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The Prevalence of Transient and Permanent Congenital http:// ijp.mums.ac.ir Original Article (Pages: 4309-4318) The Prevalence of Transient and Permanent Congenital Hypothyroidism in Infants of Kurdistan Province, Iran (2006-2014) Zaher Khazaei1, Elham Goodarzi2, Ebrahim Ghaderi1, Salman Khazaei3, Alireza Alikhani4, Saeeid Ghavi5, Kamyar Mansori6, Erfan Ayubi7, Behzad Gholamaliee8, Reza Beiranvand9, Seyedeh Leila Dehghani10, Nahid Ghotbi11, Sairan Nili121 1Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran. 2Social Determinants of Health Research Centre, Medical School, Rafsanjan University of Medical Science, Rafsanjan, Iran. 3Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 4Deputy of Medical Education Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. 5Social Determinants of Health Research Center, Department of Public Health, Birjand University of Medical Sciences, Birjand, Iran. 6Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran. 7PhD Candidate of Epidemiology, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 8Msc in Health Education, Hamadan University of Medical Sciences, Hamadan, Iran. 9MSc Department of Health and Community Medicine, Faculty of Medicine, Dezful University of Medical Sciences, Dezful, Iran. 10Department of Public Health, Behbahan Faculty of Medical sciences, Behbahan, Iran. 11Associate Professor, Cellular & Molecular Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran. 12PhD Student of Epidemiology, Kerman University of Medical Sciences, Kerman, Iran. Abstract Background: Congenital hypothyroidism (CH) is the most common endocrine diseases and one of the major causes of preventable mental retardation. This study was conducted to investigate the prevalence of transient and permanent congenital hypothyroidism in Kurdistan province, Iran. Materials and Methods: In this cross-sectional study, all registered congenital hypothyroidism neonate of health centers of cities covered by Kurdistan University of Medical Sciences during 2006 to 2014 entered to study. Demographic and laboratory information of CH neonates was collected and entered into the Stata-12 and was analyzed using student t-test and Chi-square statistic and P- value less than 0.05 was considered. Results: Overall incidence rate during 2006 to 2014 for province was 1.8, 2.3, 3.2, 4.3, 3.3, 4.0, 3.6, 4.6 and 2.7, respectively per 1000 neonates in this period. The number of diagnosed patients was 855 cases including 519 (60.7%) boys and 336 (39.3%) girls who 516 (60.4%) cases were from urban areas. Of the total patients, 202 (22.6%) were permanent. There was no significant difference between gender, location, type of childbirth, and season of birth with transient and permanent types of disease (P˃0.05); while, there was a significant statistical relationship between consanguineous marriages and congenital hypothyroidism (P<0.05). Conclusion: The prevalence of congenital hypothyroidism in Kurdistan province is significantly higher than the global and country levels that emphasize the continuation and reinforcement of screening program of infants. Therefore, complementary studies are research priorities of the health system in Kurdistan province in order to clarify the environmental and genetic factors related. Key Words: Congenital hypothyroidism, Hypothyroidism, Neonate, Iran. *Please cite this article as: Khazaei Z, Goodarzi E, Ghaderi E, Khazaei S, Alikhani A, Ghavi S, Mansori K, et al. The prevalence of Transient and Permanent Congenital Hypothyroidism in Infants of Kurdistan Province (2006-2014). Int J Pediatr 2017; 5(2): 4309-18. DOI: 10.22038/ijp.2016.7902 *Corresponding Author: Sairan Nili. Dept of Epidemiology, Kerman University of Medical Sciences, Kerman, Iran. Email: [email protected] Received date Nov.03, 2016; Accepted date: Dec 12, 2016 Int J Pediatr, Vol.5, N.2, Serial No.38, Feb.2017 4309 Effect of Video Game Play on Pain 1- INTRODUCTION paper) and confirmation with venous blood Hypothyroidism is the result of decrease samples TSH is greater than 10mu/l and in thyroid hormone synthesis or deficiency thyroxine (T4) less than 6.5gr/dl (8). in activity of thyroid hormone receptors. Congenital hypothyroidism is divided into The most common cause of congenital two groups as permanent and transient. hypothyroidism is disorder of complete or The transient type is automatically partial development of the thyroid gland or improving, while; the person has to take disorder of inappropriate replacement of medicine for the rest of his life in the thyroid during the fetal period (Entopic permanent type (9). Transient Gland) (1). CH is one of the major causes hypothyroidism is thyroid symptoms at the of preventable mental retardation in time of birth which are disappeared infants. Hypothalamic-pituitary-thyroid spontaneously and thoroughly within a few axis starts its activity in the middle of fetal weeks or months (9). The most common cause of transient