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26-07-2023 | Neonatal Screening | RESEARCH

Increased incidence of congenital hypothyroidism in China: An analysis of 119 million screened newborns

Authors: Yongna Yao, Kui Deng, Jun Zhu, Liangcheng Xiang, Xuelian Yuan, Qi Li, Lei Liu, Weijuan Xu

Published in: European Journal of Pediatrics | Issue 10/2023

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Abstract

Despite the lack of nationwide epidemiological studies, congenital hypothyroidism (CH) incidence in China has increased. We aimed to evaluate the trends of CH and the possible reasons behind them. Data from screened newborns from the Chinese Newborn Screening Information System from 2012 to 2019 was collected. We applied the Bayesian hierarchical Poisson regression model and meta-analysis to estimate incidence or proportion over the years. The estimated CH incidence increased from 4.01 per 10,000 births in 2012 to 5.77 per 10,000 births in 2019. The average annual growth rate (ARG) of CH incidence for all provinces varied from 0.59 to 20.96%. The most rapid rise in incidence was observed in cases with an initial thyroid stimulating hormone (TSH) concentration of < 10 mIU/L. The meta-analysis results showed that the proportion of permanent CH increased by 0.024% (95%CI: 0.011%, 0.037%) annually. Each 1 mIU/L decrease in TSH cutoff value was associated with a 2.96% increase in CH incidence. In the same period, the proportion of premature CH cases increased from 6.60 to 9.10%, which was much higher than the increase in preterm births. A significant relationship was not found between provincial growth rates in screening coverage and provincial baseline incidences of CH.
  Conclusion: CH incidence has substantially increased in China. The slight adjustment of the TSH cutoff value and increasing preterm birth rate contribute to such a trend; however, the contribution is limited.
What is Known:
• An uptrend in congenital hypothyroidism (CH) incidence has been reported in many European and American countries in the last two decades; however, no studies have been conducted in China to explain the increased CH incidence.
• We provide a detailed epidemiological report on the trends of CH during 2012–2019 in China, with an attempt to explore the reasons behind it.
What is New:
• This first-ever national-wide epidemiological report in China showed an uptrend in CH incidence with variations over regions and CH subtypes. The mild lowering of TSH cutoff values and the increasing preterm birth rate contributed to this uptrend.
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Literature
2.
go back to reference Kurinczuk JJ et al (2002) Congenital hypothyroidism in Western Australia 1981–1998. J Paediatr Child Health 38(2):187–191PubMedCrossRef Kurinczuk JJ et al (2002) Congenital hypothyroidism in Western Australia 1981–1998. J Paediatr Child Health 38(2):187–191PubMedCrossRef
3.
go back to reference Salim FA, Varma SK (2014) Congenital hypothyroidism and the importance of universal newborn screening. Indian J Pediatr 81(1):53–57PubMedCrossRef Salim FA, Varma SK (2014) Congenital hypothyroidism and the importance of universal newborn screening. Indian J Pediatr 81(1):53–57PubMedCrossRef
4.
go back to reference Albert BB et al (2012) Etiology of increasing incidence of congenital hypothyroidism in New Zealand from 1993–2010. J Clin Endocrinol Metab 97(9):3155–3160PubMedCrossRef Albert BB et al (2012) Etiology of increasing incidence of congenital hypothyroidism in New Zealand from 1993–2010. J Clin Endocrinol Metab 97(9):3155–3160PubMedCrossRef
5.
go back to reference Chen CY et al (2013) Epidemiology and clinical characteristics of congenital hypothyroidism in an Asian population: a nationwide population-based study. J Epidemiol 23(2):85–94PubMedPubMedCentralCrossRef Chen CY et al (2013) Epidemiology and clinical characteristics of congenital hypothyroidism in an Asian population: a nationwide population-based study. J Epidemiol 23(2):85–94PubMedPubMedCentralCrossRef
6.
go back to reference Harris KB, Pass KA (2007) Increase in congenital hypothyroidism in New York State and in the United States. Mol Genet Metab 91(3):268–277PubMedCrossRef Harris KB, Pass KA (2007) Increase in congenital hypothyroidism in New York State and in the United States. Mol Genet Metab 91(3):268–277PubMedCrossRef
7.
go back to reference Hinton CF et al (2010) Trends in incidence rates of congenital hypothyroidism related to select demographic factors: data from the United States, California, Massachusetts, New York, and Texas. Pediatrics 125(Suppl 2):S37-47PubMedCrossRef Hinton CF et al (2010) Trends in incidence rates of congenital hypothyroidism related to select demographic factors: data from the United States, California, Massachusetts, New York, and Texas. Pediatrics 125(Suppl 2):S37-47PubMedCrossRef
8.
