Risk factors associated with congenital hypothyroidism
A case-control study in southeast Iran
Keywords:
Congenital hypothyroidism, Risk Factors, IranAbstract
Background and aim: Congenital hypothyroidism (CH) is known as one of the most common preventable cause of mental retardation. This study aimed to determine factors associated with CH in Iran. Methods: This case-control study was conducted on 160 children under one year old in Zahedan in southeast Iran in 2016. The neonates who were born from March 1, 2015 to March 19, 2016 and had undergone a screening program for CH were the study population. The neonates with serum TSH > 10mIu/L and T4 < 6.5 or TSH > 30 mIu/L were considered as a case group. Each case was individually matched for sex, age at birth and place of residence with three neonates with normal TSH and T4 titers as a control group. Data was gathered using a standard checklist and analyzed using SPSS 20 and statistical tests, such as Chi-square and Fisher’s exact tests. Multivariable logistic regression analysis was also used to identify independent predictors of CH. Results: About 25 of the 40 patients with CH (62.5%) were male who, in the univariate analysis, the following explanatory factors had no significant association with CH: history of parental consanguinity, type of delivery, weight at birth, height at birth, age of mother, sampling time, nationality, and birth season (p>0.05). Although, multivariate analysis showed no significant association between the studied factors and risk of CH (p>0.05), the likelihood of CH was greater among neonates born to consanguineous parents (AOR: 1.78, 95% CI: 0.82-3.89), those who were born to lower height at birth (AOR: 1.82, 95% CI: 0.85-3.91), neonates born to mothers younger than 18 years (AOR: 2.43, 95% CI: 0.57-10.29) and those who were born in the summer (AOR: 1.76, 95% CI: 0.57-5.44). Conclusion: None of the studied factors were predictors for CH. Since consanguineous marriages are frequent in the province, and it may be a major contributory factor, future studies should be conducted on the genetic causes.References
Fan X, Chen S, Qian J, Sooranna S, Luo J, Li C, et al. Incidence and Interrelated Factors in Patients With
Congenital Hypothyroidism as Detected by Newborn Screening in Guangxi, China. Glob Pediatr Health.
doi: 10.1177/2333794X14567193. PMID: 27335934, PMCID: PMC4784601.
Ghaemi N, Bagheri S, Elmi S, Rezaee SM, Elmi S, Sayyar RE. Delayed Diagnosis of Hypothyroidism in
Children: Report of 3 Cases. Iranian Red Crescent Medical Journal. 2015; 17(11): e20306. doi:
5812/ircmj.20306. PMID: 26734478, PMCID: PMC4698140.
Löf C, Patyra K, Kuulasmaa T, Vangipurapu J, Undeutsch H, Jaeschke H, et al. Detection of novel gene
variants associated with congenital hypothyroidism in a Finnish patient cohort. Thyroid. 2016; 26(9): 1215- 24. doi: 10.1089/thy.2016.0016.
Singh A, Purani C, Mandal A, Mehariya KM, Das RR. Prevalence of Thyroid Disorders in Children at a
Tertiary Care Hospital in Western India. Journal of clinical and diagnostic research: JCDR. 2016; 10(2):
SC01-4. doi: 10.7860/JCDR/2016/16315.7189. PMID: 27042544, PMCID: PMC4800610.
Li M, Eastman CJ. Neonatal TSH screening: is it a sensitive and reliable tool for monitoring iodine status
in populations? Best Practice & Research Clinical Endocrinology & Metabolism. 2010; 24(1): 63-75. doi:
1016/j.beem.2009.08.007. PMID: 20172471.
Saleh DS, Lawrence S, Geraghty MT, Gallego PH, McAssey K, Wherrett DK, et al. Prediction of
congenital hypothyroidism based on initial screening thyroid-stimulating-hormone. BMC pediatrics. 2016;
(1): 24. doi: 10.1186/s12887-016-0559-0.
Dorreh F, Yousefi P, Javaheri J, Eshrati B, Amiri Z. Evaluation of 6 years performance of screening
program of congenital Hypothyroidism in Markazi Province (2012-2006). Arak Medical University
Journal. 2013; 16(8): 39-45.
Namakin K, Sedighi E, Sharifzadeh G, Zardast M. Prevalence of congenital hypothyroidism In South
Khorasan province (2006-2010). Journal of Birjand University of Medical Sciences. 2012; 19(2): 191-9.
Zeinalzadeh AH, Kousha A, Akhtari M, Talebi M. Screening for Congenital Hypothyroidism in East
Azerbaijan province, IRAN. Journal of Kerman University of Medical Sciences. 2011; 18(4): 301-8.
Akha O, Shabani M, Kowsarian M, Ghafari V, Sajadi Saravi S. Prevalence of congenital hypothyroidism in
Mazandaran Province, Iran, 2008. Journal of Mazandaran University of Medical Sciences. 2011; 21(84):
-70.
Abedi M, Shahsavari S, Salehi R, Hedayati NS, Nasrollahi S, Sadeghi S, et al. The Study Of Prevalence
And Risk Factors Of Hypothyroidism In Newborn Screening Program In Sanandaj City In 2009-2014.
Zanko Journal of Medical Sciences. 2015; 15(47): 46-51.
Esmailnasab N, Moasses Ghaffari B, Afkhamzadeh A. Investigation of the risk factors for congenital
hypothyroidism in the newborns in Kurdistan Province. Scientific Journal of Kurdistan University of
Medical Sciences. 2012; 17(4).
Dalili S, Rezvany SM, Medghalchi A, Mohammadi H, Dalili H, Mirzanejad M, et al. Congenital
hypothyroidism: a review of the risk factors. Acta Medica Iranica. 2012; 50(11): 735. PMID: 23292624.
