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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >The impact of transient hypothyroidism on the increasing rate of congenital hypothyroidism in the United States.
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The impact of transient hypothyroidism on the increasing rate of congenital hypothyroidism in the United States.

机译：在美国，短暂性甲状腺功能减退症对先天性甲状腺功能减退症发病率上升的影响。

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The reported incidence rate of primary congenital hypothyroidism (CH) has been increasing in the United States over the past 2 decades. We have considered the possibility that the inclusion of cases of transient hypothyroidism has inflated the reported incidence rate of CH. Assessing the effects of cases of transient hypothyroidism on the incidence rate is problematic, because the definitions, diagnostic criteria, and differentiation from transient hyperthyrotropinemia vary widely among state newborn screening programs. Among the 4 etiologies for transient hypothyroidism (maternal thyrotropin receptor-blocking antibodies, exposure to maternal antithyroid medications, iodine deficiency, and iodine excess), there is little evidence of increases in the incidence rate from thyrotropin receptor-blocking antibodies. Exposure to antithyroid drugs could contribute significantly to the incidence rate of transient CH, given the high estimated incidence of active maternal hyperthyroidism. Iodine deficiency or excess in the United States seems unlikely to have contributed significantly to the incidence rate of CH, because the secular trend toward lower iodine intake among women of reproductive age in the 1980s and 1990s seems to have plateaued, and perinatal iodine exposure has presumably declined as a result of recommendations to discontinue using iodine-containing disinfectants. Although the female-to-male sex ratio among newborns with thyroid agenesis or dysgenesis (the most common causes of CH) is typically 2:1, analysis of the sex ratio of newborns diagnosed with presumed CH in the United States suggests that a substantial proportion might have transient hypothyroidism or hyperthyrotropinemia, because the sex ratio has been well below the expected 2:1 ratio. Combined ultrasonography and (123)I scintigraphy of the thyroid gland are effective tools for identifying cases of thyroid agenesis and dysgenesis and can help to differentiate cases of transient hypothyroidism from true CH. Imaging is also a vital component in evaluating children who, at 3 years of age, undergo a trial of discontinuation of levothyroxine treatment to test for persistence of hypothyroidism. Ultimately, thyroid gland imaging, in conjunction with long-term follow-up studies that appropriately assess and report whether there was permanence of hypothyroidism, will be necessary to address the true incidence rate of CH and any contribution to the observed rate by transient cases of hypothyroidism or hyperthyrotropinemia.
机译：在过去的20年中，美国报告的原发性先天性甲状腺功能减退症（CH）的发病率一直在增加。我们考虑了包括短暂性甲状腺功能减退症的病例可能会夸大报道的CH发生率的可能性。评估暂时性甲状腺功能减退症病例对发病率的影响是有问题的，因为在各州新生儿筛查计划中，定义，诊断标准和与暂时性甲状腺功能亢进症的区分存在很大差异。在短暂性甲状腺功能减退的4种病因中（母体促甲状腺激素受体阻断抗体，母体抗甲状腺药物暴露，碘缺乏和碘过量），几乎没有证据表明促甲状腺激素受体阻断抗体的发病率增加。鉴于活动性甲状腺功能亢进症的高估计发病率，暴露于抗甲状腺药物可能显着影响短暂性CH的发生率。在美国，碘缺乏症或碘过量似乎不太可能对CH的发生率造成显着影响，因为1980年代和1990年代育龄妇女碘摄入量的长期趋势似乎已趋于平稳，围产期碘暴露可能已增加由于建议停止使用含碘消毒剂而下降。尽管在患有甲状腺发育不全或发育异常（CH的最常见原因）的新生儿中，男女性别比通常为2：1，但对美国诊断为CH的新生儿的性别比进行分析后发现，可能患有短暂性甲状腺功能减退症或甲状腺功能亢进症，因为性别比例已大大低于预期的2：1比例。超声检查和甲状腺的（123）I闪烁显像相结合是鉴别甲状腺发育不全和发育不全病例的有效工具，可帮助区分短暂性甲状腺功能减退症和真正的CH。成像也是评估3岁儿童接受左甲状腺素治疗试验以测试甲状腺功能减退症持续性的重要组成部分。最终，对甲状腺进行适当的评估并报告是否存在甲状腺功能减退症的长期随访研究，对甲状腺的影像学检查，以解决CH的真实发病率以及由短暂性脑出血病例对观察到的比率的任何贡献将是必要的。甲状腺功能减退或甲状腺功能亢进症。

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