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Da DZ, Wang Y, Wang M, Long Z, Wang Q, Liu J. Congenital Hypothyroidism Patients With Thyroid Hormone Receptor Variants Are Not Rare: A Systematic Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211067943. [PMID: 34919466 PMCID: PMC8721697 DOI: 10.1177/00469580211067943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Primary congenital hypothyroidism (CH) is a common endocrine and metabolic disease. Various genetic factors, including the thyroid hormone receptor (TSHR), play an important role in CH. Aim To explore the occurrence of pathogenic TSHR variants in CH. Methods We searched published articles in PubMed, Web of Science, and Cochrane Library databases, from the establishment of the database to September 26, 2021. Studies with sequencing partial or full exons of TSHR in CH patients were included. Gene polymorphism was excluded. Results A total of 66 articles (44 case-control studies and 22 case reports) were selected from the database. Though case-control studies, we found the incidence of pathogenic TSHR variants were not rare (range from 0% to 30.6%) and varied greatly in different countries and race. The pathogenic genotypes varied in different regions. All the variants were “loss-of-function” mutations, in which the p.(Arg450His) variant was the most common variant. In addition, we analyzed the case reports and found that CH patients with a family genetic background expressed homozygous genotypes. Homozygotes had more obvious symptoms of hypothyroidism and higher risk of comorbidities than heterozygotes. Conclusion Pathogenic TSHR variants are not uncommon cause of the CH, especially in the Arabs. The role of TSHR gene detection in the treatment of children with CH needs to be further studied.
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Affiliation(s)
- Dong-Zhu Da
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai, China.,Department of Breast and Thyroid Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Ye Wang
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai, China
| | - Min Wang
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai, China
| | - Zhi Long
- Department of Pediatrics, Shanghai General Hospital, Shanghai, China
| | - Qian Wang
- Department of Pediatrics, Shanghai General Hospital, Shanghai, China
| | - Jun Liu
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai, China
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Kollati Y, Akella RRD, Naushad SM, Thalla M, Reddy GB, Dirisala VR. The rs1991517 polymorphism is a genetic risk factor for congenital hypothyroidism. 3 Biotech 2020; 10:285. [PMID: 32550104 DOI: 10.1007/s13205-020-02273-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022] Open
Abstract
The objective of the current study is to explore the association of thyroid-stimulating hormone receptor (TSHR) rs1991517 polymorphism (c.2337 C > G, p.D727E) with congenital hypothyroidism (CH) through a case-control study followed by a meta-analysis. The case-control study was based on 45 CH subjects and 700 healthy controls. Meta-analysis comprised of seven published studies and our current findings (1044 CH cases and 1649 healthy controls). The allele contrast model showed that the presence of G- allele increased CH risk by 45% (OR: 1.45, 95% CI 1.20-1.76) and 41% (OR: 1.41, 95% CI 1.03-1.93) in fixed effect and random effect models, respectively. The GG- genotype is associated with 2.3-fold (95% CI 1.32-3.99) increased risk for CH in the fixed-effect model. I 2 (0.58) and Cochran's Q test (Q: 16.72, p = 0.02) revealed evidence of heterogeneity in the association. No publication bias was observed by Egger's test (p = 0.70). Sensitivity analysis revealed that even after excluding any study this polymorphism is associated with risk for CH. The rs1991517 mutation alters the binding affinity to cAMP (ΔG of 727D vs.727E: - 7.27 vs. - 7.34 kcal/mol). In conclusion, rs1991517 is a genetic risk factor for CH and exerts its impact by altering cAMP-mediated signal transduction.
