HIGH INCIDENCE OF CONGENITAL HYPOTHYROIDISM IN ONE REGION OF THE REPUBLIC OF MACEDONIA
Anastasovska V, Koviloska R, Kocova M,
*Corresponding Author: Professor Dr. Mirjana Kocova, University Clinic of Pediatrics, Vodnjanska 17, 1000 Skopje, Republic of Macedonia. Tel.: +389(0)2-3123-224. Fax: +389(0)2-3111-713. E-mail: mirjanakocova@ yahoo.com
page: 31

DISCUSSION

The average neonatal thyroid screening coverage in Prilep was 93.4%. The incidence of CH among neonates in Prilep has not been separately evaluated before. This study showed a CH prevalence of 1:1220 live births in the Prilep region. It is two-times higher than the state average 1:2602 [2] and three-times higher than estimated in the capital city, 1:3389 (unpublished results), for the same period. The incidence of CH is also significantly higher in this region compared with surrounding countries [3,4] and developing countries, in general (from 1:3000 to 1:4000), [5]. However, a high incidence of CH was reported in The Netherlands 1:1300 [6], Thailand 1:1800 [7] and Lebanon 1:1823 [8]. The different incidence rate in the Prilep Province may be related to dissimilarity between the environmental, genetic and immunologic factors. It might also be a consequence of the 2.5-fold higher percentage of the Romany population in the Prilep region (17.2%) compaired to that in the whole state (7.0%) [9]. Recent studies suggest that nearly all screening programs report a female preponderance, approaching 2:1 female-to-male ratio [10]. The female:male ratio varies in different studies, for example, it is 6:1 in Estonia [11] and 3:1 in Saudi Arabia [12]. In our study, this ratio was 1:1.6, with a male preponderance. A male preponderance of 1:1.41 was also reported in East Azerbaijan Province, Iran, probably due to the high prevalence of consanguineous marriages [13]. The difference in Prilep Province may be due to the small sample size and more probably to genetic factors. The reported recall neonates with borderline or abnormal initial TSH values for serum TSH and T4 determination varies from 0.16 to 3.3% between different populations [14-16]. Our recall rate of 0.18% is in the lower ranges. The difference may be due to different sampling methods, different methods of performing the laboratory tests, different TSH cutoff values, and may also reflect the levels of iodine deficiency in different regions [15,17]. During the study, 1.92% newborns with TSH levels above 5 mU/L were detected, indicating an iodine sufficiency in Prilep Province [18,19]. Along with urinary iodine concentrations, it has been proposed that neonatal TSH concentrations are a good indicator of the prevalence of iodine deficiency disorders in populations [20,21]. Elevated neonatal TSH concentrations may indicate insufficient supply of thyroid hormones to the developing fetal brain and is therefore the only measure that allows prediction of brain damage due to iodine deficiency [21]. The Word Health Organization (WHO) has proposed using the results of screening programs for CH in neonates as an additional index for the evaluation of the iodine status of the population. A frequency of neonatal TSH concentrations above 5 mU/L in less than 3.0% of the screened neonates was proposed as an indicator of iodine sufficiency. In mild iodine deficiency the frequency may be 3.0-19.9%, and the frequencies of 20.0-39.9% and above 40.0% are found in countries with moderate and severe iodine deficiency, respectively [22]. Although the cutoff TSH level in neonates of 5 mU/L, as set by the WHO, has been criticized [23-25], it has already been used for assessing the prevalence of iodine deficiency [26,27]. However, the Republic of Macedonia including the Prilep region has certified iodine sufficiency [18,19].



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