal screening in Europe: The situation in 2004. J Inherit MetabDis. 2007; 30: 430 -438.
21. Anastasovska V, Koviloska R, Kocova M. High incidence of congenital hypothyroidism in one region of the republic of Macedonia. Balkan J Med Genet. 2014; 17 (1): 3136.
22. Kapil U. Health consequences of iodine deficiency. Sultan Qaboos Univ Med J. 2007; 7 (3): 267-272.
23. Rastogi MV, LaFranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis. 2010; 5: 17.doi:10.1186/1750-1172-5-17.