Delavari AR, Yazdani Z. Laboratory protocol of neonatal thyroid screening. Tehran: Disease Control
Center, Ministry of Health and Medical Education. 2004.
Anastasovska V. High incidence of congenital hypothyroidism in one region of the Republic of Macedonia.
Balkan Journal of Medical Genetics. 2014; 17(1): 31-5. doi: 10.2478/bjmg-2014-0024.
Medda E, Olivieri A, Stazi MA, Grandolfo ME, Fazzini C, Baserga M, et al. Risk factors for congenital
hypothyroidism: results of a population case-control study (1997–2003). European Journal of
Endocrinology. 2005; 153(6): 765-73. doi: 10.1530/eje.1.02048.
Rezaeian S, Moghimbeigi A, Esmailnasab N. Gender differences in risk factors of congenital
hypothyroidism: an interaction hypothesis examination. Int J Endocrinol Metab. 2014; 12(2): e13946. doi:
5812/IJEM.13946. PMID: 24790630, PMCID: PMC4005272.
Ebadi SA, Afshar M. Epidemiology of hypothyroidism in Gilan. Feyz. 2004; 8(3): 30-5.
Rezaeian S, Poorolajal J, Moghimbegi A, Esmailnasab N. Risk factors of congenital hypothyroidism using
propensity score: a matched case-control study. J Res Health Sci. 2013; 13(2): 151-6. PMID: 24077472.
Khalafi A, Jafarisani M, Alizadeh H, Hasanzadeh M, Jafarisani A, Kameli M, et al. Screening of congenital
hypothyroidism in the Torbat-E-Heydariyeh in 1390. Journal of Torbat Heydariyeh University of Medical
Sciences. 2014; 1(4): 40-5.
Harris KB, Pass KA. Increase in congenital hypothyroidism in New York State and in the United States.
Molecular genetics and metabolism. 2007; 91(3): 268-77. doi: 10.1016/j.ymgme.2007.03.012.
Hamamy H, Antonarakis SE, Cavalli-Sforza LL, Temtamy S, Romeo G, Ten Kate LP, et al.
Consanguineous marriages, pearls and perils: Geneva international consanguinity workshop report.
Genetics in Medicine. 2011; 13(9): 841-7. doi: 10.1097/GIM.0b013e318217477f.
Valizadeh M, Mazloomzadeh S, Niksirat A, Shajari Z. High Incidence and Recall Rate of Congenital
Hypothyroidism in Zanjan Province, a Health Problem or a Study Challenge? International Journal of
Endocrinology and Metabolism. 2011; 9(4): 338-42.
Keshavarzian E, Valipoor AA, Maracy MR. The incidence of congenital hypothyroidism and its
determinants from 2012 to 2014 in Shadegan, Iran: a case-control study. Epidemiol Health. 2016; 38:
e2016021. doi: 10.4178/epih.e2016021. PMID: 27283138, PMCID: PMC4967912.
Hasani N, Dehghan B, Amini M, Heidari K, Sajadi A, Ajami A, et al. Congenital hypothyroidism; is there
any familial component? Journal of Isfahan Medical School. 2009; 27(94): 134-41.
Dalili S, Rezvani SM, Dalili H, Amiri ZM, Mohammadi H, Kesh SA, et al. Congenital hypothyroidism:
etiology and growth-development outcome. Acta Med Iran. 2014; 52(10): 752-6. PMID: 25369009.
Eftekhari N, Asadikaram Gh, Khaksari M, Salari Z. The prevalence rate of congenital hypothyroidism in
Kerman/Iran in 2005-2007. Journal of Kerman University of Medical Sciences. 2015.
Razi S, VaziriNejad R, Rezaeian M, Sheikh Fathollahi M, Manshouri A, Goujani R, et al. Survey of Birth
Weight in Newborns among Mothers with and Without a Common Underlying Disease in Rafsanjan
Niknafs Maternity in 2011-2012. JRUMS. 2014; 13(4): 323-38.
Pearce MS, Korada M, Day J, Turner S, Allison D, Kibirige M, et al. Increasing incidence, but lack of
seasonality, of elevated TSH levels, on newborn screening, in the North of England. Journal of thyroid
research. 2010; 2010. doi: 10.4061/2010/101948.
Hashemipour M, Amini M, Kelishadi R, Hovsepian S, Haghighi S, Hosseini M, et al. Seasonal variation in
the incidence of congenital hypothyroidism in Isfahan, Iran. Saudi Med J. 2007; 28(10): 1582. PMID:
Gu YH, Kato T, Harada S, Inomata H, Saito T, Aoki K. Seasonality in the incidence of congenital
hypothyroidism in Japan: gender-specific patterns and correlation with temperature. Thyroid. 2007; 17(9):
-74. doi: 10.1089/THY.2006.0317.
Ordookhani A, Padyab M, Goldasteh A, Mirmiran P, Richter J, Azizi F. Seasonal variation of neonatal
transient hyperthyrotropinemia in Tehran province, 1998–2005. Chronobiology international. 2010; 27(9- 10): 1854-69. doi: 10.3109/07420528.2010.516046.
Mohammadi E, Baneshi MR, Nakhaee N. The Incidence of Congenital Hypothyroidism in Areas Covered
by Kerman and Jiroft Universities of Medical Sciences, Iran. 2012.
Asadi Karam G, Aminzadeh F, Sheikh Fathollahi S, Masoud Pour N, Reyahi B, Yusefnia N, et al. High
recall rate in the screening program for congenital hypothyroidism in Rafsanjan. Iranian journal of
Endocrinology and Metabolism. 2004; 6(1): 21-6.
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