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Affiliation(s)
- Yedukondalu Kollati
- Department of Biotechnology, Vignan's University, Vadlamudi, Guntur, Andhra Pradesh 522213 India
| | - Radha Rama Devi Akella
- Department of Genetics, Rainbow Children's Hospital, Banjara Hills, Hyderabad, Telangana 500009 India
| | - Shaik Mohammad Naushad
- Department of Biochemical Genetics and Pharmacogenomics, Sandor Speciality Diagnostics Pvt. Ltd, Banjara Hills, Hyderabad, Telangana 500034 India
| | - Maunika Thalla
- Department of Biochemical Genetics and Pharmacogenomics, Sandor Speciality Diagnostics Pvt. Ltd, Banjara Hills, Hyderabad, Telangana 500034 India
| | - G Bhanuprakash Reddy
- Biochemistry Division, National Institute of Nutrition, Hyderabad, Telangana 500007 India
| | - Vijaya R Dirisala
- Department of Biotechnology, Vignan's University, Vadlamudi, Guntur, Andhra Pradesh 522213 India
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Sugisawa C, Abe K, Sunaga Y, Taniyama M, Hasegawa T, Narumi S. Identification of compound heterozygous TSHR mutations (R109Q and R450H) in a patient with nonclassic TSH resistance and functional characterization of the mutant receptors. Clin Pediatr Endocrinol 2018; 27:123-130. [PMID: 30083029 PMCID: PMC6073063 DOI: 10.1297/cpe.27.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/08/2018] [Indexed: 11/05/2022] Open
Abstract
Genetic defects of the TSH receptor (TSHR) signaling pathway cause a form of congenital
hypothyroidism (CH) known as TSH resistance. Consistent with the physiological
understanding that thyroidal iodine uptake is up-regulated by TSHR signaling, most
patients with TSH resistance have low to normal thyroidal 123I uptake
representing the classic TSH resistance. However, paradoxically high 123I
uptake was reported in four molecularly-confirmed patients indicating nonclassic TSH
resistance. Here, we report the fifth patient with the nonclassic phenotype. He was a
12-yr-old CH patient and treated with levothyroxine. At the age 11 yr, he showed slightly
small thyroid gland and elevated thyroidal 123I uptake. Genetic analysis showed
that he was compound heterozygous for two known missense mutations (Arg109Gln and
Arg450His) in the TSHR gene. Further, the signal transduction of Arg109Gln-TSHR was
defective in both Gs- and Gq-coupled pathways, while Arg450His-TSHR showed Gq-dominant
defect. 123I uptake was evaluated earlier in 16 patients with TSH resistance,
and a correlation between TSH levels and 123I uptake was shown in patients with
specific genotypes (Arg450His or Leu653Val). Collectively, we have re-confirmed that the
emergence of the nonclassic phenotype requires two factors: mutant TSHR with Gq-dominant
coupling defect and relatively high levels of serum TSH.
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Affiliation(s)
- Chiho Sugisawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Kiyomi Abe
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | | | - Matsuo Taniyama
- Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan.,Tokyo Health Service Association, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Narumi
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
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Generation and characterization of a hypothyroidism rat model with truncated thyroid stimulating hormone receptor. Sci Rep 2018; 8:4004. [PMID: 29507327 PMCID: PMC5838214 DOI: 10.1038/s41598-018-22405-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/22/2018] [Indexed: 11/13/2022] Open
Abstract
Thyroid stimulating hormone receptor (TSHR), a G-protein-coupled receptor, is important for thyroid development and growth. In several cases, frameshift and/or nonsense mutations in TSHR were found in the patients with congenital hypothyroidism (CH), however they have not been functionally studied in an animal model. In the present work, we generated a unique TshrDf/Df rat model that recapitulates the phenotypes in TSHR Y444X patient by CRISPR/Cas genome editing technology. In this rat model, TSHR is truncated at the second transmembrane domain, leading to CH phenotypes as what was observed in the patients, including dwarf, thyroid aplasia, infertility, TSH resistant as well as low serum thyroid hormone levels. The phenotypes can be reversed, at least partially, by levothyroxine (L-T4) treatment after weaning. The thyroid development is severely impaired in the TshrDf/Df rats due to the suppression of the thyroid specific genes, i.e., thyroperoxidase (Tpo), thyroglobulin (Tg) and sodium iodide symporter (Nis), at both mRNA and protein levels. In conclusion, the TshrDf/Df rat serves as a brand new genetic model to study CH in human, and will greatly help to shed light into the development of terminal organs that are sensitive to thyroid hormones.
