Thyroid Screening and Congenital Hypothyroidism at Khon Kaen
Transcription
Thyroid Screening and Congenital Hypothyroidism at Khon Kaen
Khon Kaen Hospital Medical Journal Vol. 32 Supplement 3 April - May 2008 165 Thyroid Screening and Congenital Hypothyroidism at Khon Kaen Hospital Chatchai Suesirisawad M.D., Thai board of Pediatrics Department of Pediatrics, Khon Kaen Hospital Abstract Background Thyroid hormone is critical for normal cerebral and growth development in the early postnatal months. The diagnosis must be made soon after birth and effective treatment must be initiated promptly to prevent irreversible brain damage. Objective To study of abnormal thyroid screening and incidence of congenital hypothyroidism including average age of onset of initial treatment in newborn admitted at Department of Pediatrics, Khon Kaen Hospital was carried out from October 1, 2002 to September 31, 2007 Research design and methods A retrospective study. Results There were 19,521 live births of which, 18,798 cases were screened (96.30%). Fifty nine newborns had abnormal thyroid screening, 13 of these were congenital hypothyroidism. The incidence of congenital hypothyroidism was 1:1,501 live births. The average age of onset of initial treatment was 49.54 ± 30.73 days. Conclusion There was high incidence of congenital hypothyroidism and most of newborn had delay hormone replacement therapy. 