1
|
Long W, Guo F, Yao R, Wang Y, Wang H, Yu B, Xue P. Genetic and Phenotypic Characteristics of Congenital Hypothyroidism in a Chinese Cohort. Front Endocrinol (Lausanne) 2021; 12:705773. [PMID: 34539567 PMCID: PMC8446595 DOI: 10.3389/fendo.2021.705773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The molecular etiology and the genotype-phenotype correlation of congenital hypothyroidism (CH) remain unclear. METHODS We performed genetic analysis in 42 newborns with CH using whole-exome sequencing. Patients were divided into a single-gene group and a multi-gene group according to the number of affected genes, or divided into a monoallelic group, a biallelic group, and an oligogenic group according to the pattern of the detected variants. The clinical characteristics were compared between groups. RESULTS Thyroid dysgenesis (TD) was observed in 10 patients and goiter in 5 patients, whereas 27 patients had normal-sized gland-in-situ (GIS). We identified 58 variants in five genes in 29 patients. The genes with the most frequent variants were DUOX2 (70.7%), followed by TSHR (12.1%), DUOXA2 (10.3%), and TPO (5.2%). Variants in the genes causing dyshormonogenesis (DH) were more common than those in the genes causing TD (87.9% versus 12.1%). Among the patients with detected variants, 26 (89.7%) were harboring a single gene variant (single-gene group), which include 22 patients harboring biallelic variants (biallelic group) and four patients harboring monoallelic variants (monoallelic group). Three (10.3%) patients harbored variants in two or three genes (multi-gene group or oligogenic group). Compared with the single-gene group, the levothyroxine (L-T4) dose at 1 year of age was higher in the multi-gene group (p = 0.018). A controllable reduction in the L-T4 dose was observed in 25% of patients in the monoallelic group and 59.1% of patients in the biallelic group; however, no patients with such reduction in the L-T4 dose were observed in the oligogenic group. CONCLUSIONS Patients with normal-sized GIS accounted for the majority of our cohort. Genetic defects in the genes causing DH were more common than those in the genes causing TD, with biallelic variants in DUOX2 being dominant. DH might be the leading pathophysiology of CH in Chinese individuals.
Collapse
Affiliation(s)
- Wei Long
- Department of Medical Genetics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Fang Guo
- Department of Medical Genetics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Ruen Yao
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Pediatrics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Huaiyan Wang
- Department of Pediatrics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Bin Yu
- Department of Medical Genetics, Affiliated Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
- *Correspondence: Bin Yu, ; Peng Xue,
| | - Peng Xue
- Department of Pediatrics, Affiliated Changzhou Children’s Hospital of Nantong University, Changzhou, China
- *Correspondence: Bin Yu, ; Peng Xue,
| |
Collapse
|
2
|
Long W, Zhou L, Wang Y, Liu J, Wang H, Yu B. Complicated Relationship between Genetic Mutations and Phenotypic Characteristics in Transient and Permanent Congenital Hypothyroidism: Analysis of Pooled Literature Data. Int J Endocrinol 2020; 2020:6808517. [PMID: 32565793 PMCID: PMC7275948 DOI: 10.1155/2020/6808517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/17/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Mutations and phenotypic characteristics remain unclear in patients with congenital hypothyroidism (CH), and no study concerning whether the outcome of transient CH (TCH) or permanent CH (PCH) is determined by mutations has been reported. METHODS We searched the literature up to April 2019. Eligible studies and data extraction were performed. We estimated the relationship between mutations and phenotypic characteristics in pooled patients with CH. RESULTS Two hundred forty-one cases were pooled from 41 eligible studies. The thyroid morphology, classification of mutated genes, and types of mutations were different between 94 patients with TCH and 147 patients with PCH. Heterozygous missense mutations prevailed in PAX8, TSHR, FOXE1, and NKX2-5, and patients with these mutated genes had a higher risk of PCH (OR = 37.38, 95% CI 5.04-277.21, P < 0.001). TCH and PCH have equal shares in patients with mutated DUOX2 or DUOXA2. Dual-site and multisite mutations were frequently detected in DUOX2. High phenotypic heterogeneity was observed in mutated DUOX2 even in the same mutations. However, there was no relationship found between mutations and transient or permanent outcome in patients with mutated DUOX2. CONCLUSION Transient or permanent outcomes were influenced by the biological function of mutated genes instead of types of mutations among patients with CH. Patients whose mutations were related to thyroid dysgenesis (TD) were more likely to have PCH. The relationship between mutations and phenotypic characteristics is complicated, and phenotypic characteristics may be affected by mutations and other factors.