go back to reference Wassner AJ, Brown RS (2015) Congenital hypothyroidism: recent advances. Curr Opin Endocrinol Diabetes Obes 22(5):407–412PubMedCrossRef Wassner AJ, Brown RS (2015) Congenital hypothyroidism: recent advances. Curr Opin Endocrinol Diabetes Obes 22(5):407–412PubMedCrossRef
9.
go back to reference McGrath N et al (2018) Incidence of congenital hypothyroidism over 37 years in Ireland. Pediatrics 142(4) McGrath N et al (2018) Incidence of congenital hypothyroidism over 37 years in Ireland. Pediatrics 142(4)
10.
go back to reference Hertzberg V, Mei J, Therrell BL (2010) Effect of laboratory practices on the incidence rate of congenital hypothyroidism. Pediatrics 125(Suppl 2):S48-53PubMedCrossRef Hertzberg V, Mei J, Therrell BL (2010) Effect of laboratory practices on the incidence rate of congenital hypothyroidism. Pediatrics 125(Suppl 2):S48-53PubMedCrossRef
11.
go back to reference Olney RS, Grosse SD, Vogt RF Jr (2010) Prevalence of congenital hypothyroidism–current trends and future directions: workshop summary. Pediatrics 125(Suppl 2):S31-36PubMedCrossRef Olney RS, Grosse SD, Vogt RF Jr (2010) Prevalence of congenital hypothyroidism–current trends and future directions: workshop summary. Pediatrics 125(Suppl 2):S31-36PubMedCrossRef
12.
go back to reference Deng K et al (2018) Incidence of congenital hypothyroidism in China: data from the national newborn screening program, 2013–2015. J Pediatr Endocrinol Metab 31(6):601–608PubMedCrossRef Deng K et al (2018) Incidence of congenital hypothyroidism in China: data from the national newborn screening program, 2013–2015. J Pediatr Endocrinol Metab 31(6):601–608PubMedCrossRef
13.
go back to reference Yao YN et al (2021) Geographic variations in the incidence of congenital hypothyroidism in China: a retrospective study based on 92 million newborns screened in 2013–2018. Chin Med J (Engl) 134(18):2223–2230PubMedCrossRef Yao YN et al (2021) Geographic variations in the incidence of congenital hypothyroidism in China: a retrospective study based on 92 million newborns screened in 2013–2018. Chin Med J (Engl) 134(18):2223–2230PubMedCrossRef
14.
go back to reference Zhan JY, Qin YF, Zhao ZY (2009) Neonatal screening for congenital hypothyroidism and phenylketonuria in China. World J Pediatr 5(2):136–139PubMedCrossRef Zhan JY, Qin YF, Zhao ZY (2009) Neonatal screening for congenital hypothyroidism and phenylketonuria in China. World J Pediatr 5(2):136–139PubMedCrossRef
15.
go back to reference Zhang B, Li X, Yu Z (2014) Study on neonatal congenital hypothyroidism prevalence trend in Beijing[in Chinease]. Chinese Journal of Child Health Care 22(7):742–745 Zhang B, Li X, Yu Z (2014) Study on neonatal congenital hypothyroidism prevalence trend in Beijing[in Chinease]. Chinese Journal of Child Health Care 22(7):742–745
16.
go back to reference Zhou Y et al (2020) Birth defects data from population-based birth defects surveillance system in a district of Southern Jiangsu, China, 2014–2018. Front Public Health 8:378PubMedPubMedCentralCrossRef Zhou Y et al (2020) Birth defects data from population-based birth defects surveillance system in a district of Southern Jiangsu, China, 2014–2018. Front Public Health 8:378PubMedPubMedCentralCrossRef
17.
go back to reference Zhu Y et al (2021) Analysis of congenital hypothyroidism screening in Jilin Province from 2010 to 2019[in Chinease]. Modern Preventive Medicine 48(2):219–221 Zhu Y et al (2021) Analysis of congenital hypothyroidism screening in Jilin Province from 2010 to 2019[in Chinease]. Modern Preventive Medicine 48(2):219–221
18.
go back to reference Xiang L et al (2019) Phenylketonuria incidence in China between 2013 and 2017 based on data from the Chinese newborn screening information system: a descriptive study. BMJ Open 9(8):e031474PubMedPubMedCentralCrossRef Xiang L et al (2019) Phenylketonuria incidence in China between 2013 and 2017 based on data from the Chinese newborn screening information system: a descriptive study. BMJ Open 9(8):e031474PubMedPubMedCentralCrossRef
19.
go back to reference NH C (2010) Technological guideline on national newborn screening. NH C (2010) Technological guideline on national newborn screening.