hypothyroidism has been life and evolves until birth of term infant. Existence of hypothyroidism in the fetus reported iodine deficiency in the world. leads to some disorders in major organs Other causes of excessive consumption of including the central nervous system and iodine are consumption of anti-thyroid the skeleton (2). Most infants seem quite medications or presence of antibodies normal at birth, but children with signs of against the thyroid during pregnancy (10). precocious puberty and short stature and In general, the incidence rate of disease in delayed bone age should be sought for the world has been estimated 1 in every hypothyroidism (3). Currently, almost all 3,000-4,000 live births. According to the industrialized countries of the world research conducted, prevalence spectrum carry out the screening program for of CH in the world varies from 7.14 per neonatal hypothyroidism systemically (4). 1000 births in Nigeria (2) to 14 per 1000 Developing countries also gradually carry births in Japan (9). Based on studies out the screening program for neonatal conducted in Iran, the incidence of this hypothyroidism at different scales. Its disorder has been reported about 1 in 400 implementation has also started in Iran to 1 in 900 live births which is much since 1997 (5). Before beginning screening higher than the global average (10). programs, early diagnosis of the disease is Results of studies from other countries usually conducted with delay due to the have shown that the prevalence of this low and non-specificity of signs and disease is 1 in 650 in Turkey (12), 1 in symptoms in the first days of life, and this 1000 in France (13), 1 in 800 in Greece issue is associated with the loss of (14), 1 in 2,372 in America (15), 1 in Intelligence Quotient (IQ) to various 2,640 in India (16), and in several studies degrees in patients (6). Congenital this amount is about 1 in 400 to 1 in 900 hypothyroidism disease can lead to the live births (17). National studies had most important and major problems in different results in this regard, so that patients including failure to weight gain, prevalence of this disease was ranged from 1 in 1000 in Tehran, 1 in 370 in Isfahan physical growth slowdown, delay in the overall growth of the body and growth (18), and 1 in 303 in Kashan (19), to 1 in failure of these children that is often 1433 live births in Shiraz (20). The remained unknown (7). Congenital incidence of this disease in Kurdistan hypothyroidism can be referred when province which is one of the western Thyroid-Stimulating Hormone (TSH) is provinces of Iran and a mountainous area greater than 5mu/l of heel sample in is higher and about 1 in 400 live births infants 3-5 days on filter paper (S&S 903 (10). Int J Pediatr, Vol.5, N.2, Serial No.38, Feb. 2017 4310 Kaheni et al. Given the relatively high prevalence of this weeks after birth (21). Treatment of disease in Kurdistan province and its infected infants starts with a dose of 10 to importance in the creation of mental 15 μg / mg levothyroxine medication. retardation in children, we decided to After 3 years of treatment, in order to investigate the prevalence of congenital determine whether permanent or transient hypothyroidism in Kurdistan province disease, treatment is discontinued for 2-4 during 2006 to 2014. weeks and tests are repeated. If the transient disease is normal, treatment will 2- MATERIALS AND METHODS be discontinued otherwise it is permanent 2-1. Study Design and Population and medication must be consumed until the end of life (22). This cross-sectional study was conducted on children with neonatal In this program, heel prick blood samples hypothyroidism. In this we used the data have been taken on Whatman filter papers collected from the CH screening in for infants by trained staff, mostly within Kurdistan Province, Iran, from August 3-5 days of birth. They dry and 2006 to August 2014. National screening immediately transfer to the reference program for early detection of CH was screening laboratory of the province by conducted by Iranian Ministry of Health express mail service. Thyroid stimulating and Medical Education (MOHME) in all hormone (TSH) test using the enzyme provinces in 2005 and has been in progress linked immunosorbent assay (ELISA) up to now. Kurdistan is located in west of method. In this study according National Iran, and according to National Census, in screening program TSH less than 4mu/l 2011 population of Kurdistan province and 5mu/l were considered normal for 3-7 was 1,493,645 out of which 66% lived in day-old and ≥ 8 day- old neonates, urban area. The capital of Kurdistan respectively. Then, the neonates with TSH province is the city of Sanandaj and other more than normal were selected. In order counties are Marivan, Baneh, Saqqez, to distinguish between permanent and Qorveh, Bijar, Kamyaran, Dehgolan, transient cases of CH, levothyroxine (LT4) Diwandarreh and Sarvabad.
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