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May 2008 ∫∑π” ∏— ¬ √Õ¬¥å Œ Õ√å ‚ ¡π‡ªì π ŒÕ√å ‚ ¡π∑’Ë ¡’ § «“¡ ”§—≠¡“°∑—Èß„π¥â“πæ—≤π“°“√∑“ß ¡Õß °“√‡®√‘≠ ‡µ‘∫‚µ ·≈–°“√¥”√ß™’«‘µ §«“¡ ”§—≠¢Õß∏—¬√Õ¬¥å ŒÕ√å‚¡π ‡√‘¡Ë ¢÷πÈ µ—ßÈ ·µà√–¬–‡ªìπ∑“√°„π§√√¿å¡“√¥“ ‚¥¬‡©æ“–„π√–¬–‰µ√¡“ ·√° ·≈–‰µ√¡“ ∑’Ë Õß ‡√◊ËÕ¬‰ª®πµ≈Õ¥™’«‘µ ¥—ßπ—Èπ¿“«–æ√àÕß∏—¬√Õ¬¥å ŒÕ√å ‚ ¡π·µà °”‡π‘ ¥ ‡ªì π ¿“«–∑’Ë µâ Õ ß¡’ ° “√µ√«® §—¥°√Õßµ—Èß·µà·√°§≈Õ¥ °“√«‘π‘®©—¬∑’Ë√«¥‡√Á« ·≈– °“√√—°…“∑’ˇÀ¡“– ¡ ®÷ß®– “¡“√∂ªÑÕß°—π°“√‡°‘¥ ¿“«–ªí≠≠“ÕàÕπÕ¬à“ß∂“«√‰¥â ‡π◊ËÕß®“°¡’√“¬ß“π æ∫«à“ Õ“¬ÿ¢Õß∑“√°¢≥–‡√‘Ë¡„Àâ°“√√—°…“ ∂â“¡’Õ“¬ÿ ¡“°°«à“ 1 —ª¥“Àå ¡’√–¥—∫ µ‘ªí≠≠“µË”°«à“∑“√° ∑’ˉ¥â√—∫°“√√—°…“‡¡◊ËÕÕ“¬ÿπâÕ¬°«à“ 1 —ª¥“Àå(1-4) ‚¥¬√–¥— ∫ µ‘ ªí ≠ ≠“≈¥µË” ≈ߪ√–¡“≥ 5-6 ®ÿ ¥ µàÕ‡¥◊Õπ∑’Ë≈à“™â“„π°“√√—°…“ Õÿ∫—µ‘°“√≥å¢Õß¿“«– æ√à Õ ß∏— ¬ √Õ¬¥å Œ Õ√å ‚ ¡π·µà °”‡π‘ ¥ (congenital hypothyroidism) æ∫ 1 µàÕ 3,000 - 4,000 ∑“√°‡°‘¥ ¡’ ™’ æ(5-10) ”À√—∫ª√–‡∑»‰∑¬Õÿ∫—µ‘°“√≥å„π·µà æ◊πÈ ∑’·Ë µ°µà“ß°—π¢÷πÈ °—∫¿“«–¢“¥ “√‰Õ‚Õ¥’π ºŸ«â ®‘ ¬— ®÷ ß π„®∑”°“√»÷ ° …“Õÿ ∫— µ‘ ° “√≥å ¢ Õß¿“«–æ√à Õ ß ∏—¬√Õ¬¥åŒÕ√å‚¡π·µà°”‡π‘¥ º≈°“√µ√«®§—¥°√Õß ∏—¬√Õ¬¥åŒÕ√å‚¡π∑’˺‘¥ª°µ‘ ·≈–Õ“¬ÿ¢Õß∑“√°‚¥¬ ‡©≈’ˬ¢≥–‡√‘Ë¡√—°…“ (√–¬–‡«≈“„π°“√µ‘¥µ“¡∑“√° ‡æ◊ËÕ√—°…“) „π∑“√°·√°‡°‘¥∑’˧≈Õ¥„π‚√ßæ¬“∫“≈ »Ÿπ¬å¢Õπ·°àπ ´÷ßË º≈∑’‰Ë ¥â®–π”¡“ª√—∫ª√ÿß°“√√—°…“ ·≈–°“√µ‘¥µ“¡°“√√—°…“„À⥒¡“°¬‘Ëߢ÷ÈπµàÕ‰ª «—µ∂ÿª√– ß§å ‡æ◊Ë Õ »÷ ° …“º≈°“√µ√«®§— ¥ °√Õß∏— ¬ √Õ¬¥å ŒÕ√å‚¡π∑’˺‘¥ª°µ‘ ¿“«–æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π·µà °”‡π‘¥ ·≈–Õ“¬ÿ¢Õß∑“√° («—π) ‚¥¬‡©≈’ˬ¢≥–‡√‘Ë¡ ∑”°“√√—°…“ (√–¬–‡«≈“„π°“√µ‘¥µ“¡∑“√°‡æ◊ÕË √—°…“ ¿“«–æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π) „π∑“√°·√°‡°‘¥ ·ºπ° °ÿ¡“√‡«™°√√¡ ‚√ßæ¬“∫“≈»Ÿπ¬å¢Õπ·°àπ µ—Èß·µà 167 1 µÿ≈“§¡ æ.». 2545 ∂÷ß 31 °—𬓬π æ.». 