20.
go back to reference Center NHCCL (2020) Consensus on screening for genetic and metabolic diseases in preterm, low birth weight and diseased infants. Chin J Pract Pediatr 35(3):180–184 Center NHCCL (2020) Consensus on screening for genetic and metabolic diseases in preterm, low birth weight and diseased infants. Chin J Pract Pediatr 35(3):180–184
21.
go back to reference Brown RS, Demmer LA (2002) The etiology of thyroid dysgenesis-still an enigma after all these years. J Clin Endocrinol Metab 87(9):4069–4071PubMedCrossRef Brown RS, Demmer LA (2002) The etiology of thyroid dysgenesis-still an enigma after all these years. J Clin Endocrinol Metab 87(9):4069–4071PubMedCrossRef
22.
23.
go back to reference Finucane MM (2014) Bayesian estimation of population-level trends in measures of health status. Stat Sci 29(1):18–25CrossRef Finucane MM (2014) Bayesian estimation of population-level trends in measures of health status. Stat Sci 29(1):18–25CrossRef
24.
go back to reference CSoECSoP M (2019) Guideline on diagnosis and management of thyroid diseases during pregnancy and postpartum, 2nd edn. [in Chinease]. Chin J Endocrinol Metab 35(8):636–665 CSoECSoP M (2019) Guideline on diagnosis and management of thyroid diseases during pregnancy and postpartum, 2nd edn. [in Chinease]. Chin J Endocrinol Metab 35(8):636–665
25.
go back to reference Jacob H, Peters C (2015) Screening, diagnosis and management of congenital hypothyroidism: European Society for Paediatric Endocrinology Consensus Guideline. Arch Dis Child Educ Pract Ed 100(5):260–263PubMedCrossRef Jacob H, Peters C (2015) Screening, diagnosis and management of congenital hypothyroidism: European Society for Paediatric Endocrinology Consensus Guideline. Arch Dis Child Educ Pract Ed 100(5):260–263PubMedCrossRef
26.
go back to reference Surks MI et al (2004) Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 291(2):228–238PubMedCrossRef Surks MI et al (2004) Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 291(2):228–238PubMedCrossRef
27.
go back to reference Deng K et al (2021) Preterm births in China between 2012 and 2018: an observational study of more than 9 million women. Lancet Glob Health 9(9):e1226–e1241PubMedPubMedCentralCrossRef Deng K et al (2021) Preterm births in China between 2012 and 2018: an observational study of more than 9 million women. Lancet Glob Health 9(9):e1226–e1241PubMedPubMedCentralCrossRef
28.
go back to reference Mengreli C et al (2010) Screening for congenital hypothyroidism: the significance of threshold limit in false-negative results. J Clin Endocrinol Metab 95(9):4283–4290PubMedCrossRef Mengreli C et al (2010) Screening for congenital hypothyroidism: the significance of threshold limit in false-negative results. J Clin Endocrinol Metab 95(9):4283–4290PubMedCrossRef
29.
go back to reference Pearce MS et al (2010) Increasing incidence, but lack of seasonality, of elevated TSH levels, on newborn screening, in the north of England. J Thyroid Res 2010:101948PubMedPubMedCentralCrossRef Pearce MS et al (2010) Increasing incidence, but lack of seasonality, of elevated TSH levels, on newborn screening, in the north of England. J Thyroid Res 2010:101948PubMedPubMedCentralCrossRef
30.
go back to reference Liu L, He W, Zhu J, Deng K, Tan H, Xiang L, Yuan X, Li Q, Huang M, Guo Y, Yao Y, Li X (2023) Global prevalence of congenital hypothyroidism among neonates from 1969 to 2020: a systematic review and meta‑analysis. Eur J Pediatr Liu L, He W, Zhu J, Deng K, Tan H, Xiang L, Yuan X, Li Q, Huang M, Guo Y, Yao Y, Li X (2023) Global prevalence of congenital hypothyroidism among neonates from 1969 to 2020: a systematic review and meta‑analysis. Eur J Pediatr
31.
go back to reference Olivieri A et al (2015) Multiple factors influencing the incidence of congenital hypothyroidism detected by neonatal screening. Horm Res Paediatr 83(2):86–93PubMedCrossRef Olivieri A et al (2015) Multiple factors influencing the incidence of congenital hypothyroidism detected by neonatal screening. Horm Res Paediatr 83(2):86–93PubMedCrossRef
32.
