To Explore The Epidemiological Characteristics And Prognostic Factors Of Congenital Hypothyroidism

Objective:To explore the epidemiological characteristics and prognostic factors of CH in six regions of Shanxi Province,so as to provide reasonable reference for early prevention,early detection,early treatment and early prediction of disease classification in children with CH.Methods:Part ?: epidemiological analysis of CH in six cities of Shanxi ProvinceRetrospective analysis of the basic situation of screening for congenital hypothyroidism of newborns in six cities of Shanxi Province during2010.10.1-2018.9.30,and combining with the "neonatal disease screening registration form",the data of gender,gestational age,birth weight,place of birth,parents' educational level,age,occupation and maternal health status of CH children diagnosed from 2014.10.1 to 2018.9.30 were sorted out,and statistical analysis was conducted with EXCEL2010,spss22.0 and other software.Part ?: analysis of prognostic factors of congenital hypothyroidism1.Eighty-four children with congenital hypothyroidism(CH)diagnosed by neonatal disease screening from October 2014 to October 2016 and with complete physical and intellectual data were enrolled in the study.According to the different initial treatmenttiming,they were classified into treatment group within 1 month(38 cases)and treatment group from 1 to 3 months(46 cases).The thyroid function,physical development levels and neural development of the two groups were compared at 6 months,12 months and24months old.2.The subject who were diagnosed in Shanxi Provience neonatal disease screening center from October 2009 to October 2014 and treated with L-T4 for 2 ~3years and continued to follow up for more than 1 year after drug withdrawl are enrolled.According to the follow-up results,permanent hypothyroidism(PCH)and transient hypothyroidism(TCH)were distinguished.The clinical basic conditions of the two groups and the L-T4 dose during follow-up period were compared to find early predictors.Results:Part ?: epidemiological analysis of CH in six cities of Shanxi Province1.A total of 1237,222 newborn babies were screened in six prefecture-level cities in Shanxi Province from October 1,2010 to September 30,2018.The number of newborn screenings showed an overall upward trend from 2010 to 2018,and the screening rate also increased year by year,with an average screening rate of 71.9%.534 children with CH diagnosed in six cities in 8 years,the average prevalence rate was 1/2316.2.The incidence rate of congenital hypothyroidism were different in six cities,among which the incidence was highest in Luliang(1/1708),and lowest in xinzhou(1/2850).3.The case distribution of the children with positive initial screening and the children with confirmed congenital hypothyroidism in different months presented a "u-shaped" distribution,which was mainly reflected in the large number of children with positive initial screening in cold season and confirmed congenital hypothyroidism,and the small number of children with positive initial screening in warm season and confirmed congenital hypothyroidism.4.The distribution rate of children with congenital hypothyroidism in rural areas(56.6%)was higher than that in urban areas(43.4%),and the gender composition of children with congenital hypothyroidism was not statistically significant(P>0.05).5.There were significant differences in the initial screening positive rate(?~2=14.199,P=0.001)and prevalence rate(?~2=6.466,P=0.039)among the three groups of low weight,normal weight and macrosomia.Part ?: analysis of prognostic factors of congenital hypothyroidism1.After long-term treatment,there were no statistically significant differences in TSH,FT4,height and weight(P>0.05)between children aged 6 months,12 months and24 months at different initial treatment time(P>0.05).In addition,there was no statistically significant difference in the scores of the five energy domains between the two groups at 6 months and 24 months of age(P>0.05),and the difference was statistically significant only at 12 months of age(P<0.05).2.The differences in initial screening TSH level,initial treatment timing,time required for TSH to return to normal,thyroid situation composition,and L-T4 dose during follow-up period were statistically significant in children with PCH and TCH.There were no significant differences in gender composition,gestational weeks,birth weight,initial treatment months composition,and time required for FT4 to return to normal.In addition,during the follow-up period,the dose of PCH increased with age,while the dose of TCH decreased with age.The initial screening TSH levels in children(optimal cut-off: 71.29 ?IU/ml;AUC,0.777;sensitivity,83.3%;specificity,62.3%)and L-T4 dose at 7 months after diagnosis(optimal cut-off:24.4 ug/d;AUC,0.745;sensitivity,83.3%;specificity,50.9%)can be used for early differentiation in children between PCH and TCH.Conclusions1.The implementation of neonatal disease screening program significantly increases the screening rate of congenital hypothyroidism,which is of great significance for theearly detection and early treatment of congenital hypothyroidism.2.The number of positive cases and the incidence of congenital hypothyroidism are affected by seasonal factors,and the main manifestation is that the incidence of cold season is higher than that of warm season.3.Different initial treatment timing has a certain influence on the neurodevelopment of children with CH.Therefore,once the child is diagnosed,it should be treated as soon as possible.4.The initial TSH screening levels and the dose of L-T4 during the follow-up period have predictive significance for early differentiation of PCH and TCH.5.Combined with etiology,initial screening TSH level and TSH and FT4 levels at diagnosis,initial differential dose administration for children is of great significance for the early recovery of thyroid function in children.6.For some children requiring low dose L-T4,it can be considered to advance the time of drug withdrawal and re-evaluation.