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Abstract
Resistance to thyrotropin (RTSH) is broadly defined as reduced sensitivity of thyroid follicle cells to stimulation by biologically active TSH due to genetic defects. Affected individuals have elevated serum TSH in the absence of goiter, with the severity ranging from nongoitrous isolated hyperthyrotropinemia to severe congenital hypothyroidism with thyroid hypoplasia. Conceptually, defects leading to RTSH impair both aspects of TSH-mediated action, namely thyroid hormone synthesis and gland growth. These include inactivating mutations in the genes encoding the TSH receptor and the PAX8 transcription factor. A common third cause has been genetically mapped to a locus on chromosome 15, but the underlying pathophysiology has not yet been elucidated. This review provides a succinct overview of currently defined causes of nonsyndromic RTSH, their differential diagnoses (autoimmune; partial iodine organification defects; syndromic forms of RTSH) and implications for the clinical approach to patients with RTSH.
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Affiliation(s)
- Helmut Grasberger
- University of Michigan, 6504 MSRB I, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Samuel Refetoff
- The University of Chicago, MC3090, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Abstract
Rare diseases are usually defined as entities affecting less than 1 person per 2,000. About 7,000 different rare entities are distinguished and, among them, rare diseases of the thyroid gland. Although not frequent, they can be found in the everyday practice of endocrinologists and should be considered in differential diagnosis. Rare non-neoplastic thyroid diseases will be discussed. Congenital hypothyroidism's frequency is relatively high and its early treatment is of vital importance for neonatal psychomotor development; CH is caused primarily by thyroid dysgenesis (85%) or dyshormonogenesis (10-15%), although secondary defects - hypothalamic and pituitary - can also be found; up to 40% of cases diagnosed on neonatal screening are transient. Inherited abnormalities of thyroid hormone binding proteins (TBG, TBP and albumin) include alterations in their concentration or affinity for iodothyronines, this leads to laboratory test abnormalities, although usually with normal free hormones and clinical euthyroidism. Thyroid hormone resistance is most commonly found in THRB gene mutations and more rarely in THRA mutations; in some cases both genes are unchanged (non-TR RTH). Recently the term 'reduced sensitivity to thyroid hormones' was introduced, which encompass not only iodothyronine receptor defects but also their defective transmembrane transport or metabolism. Rare causes of hyperthyroidism are: activating mutations in TSHR or GNAS genes, pituitary adenomas, differentiated thyroid cancer or gestational trophoblastic disease; congenital hyperthyroidism cases are also seen, although less frequently than CH. Like other organs and tissues, the thyroid can be affected by different inflammatory and infectious processes, including tuberculosis and sarcoidosis. In most of the rare thyroid diseases genetic factors play a key role, many of them can be classified as monogenic disorders. Although there are still some limitations, progress has been made in our understanding of rare thyroid diseases etiopathogenesis, and, thanks to these studies, also in our understanding of how normal thyroid gland functions.
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Affiliation(s)
- Katarzyna Lacka
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, Poznan, Poland
| | - Adam Maciejewski
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, Poznan, Poland
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Nettore IC, Cacace V, De Fusco C, Colao A, Macchia PE. The molecular causes of thyroid dysgenesis: a systematic review. J Endocrinol Invest 2013; 36:654-64. [PMID: 23698639 DOI: 10.3275/8973] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH) is a frequent disease occurring with an incidence of about 1/2500 newborns/year. In 80-85% of the cases CH is caused by alterations in thyroid morphogenesis, generally indicated by the term "thyroid dysgenesis" (TD). TD is generally a sporadic disease, but in about 5% of the cases a genetic origin has been demonstrated. In these cases, mutations in genes playing a role during thyroid morphogenesis (NKX2-1, PAX8, FOXE1, NKX2-5, TSHR) have been reported. AIM This work reviews the main steps of thyroid morphogenesis and all the genetic alterations associated with TD and published in the literature.