go back to reference Barry Y et al (2016) Increased incidence of congenital hypothyroidism in France from 1982 to 2012: a nationwide multicenter analysis. Ann Epidemiol 26(2):100–105 e104 Barry Y et al (2016) Increased incidence of congenital hypothyroidism in France from 1982 to 2012: a nationwide multicenter analysis. Ann Epidemiol 26(2):100–105 e104
33.
go back to reference Taheri Soodejani M et al (2020) Trend of congenital hypothyroidism incidence and its affecting factors in Shahr-e-Kord. Western Iran Iran J Public Health 49(5):989–994PubMed Taheri Soodejani M et al (2020) Trend of congenital hypothyroidism incidence and its affecting factors in Shahr-e-Kord. Western Iran Iran J Public Health 49(5):989–994PubMed
34.
go back to reference Klosinska M, Kaczynska A, Ben-Skowronek I (2022) Congenital hypothyroidism in preterm newborns - the challenges of diagnostics and treatment: a review. Front Endocrinol (Lausanne) 13:860862 Klosinska M, Kaczynska A, Ben-Skowronek I (2022) Congenital hypothyroidism in preterm newborns - the challenges of diagnostics and treatment: a review. Front Endocrinol (Lausanne) 13:860862
36.
go back to reference Matejek N et al (2021) Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”). Eur J Pediatr 180(8):2401–2408PubMedPubMedCentralCrossRef Matejek N et al (2021) Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”). Eur J Pediatr 180(8):2401–2408PubMedPubMedCentralCrossRef
37.
go back to reference Fang Y et al (2019) Mutation screening of the TSHR gene in 220 Chinese patients with congenital hypothyroidism. Clin Chim Acta 497:147–152PubMedCrossRef Fang Y et al (2019) Mutation screening of the TSHR gene in 220 Chinese patients with congenital hypothyroidism. Clin Chim Acta 497:147–152PubMedCrossRef
38.
go back to reference Ford G, LaFranchi SH (2014) Screening for congenital hypothyroidism: a worldwide view of strategies. Best Pract Res Clin Endocrinol Metab 28(2):175–187PubMedCrossRef Ford G, LaFranchi SH (2014) Screening for congenital hypothyroidism: a worldwide view of strategies. Best Pract Res Clin Endocrinol Metab 28(2):175–187PubMedCrossRef
39.
go back to reference Corbetta C et al (2009) A 7-year experience with low blood TSH cutoff levels for neonatal screening reveals an unsuspected frequency of congenital hypothyroidism (CH). Clin Endocrinol (Oxf) 71(5):739–745PubMedCrossRef Corbetta C et al (2009) A 7-year experience with low blood TSH cutoff levels for neonatal screening reveals an unsuspected frequency of congenital hypothyroidism (CH). Clin Endocrinol (Oxf) 71(5):739–745PubMedCrossRef
40.
go back to reference Deladoëy J et al (2011) Is the incidence of congenital hypothyroidism really increasing? A 20-year retrospective population-based study in Québec. J Clin Endocrinol Metab 96(8):2422–2429PubMedCrossRef Deladoëy J et al (2011) Is the incidence of congenital hypothyroidism really increasing? A 20-year retrospective population-based study in Québec. J Clin Endocrinol Metab 96(8):2422–2429PubMedCrossRef
41.
go back to reference Shi Z, Yi S, Liu XA (2010) Research on cut-off value thyroid stimulation hormone(TSH) for screening of congenital hypothyroidism(CH) newborn in Hubei province[in Chinese]. Matern Child Health Care of Chin 18(5):89–90, 100 Shi Z, Yi S, Liu XA (2010) Research on cut-off value thyroid stimulation hormone(TSH) for screening of congenital hypothyroidism(CH) newborn in Hubei province[in Chinese]. Matern Child Health Care of Chin 18(5):89–90, 100
42.
go back to reference Xie J, Zhang Y, Guo S (2017) Study on the value of TSH screening for neonatal congenital hypothyroidism in Shantou[in Chinease]. International Journal of Laboratory Medicine 38(1):77–79 Xie J, Zhang Y, Guo S (2017) Study on the value of TSH screening for neonatal congenital hypothyroidism in Shantou[in Chinease]. International Journal of Laboratory Medicine 38(1):77–79
43.
