[Pathogenic TSHR variants in children with thyroid dysgenesis].

Q4 Medicine
E V Shreder, T A Vadina, E N Solodovnikova, V V Zakharova, M V Degtyarev, M B Konyukhova, N V Sergeeva, O B Bezlepkina
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引用次数: 0

Abstract

Background: Loss-of-function mutations in the TSH receptor gene (TSHR) (NP_000360.2) are the potential causes of thyroid dysgenesis in patients with congenital hypothyroidism. Heterozygous variants of the TSHR gene lead to partial resistance to TSH, homozygous and compound heterozygous variants have been shown to cause CH due to thyroid hypoplasia or TSH resistance. Recently more and more articles in this field have appeared in the international literature sources, while local publications are limited. The studies are necessary to understand the etiology, pathogenesis of the disease, to improve the management of these patients.

Aim: To assess the frequency of incidence of pathogenic variants of the TSHR gene in children with CH due to thyroid dysgenesis. To study inheritance and phenotypic patterns of CH in families.

Materials and methods: In this single-center interventional one-stage non-comparative study a group of CH patients was examined. The patients underwent neck ultrasound and radionuclide imaging. The examination was performed 14 days after hormone replacement therapy suspension or prior to its initiation. The structure of thyroid dysgenesis was estimated, genetic testing for mutations in the TSHR gene was performed using the NGS method.

Results: The study included 95 children with primary CH (75 girls; 20 boys). The patients' median age at the time of examination was 6.2 years [4.5; 8.9], the median level of neonatal TSH was 157.5 mU/l [60.9; 257.2]. Ectopic thyroid was found in 52% of children, aplasia in 36%, hypoplasia and hemiagenesis in 10% and 2%, respectively. In 5.4% of cases (in 5 out of 95 patients), different variants of the TSH gene were detected. Two children had heterozygous p.R450H and p.D487N variants in TSHR gene, two patients was homozygous for the p.S49Afs * 9 variant, one child had compound heterozygous variants (p.A485D and p.R450H). According to ultrasound imaging, all patients had thyroid hypoplasia of varying severity. Three children underwent thyroid scintigraphy, which revealed decreased 99mТc pertechnetate uptake (0.3-0.9%).

Conclusion: In our study, the incidence of different variants in the TSHR gene in children with CH was 5.3%. Our analysis uncovered two previously undescribed variants. Genetic testing may be able to help with making the diagnosis, patient's management, and genetic counseling.

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[甲状腺发育不良儿童致病性TSHR变异]。
背景:TSH受体基因(TSHR) (NP_000360.2)的功能缺失突变是先天性甲状腺功能减退症患者甲状腺发育不良的潜在原因。TSHR基因的杂合变异导致对TSH的部分抗性,纯合和复合杂合变异已被证明由于甲状腺发育不全或TSH抗性而导致CH。近年来,国际文献中出现了越来越多的关于这一领域的文章,而国内出版物却很有限。这些研究对于了解该病的病因、发病机制,改善对这些患者的治疗是必要的。目的:探讨甲状腺发育不良所致CH患儿TSHR基因致病性变异的发生率。目的:研究CH家族遗传和表型模式。材料和方法:在这项单中心介入一期非比较研究中,对一组CH患者进行了检查。患者均行颈部超声及放射性核素显像。检查在激素替代治疗暂停后14天或开始前进行。估计甲状腺发育不良的结构,使用NGS方法进行TSHR基因突变的基因检测。结果:本研究纳入95例原发性CH患儿(75例女童;20个男孩)。患者检查时的中位年龄为6.2岁[4.5;8.9],新生儿TSH中位水平为157.5 mU/l [60.9;257.2]。52%的儿童甲状腺异位,36%的儿童甲状腺发育不全,10%的儿童甲状腺发育不全,2%的儿童甲状腺发育不全。在5.4%的病例(95例患者中有5例)中,检测到不同的TSH基因变体。2例患儿TSHR基因为p.R450H和p.D487N杂合变异,2例患儿为p.S49Afs * 9纯合变异,1例患儿为p.A485D和p.R450H复合杂合变异。根据超声成像,所有患者均有不同程度的甲状腺发育不全。三名儿童接受甲状腺显像检查,发现99mТc高锝酸盐摄取减少(0.3-0.9%)。结论:在我们的研究中,CH患儿TSHR基因不同变异的发生率为5.3%。我们的分析揭示了两个先前未描述的变体。基因检测可能有助于做出诊断,病人的管理和遗传咨询。
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来源期刊
Problemy endokrinologii
Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
1.40
自引率
0.00%
发文量
59
期刊介绍: Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.
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