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Affiliation(s)
- I C Nettore
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini, 5 - 80131 Naples, Italy
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Cassio A, Nicoletti A, Rizzello A, Zazzetta E, Bal M, Baldazzi L. Current loss-of-function mutations in the thyrotropin receptor gene: when to investigate, clinical effects, and treatment. J Clin Res Pediatr Endocrinol 2013; 5 Suppl 1:29-39. [PMID: 23154162 PMCID: PMC3608004 DOI: 10.4274/jcrpe.864] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Thyroid-stimulating hormone receptor (TSHR) loss-of-function (LOF) mutations lead to a wide spectrum of phenotypes, ranging from severe congenital hypothyroidism (CH) to mild euthyroid hyperthyrotropinemia. The degree of TSH resistance depends on the severity of the impairment of the receptor function caused by the mutation and on the number of mutated alleles In this review data about genotype-phenotype correlation and criteria for clinical work-up will be presented and discussed. Complete TSH resistance due to biallelic LOF TSHR mutations must be suspected in all patients with severe not syndromic CH and severe thyroid hypoplasia diagnosed at birth by neonatal screening. Partial forms of TSH resistance show a more heterogeneous hormonal and clinical pattern . In these cases TSH serum levels are above the upper limit of normal range for the age but with a very variable pattern, free thyroxine (T4) concentrations are within the normal range and thyroid size can be normal or hypoplastic at ultrasound scan. An early substitutive treatment with L-T4 must be mandatory in all patients with severe CH due to complete uncompensated TSH resistance diagnosed at birth by neonatal screening. The usefulness of substitutive treatment appears much more controversial inpatients with subclinical hypothyroidism due to partial TSH resistance in whom the increased TSH concentration should be able to compensate the mild functional impairment of the mutant receptor. Together with standard criteria we recommend also an accurate clinical work-up to select patients who are candidates for a LOF TSHR mutation.
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Affiliation(s)
- Alessandra Cassio
- Department of Gynaecologic, Obstetric and Paediatric Sciences, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Annalisa Nicoletti
- Department of Gynaecologic, Obstetric and Paediatric Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Angela Rizzello
- Department of Gynaecologic, Obstetric and Paediatric Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emanuela Zazzetta
- Department of Gynaecologic, Obstetric and Paediatric Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Milva Bal
- Department of Gynaecologic, Obstetric and Paediatric Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lilia Baldazzi
- Department of Gynaecologic, Obstetric and Paediatric Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Ma SG, Fang PH, Hong B, Yu WN. The R450H mutation and D727E polymorphism of the thyrotropin receptor gene in a Chinese child with congenital hypothyroidism. J Pediatr Endocrinol Metab 2010; 23:1339-44. [PMID: 21714469 DOI: 10.1515/jpem.2010.209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Congenital hypothyroidism (CH) is the most prevalent congenital endocrine disorder. The molecular cause of CH in the majority of newborns is unknown. The aim of this study was to investigate the mutation of thyrotropin receptor (TSHR) gene in Chinese children with congenital hypothyroidism (CH). and the hereditary characteristic. METHODS Eighteen Chinese children with CH were enrolled for molecular analysis of the TSHR gene and 105 normal controls were evaluated. The exons 1-9, and 10 of TSHR gene were detected by PCR-SSCP (single-stranded conformation polymorphism) and sequenced. RESULTS A slower and a faster mobility SSCP shift showed in a 12-year old child with hypoplasic gland. Sequencing of TSHR gene revealed a homozygous mutation (CGC --> CAC, Arg450His) and a polymorphism (GAC --> GAG, Asp727Glu). The controls revealed no variants. The 12 relatives of the proband were enrolled and investigated. Six relatives, including his mother and father, were heterozygous for R450H mutation and D727E polymorphism of the TSHR gene. Thyroid hormone levels were normal except for circulating TSH (5.96-6.92 mU/L) level slightly elevated in six heterozygous family members. CONCLUSIONS Homozygous mutation R450H of the TSHR gene led to CH. Heterozygous mutation R450H was the cause of subclinical hypothyroidism.