Collapse
Affiliation(s)
- Wei Long
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Lingna Zhou
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Ying Wang
- Department of Pediatrics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Jiaxuan Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Huaiyan Wang
- Department of Pediatrics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Bin Yu
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| |
Collapse
|
3
|
Kwak MJ. Clinical genetics of defects in thyroid hormone synthesis. Ann Pediatr Endocrinol Metab 2018; 23:169-175. [PMID: 30599477 PMCID: PMC6312914 DOI: 10.6065/apem.2018.23.4.169] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/10/2018] [Indexed: 01/08/2023] Open
Abstract
Thyroid dyshormonogenesis is characterized by impairment in one of the several stages of thyroid hormone synthesis and accounts for 10%-15% of congenital hypothyroidism (CH). Seven genes are known to be associated with thyroid dyshormonogenesis: SLC5A5 (NIS), SCL26A4 (PDS), TG, TPO, DUOX2, DUOXA2, and IYD (DHEAL1). Depending on the underlying mechanism, CH can be permanent or transient. Inheritance is usually autosomal recessive, but there are also cases of autosomal dominant inheritance. In this review, we describe the molecular basis, clinical presentation, and genetic diagnosis of CH due to thyroid dyshormonogenesis, with an emphasis on the benefits of targeted exome sequencing as an updated diagnostic approach.
Collapse
Affiliation(s)
- Min Jung Kwak
- Address for correspondence: Min Jung Kwak, MD, PhD Department of Pediatrics, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7298 Fax: +82-51-248-6205 E-mail:
| |
Collapse
|
4
|
Grasberger H, Noureldin M, Kao TD, Adler J, Lee JM, Bishu S, El-Zaatari M, Kao JY, Waljee AK. Increased risk for inflammatory bowel disease in congenital hypothyroidism supports the existence of a shared susceptibility factor. Sci Rep 2018; 8:10158. [PMID: 29977049 PMCID: PMC6033893 DOI: 10.1038/s41598-018-28586-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022] Open
Abstract
Loss-of-function mutations in dual oxidase (DUOX) 2 are the most common genetic variants found in congenital hypothyroidism (CH), and similar mutations have been recently reported in few very-early-onset inflammatory bowel disease (IBD) patients without CH. If DUOX2 variants indeed increase susceptibility for IBD, the enrichment of DUOX2 mutation carriers among CH patients should be reflected in higher risk for developing IBD. Using a database containing health insurance claims data for over 230 million patients in the United States, 42,922 subjects with CH were identified based on strict inclusion criteria using diagnostic codes. For subgroup analysis, CH patients with pharmacy records were stratified as transient or permanent CH based on the absence or presence of levothyroxine treatment, respectively. Patients were matched to an equal-sized, age- and gender-matched non-CH group. Compared to controls, CH patients had a 73% higher overall IBD prevalence (0.52% vs 0.30%; P < 0.0001). The CH-associated relative risk was higher for indeterminate or ulcerative colitis than Crohn’s disease. Patients with transient CH had higher odds for IBD (OR 2.39 (95% CI 1.77–3.23) than those with permanent CH (1.69 (95% CI 1.31–2.18). We conclude that patients with CH are at an increased risk of developing IBD. The risk was highest for patients with transient CH, for which partial defects in the DUOX2 system are a particularly common finding.
Collapse
Affiliation(s)
- Helmut Grasberger
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Mohamed Noureldin
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA.,Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, 48109, USA
| | - Timothy D Kao
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Jeremy Adler
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, 48109, USA.,Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Joyce M Lee
- Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Shrinivas Bishu
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Mohamad El-Zaatari
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - John Y Kao
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA.
| | - Akbar K Waljee
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 48109, USA. .,Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, 48109, USA.
| |
Collapse
|