Abstract Purpose Recent studies have shown an increased incidence of congenital hypothyroidism over the past 2 or 3 decades. The etiology of this change is unknown, but it has been related by several ...authors to lowering of cutoffs. We sought to determine whether the incidence of congenital hypothyroidism (CH) in France has changed. Methods We analyzed data from the nationwide neonatal screening program for CH during the period 1982–2012. We included all children having thyroid-stimulating hormone values above the threshold and for whom diagnosis of CH confirmed by the pediatrician. We estimated multicentric temporal trends in the annual incidence rates adjusted for screening methods for thyroid dysgenesis and eutopic gland. Results We found 6622 cases of CH (28.0 per 100,000 newborns); 1895 had a eutopic gland, and 4727 had thyroid dysgenesis. The incidence of eutopic glands showed a significant annual average increase of (5.1%; 95% confidence interval: 4.3–5.9) regardless of the screening method or screening center. This increase was confirmed in severe cases (thyroid-stimulating hormone ≥50: 2.1%; 95% confidence interval, 1.4–2.9). The incidence of dysgenesis remained constant. Conclusions The incidence of eutopic glands increased in France, not only in mild forms but also in severe cases.
Graves' disease in children Léger, Juliane, MD; Kaguelidou, Florentia, MD, PhD; Alberti, Corinne, MD, PhD ...
Best Practice & Research Clinical Endocrinology & Metabolism,
03/2014, Letnik:
28, Številka:
2
Journal Article
Recenzirano
Graves' disease is an autoimmune disorder resulting from thyrotropin receptor stimulation by autoantibodies. It may occur at any age during childhood, but its frequency increases with age, peaking ...during adolescence. Symptoms and signs are often recognizable and proportional to the increase in serum free thyroid hormone levels. Antithyroid drug treatment with methimazole (or carbimazole) is recommended for initial treatment, but relapse rates are high, with remission achieved in only 30% of children after a first course of treatment for about two years. More prolonged medical treatment may increase the remission rate to up to 50%. Alternative treatments, such as radioactive iodine or thyroidectomy, are considered in cases of relapse, lack of compliance or antithyroid drug toxicity. Relapse risk decreases with increasing duration of the first course of antithyroid drug treatment. The identification of other predictive factors, such as severe biochemical hyperthyroidism at diagnosis, young age and the absence of other autoimmune conditions, has made it possible to stratify patients according to the risk of relapse, leading to improvements in patient management, by facilitating the identification of patients requiring long-term antithyroid drug treatment or early alternative therapy.
Congenital Hypothyroidism: Role of Nuclear Medicine Keller-Petrot, Isabelle, MD; Leger, Juliane, MD, PhD; Sergent-Alaoui, Aline, MD ...
Seminars in nuclear medicine,
03/2017, Letnik:
47, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Thyroid scintigraphy holds a key place in the etiologic workup of neonatal hypothyroidism. Routine screening for this disorder in maternity hospitals in industrialized countries, for nearly 40 years, ...has permitted early treatment and thereby helped to prevent its physical and mental complications. Neonatal hypothyroidism affects approximately 1 in 3000 births. The most common causes are abnormal thyroid gland development and defective hormone synthesis by an eutopic thyroid gland. The incidence of the latter has risen in recent years, for reasons that remain unclear. A thorough etiologic workup helps to determine the disease type. Current guidelines recommend thyroid imaging by means of ultrasound and scintigraphy. Ultrasound should be done by a practitioner trained to examine the cervical region of newborns, as the thyroid is very small and must be distinguished from the particular aspect of the “thyroid empty lodge.” Ultrasound lacks sensitivity for detecting small ectopic glands but is the gold standard for measuring thyroid dimensions. Scintigraphy provides an etiologic diagnosis in most cases. The two isotopes used in this setting are technetium-99m and iodine-123. The latter isotope gives more contrast and allows the perchlorate discharge test to be performed to detect abnormal iodide organification in the neonate with an eutopic thyroid. If scintigraphy cannot be performed during the neonatal period, a postponed procedure can be achieved after 3 years of age. Close cooperation between the nuclear medicine physician and the pediatric endocrinologist is crucial for timely and optimized scintigraphy.
Objective To analyze glycemic profile in children with congenital central hypoventilation syndrome, which is characterized by autonomic nervous system dysfunction. Study design We carried out a ...university hospital–based observational study. Participants included 14 patients assessed from 2007 to 2009 with a median age of 7.6 (25th-75th percentiles, 1.5-9.6) years at the time of the study. Glucose metabolism was assessed by calculating 24-hour plasma glucose (before and after meals) and fasting insulin concentrations and carrying out an oral glucose tolerance test (OGTT). The main outcome measure was the proportion of patients with abnormal glucose concentrations. Results Abnormal plasma glucose concentrations were found in 6 (43%) of the 14 patients with high fasting (n = 1) or postprandial (n = 5) hyperglycemia. OGTT was performed in 8 patients, of whom 3 (38%) had impaired glucose tolerance. Indices of insulin resistance and secretion were normal. No difference in clinical aspects relating to the presence of affected organs and/or systems related to central nervous system dysfunction, age, or auxology findings was found between patients with normal (43%) and abnormal (57%) glucose homeostasis over a 24-hour glycemia cycle or OGTT. Conclusion This study provides new information about glucose homeostasis in congenital central hypoventilation syndrome, revealing a high incidence of hyperglycemia and expanding the spectrum of the disease. It highlights the link between autonomic nervous system dysfunction and glycemic dysregulation. Regular, long-term monitoring of glucose metabolism is recommended in these patients.
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