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Affiliation(s)
- Shao-gang Ma
- Department of Endocrinology, The Affiliated Huai'an Hospital, Xuzhou Medical College, Huai'an 223002, China
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Sura-Trueba S, Aumas C, Carre A, Durif S, Leger J, Polak M, de Roux N. An inactivating mutation within the first extracellular loop of the thyrotropin receptor impedes normal posttranslational maturation of the extracellular domain. Endocrinology 2009; 150:1043-50. [PMID: 18927215 DOI: 10.1210/en.2008-1145] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The TSH receptor (TSHR), a member of the large family of G protein-coupled receptors, controls both function and growth of thyroid cells; hence, mutations of this receptor result in thyroid dysfunction. Here, we took advantage of the description of a new inactivating TSHR mutation (Q489H) in two brothers with hypothyroidism, to precise maturation, intracellular trafficking, exporting pathways, and activation mechanisms of this receptor. Functional characterization of the Q489H-TSHR in transiently transfected HEK293 cells showed cell surface expression, normal TSH binding affinity, and its inability to generate intracellular cAMP in response to TSH stimulation. Western blot analysis of the whole membrane proteins or proteins expressed at the cell surface showed that Q489H-TSHR expressed in HEK293 transfected cells are restricted to mannose-rich uncleaved receptor. Analysis of the export pathway toward cell surface indicated that both Q489H and wild-type receptors followed the same intracellular route to cell surface throughout endoplasmic reticulum and Golgi apparatus. This study shows that Q489H substitution impedes complete glycosylation of TSHR extracellular domain within the Golgi apparatus and that Q489H-TSHR expressed at the cell surface is unable to undergo intramolecular cleavage as well as to switch toward an active conformation under TSH stimulation. Altogether, our results show that 1) Q489H substitution within the first extracellular loop induces a misfolding of TSHR, blocking it into an inactive conformation and impeding complete glycosylation and intramolecular cleavage, and 2) a misfolded G protein-coupled receptor can bypass endoplasmic reticulum or Golgi apparatus quality control and reach the cell surface as an immature receptor.
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Affiliation(s)
- Sylvia Sura-Trueba
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 690, Hôpital Robert-Debré, Paris, France
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Yuan ZF, Mao HQ, Luo YF, Wu YD, Shen Z, Zhao ZY. Thyrotropin receptor and thyroid transcription factor-1 genes variant in Chinese children with congenital hypothyroidism. Endocr J 2008; 55:415-23. [PMID: 18379122 DOI: 10.1507/endocrj.k07e-064] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to investigate the mutation/variant of thyrotropin receptor (TSHR) and thyroid transcription factor-1 (TTF-1) genes in Chinese children with congenital hypothyroidism (CH). Seventy-nine and forty-nine Chinese children with CH were enrolled for molecular analysis of the TSHR gene and TTF-1 gene, respectively. One hundred normal children were evaluated as control. The coding regions of TSHR and TTF-1 genes were amplified by polymerase chain reaction and sequenced. Sequencing of the TSHR gene revealed a compound heterozygous variants (Pro52Thr/Val689Gly) and a heterozygous variant (Gly245Ser) in 2 of 79 patients. In 30 patients and 33 controls the normal cytosine at position 2181 in exon 10 of TSHR gene was replaced by a guanineCresulting in the replacement of Asp (727) by Glu. In 47 patients and 50 controls, the normal thymidine at position 561 in exon 7 of TSHR gene was replaced by a cytosine. This substitution did not change the amino acid in position 187. Sequencing of the TTF-1 gene revealed no mutation or polymorphism in 49 patients and 100 controls. In conclusion, three heterozygous variants (Pro52Thr, Gly245Ser, Val689Gly) of TSHR gene were firstly detected in Chinese children with CH. There were polymorphisms in exon 10 at nucleotide 2181 (C/G) and in exon 7 at nucleotide 561 (T/C) in TSHR gene. No mutation or polymorphism was detected in the coding region of TTF-1 gene. The mutation/variant of TSHR and TTF-1 genes is relatively rare in Chinese children with CH.
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Affiliation(s)
- Zhe Feng Yuan
- Department of Child Health Care, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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