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Neonatal screening for congenital hypothyroidism in West Black Sea area, Turkey
E Simsek1, M Karabay, K Kocabay
1Abant Izzet Baysal University, Düzce School of Medicine, Department of Pediatrics, Düzce, Turkey. enversimsek06@hotmail.com
Insights
Congenital hypothyroidism (CH) incidence was investigated in Turkey's iodine-deficient West Black Sea Area. Neonatal screening revealed a higher CH incidence than in many European countries, highlighting the need for national screening and iodine policies.
Area of Science:
- Endocrinology
- Pediatrics
- Public Health
Background:
- Congenital hypothyroidism (CH) is a significant cause of preventable intellectual disability.
- Iodine deficiency is a major risk factor for CH.
- The West Black Sea Area in Turkey is characterized by mild-to-moderate iodine deficiency.
Purpose of the Study:
- To determine the incidence of CH in the West Black Sea Area of Turkey.
- To assess the iodine status of the population in the study area.
- To provide data supporting the implementation of neonatal screening for CH in Turkey.
Main Methods:
- Neonatal screening for CH using filter paper blood samples.
- Radioimmunoassay measurement of Thyrotropin (TSH) with a cut-off of >20 microU/ml.
- Measurement of urinary iodine concentrations in neonates and mothers to assess iodine status.
Main Results:
- A total of 18,606 neonates were screened between 2000 and 2002.
- The incidence of CH was 1/2326, and transient hypothyroidism was 1/6202.
- Median urinary iodine levels indicated mild-to-moderate iodine deficiency (85 microg/l in neonates, 40 microg/l in mothers).
Conclusions:
- The incidence of CH and transient hypothyroidism in the study area is higher than in many European countries.
- Mild-to-moderate iodine deficiency likely contributes to the observed CH incidence.
- Urgent implementation of neonatal CH screening and national iodine prophylaxis policies in Turkey is recommended.
Abstract:
The aim of this study was to investigate the incidence of congenital hypothyroidism (CH) in the West Black Sea Area, a mild-to-moderate iodine deficient area in Turkey. Neonatal screening for CH was performed using blood specimens collected onto filter paper. Thyrotropin [thyroid-stimulating hormone (TSH)] was measured by radioimmunoassay, and a value >20 microU/ml was considered as cut-off point for re-examining. Venous serum was obtained to measure TSH, thyroxin (T4), free T4 (FT4) and thyroglobulin (TG). To determine the iodine status of the study area, median urinary iodine was measured in 212 randomly selected neonates and their mothers. A total of 18606 neonates were screened from three cities (Bolu, Düzce, and Zonguldak) between 2000 and 2002. With a cut-off point of TSH value >20 microU/ml, the recall rate was found 1.6%. Eight cases of CH were diagnosed (incidence 1/2326). There were three cases of transient hypothyroidism, with an incidence of 1/6202. Twenty-six percent of the TSH values was greater than 5 microU/ml. Median urinary iodine concentrations in neonates and their mothers were 85 microg/l and 40 microg/l, respectively. The incidences of CH, transient hypothyroidism and the recall rate were higher in our study area than many countries in Europe. The study area has been affected by mild-to-moderate iodine deficiency. Neonatal screening for CH should be introduced in Turkey without delay. A national comprehensive infantile hypothyroidism and iodine prophylaxis policies should be developed.