Space–time clustering of elevated thyroid stimulating hormone levels

Pearce, Mark S.; McNally, Richard J.Q.; Day, Julie; Korada, Srinivasa Murthy; Turner, Steve; Cheetham, Tim

doi:10.1007/s10654-011-9571-8

Cited by 9 publications

(5 citation statements)

References 40 publications

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“…2 ), although only one reached formal statistical significance for DG cases, while two reached significance among unknown cases. There were differences in the nature of space–time clustering in Scottish patients when compared with our earlier study ( 8 ), but the population distribution and nature of environmental factors will be different.…”

Section: Discussioncontrasting

confidence: 81%

“…Space–time clustering cannot be attributed to underlying spatial fluctuations in disease incidence or change in incidence with time. We have described space–time clustering of babies born with an elevated TSH in northern England ( 8 ), suggesting that environmental factors are involved in CHT. One of the study limitations was that babies were only identified as having raised TSH concentrations.…”

Section: Introductionmentioning

confidence: 99%

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Congenital Hypothyroidism: Space–Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology

McNally

Jones

Shaikh

et al. 2021

Thyroid

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Background: The etiology of most cases of congenital hypothyroidism (CHT) due to thyroid dysgenesis is unknown. If transient environmental factors can impact on thyroid gland development then clustering of cases in time and / or space may occur and this would be more likely in thyroid dysgenesis than dyshormonogenesis. Methods: The newborn screening programme for CHT in Scotland is linked to a central database that includes case details such as post-code. The etiology of CHT is investigated in many cases of CHT using scintigraphy and/or ultrasonography. We looked for evidence of a change in CHT incidence with year of birth and according to season of the year. We then undertook space-time clustering analysis (using a method based on K-functions, with nearest neighbor thresholds) of CHT in Scotland 1979-2015. We also looked for evidence of overall changes associated with sex and area-based birth density. Results: Of 531 cases with CHT during the study period, 290 had been categorized as dysgenesis (229) or dyshormonogenesis (61) following more detailed investigation. The incidence of CHT increased with year of birth and was in part linked to changing methodology but there was no seasonality. There was no evidence of overall space-time clustering (p = 0.06), but there was evidence of clustering in babies with dysgenesis (p = 0.007). This picture appeared to be most closely linked to underlying thyroid gland hypoplasia rather than thyroid gland agenesis or ectopia. There was significant space-time clustering for both males and females, but clustering was restricted to lesser birth density areas. There was also evidence of clustering for unknown cases (p < 0.001). Clustering of these cases was restricted to females, but was present for cases from both greater and lesser birth density areas. There was no evidence of clustering in cases of dyshormonogenesis. Conclusions: These data suggest that an unidentified environmental factor or factors may be involved in the etiology of thyroid dysgenesis in Scotland. The variation in CHT incidence observed internationally may reflect environmental as well as genetic factors.

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Section: Discussioncontrasting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Congenital Hypothyroidism: Space–Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology

McNally

Jones

Shaikh

et al. 2021

Thyroid

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“…In a single centre in Northern England males seemed to have higher TSH levels than females [35]. In Belgium there was no difference in TSH levels between boys and girls.…”

Section: Discussionmentioning

confidence: 74%

Neonatal Thyroid-Stimulating Hormone Concentrations in Belgium: A Useful Indicator for Detecting Mild Iodine Deficiency?

et al. 2012

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It has been proposed that neonatal thyroid-stimulating hormone (TSH) concentrations are a good indicator of iodine deficiency in the population. A frequency of neonatal TSH concentrations above 5 mU/L below 3% has been proposed as the threshold indicating iodine sufficiency. The objective of the present study was to evaluate feasibility and usefulness of nation-wide neonatal TSH concentration screening results to assess iodine status in Belgium. All newborns born in Belgium during the period 2009–2011 (n = 377713) were included in the study, except those suffering from congenital hypothyroidism and premature neonates. The frequency of neonatal TSH concentrations above 5 mU/L from 2009 to 2011 in Belgium fluctuated between 2.6 and 3.3% in the centres using the same TSH assay. There was a significant inverse association between neonatal TSH level and birth weight. The longer the duration between birth and screening, the lower the TSH level. Neonatal TSH levels were significantly lower in winter than in spring or autumn and significantly lower in spring and summer than in autumn while significantly higher in spring compared to summer. In conclusion, despite that pregnant women in Belgium are mildly iodine deficient, the frequency of neonatal TSH concentrations above 5 mU/L was very low, suggesting that the neonatal TSH threshold proposed for detecting iodine deficiency needs to be re-evaluated. Although neonatal TSH is useful to detect severe iodine deficiency, it should not be recommended presently for the evaluation of iodine status in mildly iodine deficient regions.

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“…Evidence on the effect of toxic agents is scarce, but Pearce et al [19] have recently shown a time-space association, pointing out a still unclear environmental impact.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Etiology of Congenital Hypothyroidism Detected through an Argentine Neonatal Screening Program (1997-2010)

et al. 2013

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Introduction: We retrospectively assessed the incidence of congenital hypothyroidism (CH) detected through our neonatal screening program between 1997 and 2010. We describe the diagnostic characteristics of the detected population and verify the impact of a TSH cutoff (CO) change. Patients and Methods: Screening was based on TSH determination on dried blood spot on filter paper samples (IFMA) using a 15 mU/l blood CO until 12/2002 (P1) and 10 mU/l thereafter (P2). Patients were classified as having transient or permanent CH (athyreotic, ectopic, eutopic, with goiter and unknown etiology). Global and diagnostic-related incidences were calculated for the whole studied period with the same CO, and P1 and P2 were compared. Results: Incidences of permanent CH were 1:3,108 (P1) and 1:2,367 (P2). The lower CO detected 22 extra CH, 13 of them definitive (70% with eutopic glands). Only a significant increase (p < 0.05) in eutopic CH was found, partially related to the lower CO applied. A statistically significant association with time was seen for total definitive and ectopic cases (p < 0.05). Conclusion: Our findings revealed some changes in the detected population partially related to the CO applied, with only eutopic dysfunctional disorders being more prevalent in the later years. Total permanent CH and ectopic thyroid disorders showed a trend toward higher detection over time, but their prevalence has not changed significantly in our screening program.

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Space–time clustering of elevated thyroid stimulating hormone levels

Cited by 9 publications

References 40 publications

Congenital Hypothyroidism: Space–Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology

Congenital Hypothyroidism: Space–Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology

Neonatal Thyroid-Stimulating Hormone Concentrations in Belgium: A Useful Indicator for Detecting Mild Iodine Deficiency?

Prevalence and Etiology of Congenital Hypothyroidism Detected through an Argentine Neonatal Screening Program (1997-2010)

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