Primary congenital hypothyroidism (CH) is a common and preventable cause of intellectual disability. The incidence rate of CH has been reported to be increasing in the United States, but the factors behind the observed rate increase are not known. We summarize here the data presented at a workshop on CH, at which factors potentially related to the CH-incidence-rate increase (namely, race, ethnicity, sex, and birth outcomes) were evaluated. Data sources for the analyses included a national data set of newborn-screening results and state-specific data from newborn-screening programs in California, Massachusetts, New York, and Texas. The incidence rate of CH increased in the United States by 3% per year; however, an increase did not occur in all states, at a constant rate, or even at the same rate. Analysis of US data (1991–2000) showed a CH-incidence-rate increase only among white newborns. More recently, in California (2000–2007), the rate was constant in non-Hispanic newborns, but it increased among Hispanic newborns. In the national data, the CH-incidence rate increased similarly among boys and girls, whereas in Texas (1992–2006), the rate among boys increased significantly more than among girls and varied according to race and ethnicity. In Massachusetts (1995–2007), low birth weight newborns or newborns who had a delayed rise in thyrotropin concentration accounted for the majority of the recent rate increase. Race, ethnicity, sex, and pregnancy outcomes have affected the observed increasing incidence rate of CH, although there have been some inconsistencies and regional differences. The association with preterm birth or low birth weight could reflect the misclassification of some cases of transient hypothyroxinemia as true CH. Future studies of risk factors should focus on correct initial identification and reporting of demographic characteristics and pregnancy outcomes for cases of CH. In addition, long-term follow-up data of presumed cases of CH should be ascertained to differentiate true cases of CH from cases of transient hypothyroidism.
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May 01 2010
Trends in Incidence Rates of Congenital Hypothyroidism Related to Select Demographic Factors: Data From the United States, California, Massachusetts, New York, and Texas
Cynthia F. Hinton, PhD, MS, MPH;
aDivision of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
Address correspondence to Cynthia F. Hinton, PhD, MS, MPH, Division of Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E-86, Atlanta, GA 30333. E-mail: chinton@cdc.gov
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Katharine B. Harris, MBA;
Katharine B. Harris, MBA
bWadsworth Center, New York State Department of Health, Albany, New York;
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Lynette Borgfeld, MT;
Lynette Borgfeld, MT
cDepartment of State Health Services, Austin, Texas;
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Margaret Drummond-Borg, MD;
Margaret Drummond-Borg, MD
cDepartment of State Health Services, Austin, Texas;
dCook Children's Physician Network, Fort Worth, Texas;
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Roger Eaton, PhD;
Roger Eaton, PhD
eNew England Regional Newborn Screening Program, University of Massachusetts Medical School, Jamaica Plain, Massachusetts;
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Fred Lorey, PhD;
Fred Lorey, PhD
fGenetic Disease Screening Program, California Department of Public Health, Richmond, California; and
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Bradford L. Therrell, PhD;
Bradford L. Therrell, PhD
gNational Newborn Screening and Genetics Resource Center, University of Texas Health Science Center at San Antonio, Austin, Texas
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Jill Wallace, MA;
Jill Wallace, MA
cDepartment of State Health Services, Austin, Texas;
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Kenneth A. Pass, PhD
Kenneth A. Pass, PhD
bWadsworth Center, New York State Department of Health, Albany, New York;
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Address correspondence to Cynthia F. Hinton, PhD, MS, MPH, Division of Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E-86, Atlanta, GA 30333. E-mail: chinton@cdc.gov
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2010) 125 (Supplement_2): S37–S47.
Article history
Accepted:
January 22 2010
Citation
Cynthia F. Hinton, Katharine B. Harris, Lynette Borgfeld, Margaret Drummond-Borg, Roger Eaton, Fred Lorey, Bradford L. Therrell, Jill Wallace, Kenneth A. Pass; Trends in Incidence Rates of Congenital Hypothyroidism Related to Select Demographic Factors: Data From the United States, California, Massachusetts, New York, and Texas. Pediatrics May 2010; 125 (Supplement_2): S37–S47. 10.1542/peds.2009-1975D
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Have you considered the regional fluoridation as impacting this trend?
We know that fluoride is an endocrine disruptor.
We know that there are higher rates of low thyroid in fluoridated regions.
We know that fluoridated regions have higher incidences of hyperactivity.
We know that twenty years of animal studies confirm fluoride exposure en utero or during youth results in cognitive and emotional deficits in rats.
We know that racial, genetic, and health profiles impact sensitivity and that non-white ethnicities exhibit approximately twice the dental fluorosis as whites.
We know that dental fluorosis is correlated with learning disabilities, after adjusting for SES.
I'd love to see an overlay of fluoridation on these trend lines, and more.
See attached references.