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
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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city, 1:3389 (unpublished results), for the same period.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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