Abstract
Objectives:The study objective was to establish serum TSH cut off value for diagnosis of new case of congenital hypothyroidism and to estimate frequency of Congenital Neonatal Hypothyroidism.Methods:A case control study was conducted at DHQ Teaching Hospital of DG Khan Medical College, Dera Ghazi Khan during 2020 to establish reference values of TSH and T4 for study population. Sample size was calculated by classical sample size calculation formula Cochran WG 1977 sampling technique. A group of 30 neonates of normal, healthy, euthyroid mothers was taken as Neonatal Control Group to estimate levels of TSH and total T4 in normal neonates. Neonatal Study Group was neonates of hypothyroid mothers (n=75). Simple random sampling technique was applied.Results:Mean (mean ± SD) Serum TSH levels of Neonatal Control Group were found to be 3.58 ± 03.09 mIU/l. Mean Serum TSH levels among Neonatal Study Group were found to be 6.88 ±12.95 mIU/l and serum total T4 were found to be 16.78 ± 6.96ug/dl on 3-7 days of life. Serum total T4 (mean ± SD) levels of Neonatal Control Group were 9.73 ± 03.39 ug/dl. Neonatal serum TSH more than 15mIU/l was taken as cut off value to diagnose a case of CNH. So, frequency of CNH was 8% among neonates of study group.Conclusions:The TSH cut off value of >15mIU/l was established for case detection of CNH. Our findings of CNH in district Dera Ghazi Khan (8%) are the highest frequency of CNH reported so far in Pakistan.
Highlights
Congenital neonatal hypothyroidism (CNH) is a common cause of mental retardation in children
0.06 0.000 t-test was applied to compare serum total T4 levels of Neonatal Study Group with TSH levels of Neonatal Control Group, SEM for Neonatal Study Group was 0.883 and SEM for Neonatal Control Group was 0.652, the results shown were highly significant statistically (P < 0.001) (Table-II)
They reported serum TSH cut off value of more than 13 mIU/l to diagnose a case of congenital hypothyroidism.[14]
Summary
Congenital neonatal hypothyroidism (CNH) is a common cause of mental retardation in children. Fetuses of mothers, having hypo-thyroxinemia, may present with fetal goiter and fetal hypothyroidism. Enlarged thyroid gland (goiter) in fetus just like in adults may be associated with euthyroidism, hypothyroidism or hyperthyroidism.[1]. The incidence of CNH was estimated 1:2500 to 1: 4000 live births worldwide. The major maternal causes of CNH are maternal iodine deficiency, maternal intake of anti-thyroid drugs, excessive iodine intake. Fetal causes may be fetal thyroid dysgenesis, fetal hormonogenesis defect (Pandered syndrome), autoimmune thyroid disease in the fetus, fetal TSH receptor mutation or fetal thyroid tumors.[2]
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