go back to reference Goissen C et al (2011) Prospective study at 1 week of life of thyroid function in 97 consecutive pre-term newborns under 32 weeks of gestation. Arch Pediatr 18(3):253–260PubMedCrossRef Goissen C et al (2011) Prospective study at 1 week of life of thyroid function in 97 consecutive pre-term newborns under 32 weeks of gestation. Arch Pediatr 18(3):253–260PubMedCrossRef
45.
go back to reference Haim A et al (2021) Thyroid function tests in newborns of mothers with hypothyroidism. Eur J Pediatr 180(2):519–525PubMedCrossRef Haim A et al (2021) Thyroid function tests in newborns of mothers with hypothyroidism. Eur J Pediatr 180(2):519–525PubMedCrossRef
46.
go back to reference Desai MP et al (2018) Newborn screening guidelines for congenital hypothyroidism in India: recommendations of the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) - part i: screening and confirmation of diagnosis. Indian J Pediatr 85(6):440–447PubMedCrossRef Desai MP et al (2018) Newborn screening guidelines for congenital hypothyroidism in India: recommendations of the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) - part i: screening and confirmation of diagnosis. Indian J Pediatr 85(6):440–447PubMedCrossRef
47.
go back to reference Kaluarachchi DC et al (2019) Increased congenital hypothyroidism detection in preterm infants with serial newborn screening. J Pediatr 207:220–225PubMedCrossRef Kaluarachchi DC et al (2019) Increased congenital hypothyroidism detection in preterm infants with serial newborn screening. J Pediatr 207:220–225PubMedCrossRef
48.
go back to reference McGrath N et al (2019) Optimal timing of repeat newborn screening for congenital hypothyroidism in preterm infants to detect delayed thyroid-stimulating hormone elevation. J Pediatr 205:77–82PubMedCrossRef McGrath N et al (2019) Optimal timing of repeat newborn screening for congenital hypothyroidism in preterm infants to detect delayed thyroid-stimulating hormone elevation. J Pediatr 205:77–82PubMedCrossRef
49.
go back to reference Zhang J, Li Y (2021) Risk factors for neonatal congenital hypothyroidism: a meta analysis[in Chinese]. Chinese Journal of Contemporary Pediatrics 23(5):505–512PubMed Zhang J, Li Y (2021) Risk factors for neonatal congenital hypothyroidism: a meta analysis[in Chinese]. Chinese Journal of Contemporary Pediatrics 23(5):505–512PubMed
50.
go back to reference Zhou J et al (2015) Risk factors of 125 cases of neonatal congenital hypothyroidism during perinatal period. Zhonghua Liu Xing Bing Xue Za Zhi 36(7):747–751PubMed Zhou J et al (2015) Risk factors of 125 cases of neonatal congenital hypothyroidism during perinatal period. Zhonghua Liu Xing Bing Xue Za Zhi 36(7):747–751PubMed
51.
go back to reference Koopman-Esseboom C et al (1994) Effects of dioxins and polychlorinated biphenyls on thyroid hormone status of pregnant women and their infants. Pediatr Res 36(4):468–473PubMedCrossRef Koopman-Esseboom C et al (1994) Effects of dioxins and polychlorinated biphenyls on thyroid hormone status of pregnant women and their infants. Pediatr Res 36(4):468–473PubMedCrossRef
52.
go back to reference Turyk ME, Anderson HA, Persky VW (2007) Relationships of thyroid hormones with polychlorinated biphenyls, dioxins, furans, and DDE in adults. Environ Health Perspect 115(8):1197–1203PubMedPubMedCentralCrossRef Turyk ME, Anderson HA, Persky VW (2007) Relationships of thyroid hormones with polychlorinated biphenyls, dioxins, furans, and DDE in adults. Environ Health Perspect 115(8):1197–1203PubMedPubMedCentralCrossRef
53.
go back to reference Zhang L et al (2016) Increase of polychlorinated dibenzo-p-dioxins and dibenzofurans and dioxin-like polychlorinated biphenyls in human milk from China in 2007–2011. Int J Hyg Environ Health 219(8):843–849PubMedCrossRef Zhang L et al (2016) Increase of polychlorinated dibenzo-p-dioxins and dibenzofurans and dioxin-like polychlorinated biphenyls in human milk from China in 2007–2011. Int J Hyg Environ Health 219(8):843–849PubMedCrossRef
Metadata
Title
Increased incidence of congenital hypothyroidism in China: An analysis of 119 million screened newborns
Authors
Yongna Yao
Kui Deng
Jun Zhu
Liangcheng Xiang
Xuelian Yuan
Qi Li
Lei Liu
Weijuan Xu
Publication date
26-07-2023
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 10/2023
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-023-05108-8

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