2550 «‘∏’°“√»÷°…“ °“√»÷ ° …“π’È ‡ ªì π °“√»÷ ° …“¬â Õ πÀ≈— ß (retrospective study) ‚¥¬»÷°…“„π∑“√°·√°‡°‘¥ ∑’˧≈Õ¥„π°≈ÿà¡ß“π°ÿ¡“√‡«™°√√¡ ‚√ßæ¬“∫“≈ »Ÿπ¬å¢Õπ·°àπµ—Èß·µà 1 µÿ≈“§¡ æ.».2545 ∂÷ß 31 °—𬓬π æ.».2550 √«¡‡«≈“ 5 ªï ‚¥¬§âπÀ“ ºŸâªÉ«¬®“°™◊ËÕ ‡≈¢ª√–®”µ—«ºŸâªÉ«¬ ‡«™√–‡∫’¬π¢Õß ‚√ßæ¬“∫“≈»Ÿπ¬å¢Õπ·°àπ ·≈–‰¥â√—∫Õπÿ≠“µ®“° §≥–°√√¡°“√®√‘ ¬ ∏√√¡°“√«‘ ®— ¬ „π¡πÿ … ¬å ¢ Õß ‚√ßæ¬“∫“≈»Ÿπ¬å¢Õπ·°àπ °“√µ√«®§—¥°√Õß ‡®“–‡≈◊Õ¥∑’∫Ë √‘‡«≥ âπ‡∑â“ À√◊ÕÀ≈—ß¡◊Õ∫√‘‡«≥ ‡ âπ‡≈◊Õ¥¥”¢Õß∑“√°·√°‡°‘¥‡¡◊ËÕ∑“√°Õ“¬ÿ 2 «—π À¬¥≈ß∫π°√–¥“…´—∫‡≈◊Õ¥ ”À√—∫°“√µ√«®§—¥°√Õß ÿ¢¿“æ∑“√°·√°‡°‘¥¢Õß°√¡«‘∑¬“»“ µ√å°“√·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢ ‡æ◊ÕË àßµ√«®«‘‡§√“–Àå∑“ßÀâÕß ªØ‘∫—µ‘°“√ ∑’Ë»Ÿπ¬å«‘∑¬“»“ µ√å°“√·æ∑¬å ¢Õπ·°àπ °“√µ√«®¬◊π¬—𠇮“–‡≈◊Õ¥∑’˵”·Àπà߇ âπ‡≈◊Õ¥¥” „ àÀ≈Õ¥ ∑¥≈Õß ª√‘¡“≥ 2 - 3 ¡‘≈≈‘≈‘µ√ ·≈⫪≈àÕ¬„Àâ ‡≈◊Õ¥·¢Áßµ—« ·¬°‡ªìπ´’√—Ë¡ À√◊ÕπÈ”‡À≈◊Õß ‡æ◊ËÕ àßµ√«®¬◊π¬—𠧔𑬓¡ 1. º≈°“√µ√«®§—¥°√Õß∏—¬√Õ¬¥åŒÕ√å‚¡π ∑’˺‘¥ª°µ‘ (abnormal thyroid screening test) À¡“¬∂÷ß √–¥—∫∏—¬√Õ¬¥åŒÕ√å‚¡π (TSH) ¡“°°«à“ 25 ¡‘≈≈‘¬Ÿπ‘µµàÕ≈‘µ√ 2. ¿“«–æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π·µà°”‡π‘¥ (congenital hypothyroidism) À¡“¬∂÷ß ¿“«–¢“¥ ∏—¬√Õ¬¥åŒÕ√å‚¡π®“°°“√µ√«®¬◊π¬—π ‚¥¬‡ª√’¬∫‡∑’¬∫ °—∫§à“ª°µ‘∑’ËÕ“¬ÿπ—ÈπÊ 168 3. √–¬–‡«≈“„π°“√µ‘ ¥ µ“¡∑“√°‡æ◊Ë Õ ∑”°“√√—°…“ À¡“¬∂÷ß Õ“¬ÿ¢Õß∑“√° (‡ªìπ«—π) ∑’ˇ√‘Ë¡‰¥â√—∫°“√√—°…“ °“√µ‘¥µ“¡ºŸâªÉ«¬ 1. direct follow up °“√µ‘¥µ“¡¢âÕ¡Ÿ≈®“° ‡«™√–‡∫’¬πª√–«—µ‘ºŸâªÉ«¬ 2. indirect follow up °“√µ‘¥µàÕ Õ∫∂“¡ ∑“ß‚∑√»—æ∑å º≈°“√µ√«®¬◊π¬—π∑’Ë‚√ßæ¬“∫“≈„π ¿Ÿ¡‘≈”‡π“¢ÕߺŸâªÉ«¬ ¢Õπ·°àπ‡«™ “√ ªï∑’Ë 32 ©∫—∫摇»… 3 ‡¥◊Õπ‡¡…“¬π - 情¿“§¡ 2551 §«“¡∂’Ë §à“‡©≈’ˬ (§à“‡∫’ˬ߇∫π¡“µ√∞“π) ·≈– √âÕ¬≈–°√≥’¢âÕ¡Ÿ≈·®ßπ—∫ º≈°“√»÷°…“ „π√–À«à “ ß 1 µÿ ≈ “§¡ æ.».2545 ∂÷ ß 31 °— 𠬓¬π æ.».2550 √«¡√–¬–‡«≈“ 5 ªï ¡’∑“√°‡°‘¥¡’™æ’ „π‚√ßæ¬“∫“≈»Ÿπ¬å¢Õπ·°àπ ®”π«π 19,521 §π àßµ√«®§—¥°√Õß∏—¬√Õ¬¥åŒÕ√å‚¡π ®”π«π 18,798 §π §‘¥‡ªìπ√âÕ¬≈– 96.30 ¢Õß ®”π«π∑“√°∑’Ë àßµ√«®§—¥°√Õß∏—¬√Õ¬¥åŒÕ√å‚¡π °“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ ¢â Õ ¡Ÿ ≈ ∑’Ë ‰ ¥â ® “°°“√»÷ ° …“π”¡“«‘ ‡ §√“–Àå ∑“ß ∂‘µ‘‚¥¬„™â ∂‘µ‘‡™‘ßæ√√≥π“ 𔇠πÕ„π√Ÿª º≈°“√»÷°…“ æ∫«à“∑“√°∑’˺≈°“√µ√«®§—¥ °√Õß∏—¬√Õ¬¥åŒÕ√å‚¡πº‘¥ª°µ‘ ¡’®”π«π 59 §π ®“° ∑“√°∑’Ë à ß µ√«®§— ¥ °√Õß∑—È ß À¡¥ 18,798 §π §‘ ¥ ‡ªì π Õ— µ √“ à « πº≈°“√µ√«®§— ¥ °√Õß∏— ¬ √Õ¬¥å ŒÕ√å‚¡πº‘¥ª°µ‘ 3.14 §πµàÕª√–™“°√ 1,000 §π Khon Kaen Hospital Medical Journal Vol. 32 Supplement 3 April - May 2008 ∑“√°∑’Ë º ≈°“√µ√«®§— ¥ °√Õ߬◊ π ¬— π «à “ ¡’ ¿“«–æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π·µà°”‡π‘¥¡’®”π«π 13 §π ®“°®”π«π∑“√°∑’Ë º ≈°“√µ√«®§— ¥ °√Õß 169 ∏—¬√Õ¬¥åŒÕ√å‚¡πº‘¥ª°µ‘ 59 §π ‚¥¬∑“√° 1 §π ‰¡à “¡“√∂µ‘¥µ“¡¡“‡®“–‡≈◊Õ¥¬◊π¬—π‰¥â ‡π◊ËÕß®“° ∑“√°¬â“¬¿Ÿ¡‘≈”‡π“ Õ“¬ÿ¢Õß∑“√°‚¥¬‡©≈’ˬ¢≥–‡√‘Ë¡∑”°“√√—°…“ À√◊Õ√–¬–‡«≈“„π°“√µ‘¥µ“¡∑“√°‡æ◊ËÕ∑”°“√√—°…“ ¿“«–æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π §◊Õ 49.54 ± 30.73 «—π 170 «‘®“√≥å ®“°°“√»÷ ° …“∑“√°·√°‡°‘ ¥ ‚√ßæ¬“∫“≈ »Ÿπ¬å¢Õπ·°àπ „π√–¬–‡«≈“ 5 ªï æ∫«à“ 1. ®”π«π∑“√°∑’‰Ë ¥â√∫— °“√ àßµ√«®§—¥°√Õß ‚¥¬‡©≈’ˬ√âÕ¬≈– 96.30 µ“¡‚§√ß°“√√≥√ߧ凿◊ËÕ ‡©≈‘¡æ√–‡°’¬√µ‘®—¥‚§√ß°“√§—¥°√Õß¿“«–æ√àÕß ∏—¬√Õ¬¥åŒÕ√å‚¡π„π∑“√°·√°‡°‘¥ ‚¥¬¡’‡ªÑ“À¡“¬ „Àâ¡°’ “√µ√«®§—¥°√Õ߇¥Á°∑“√°·√°‡°‘¥∑ÿ°§π ¥—ßπ—πÈ ®“°°“√»÷°…“§√—Èßπ’È ®÷ß§«√¡’°“√ª√—∫ª√ÿß°“√ àß µ√«®§—¥°√Õß„Àâ∑“√°∑ÿ°§π‰¥â√—∫°“√µ√«®‡≈◊Õ¥ √âÕ¬≈– 100 ´÷Ëߪí≠À“∑’ˇ°‘¥¢÷Èπ ‡π◊ËÕß®“°∑“√°∑’Ë¡’ §«“¡º‘¥ª°µ‘ µ—Èß·µà·√°‡°‘¥ ¡’°“√‡§≈◊ËÕπ¬â“¬‰ª¬—ß ÀÕºŸâ ªÉ « ¬Àπ— ° ®÷ ß ¢“¥°“√ª√– “πß“π„π°“√ µ‘¥µ“¡∑“√°‡æ◊ËÕ‡®“–‡≈◊Õ¥µ√«®§—¥°√Õß ªí®®ÿ∫—π ‰¥â¡’°“√ª√—∫ª√ÿß√–∫∫°“√ª√– “πß“π ·≈–°“√ µ‘¥µ“¡∑“√° „Àâ¡’°“√‡®“–‡≈◊Õ¥ àßµ√«®§—¥°√Õß ∑ÿ°√“¬ ∑—Èß∑“√°∑’˧≈Õ¥„π‚√ßæ¬“∫“≈¢Õπ·°àπ ·≈–∑“√°∑’ Ë ßà µ—«¡“√—°…“µàÕ„π‚√ßæ¬“∫“≈¢Õπ·°àπ ¥—ß®–‡ÀÁπ‰¥â®“°®”π«π∑“√°∑’Ë àßµ√«®§—¥°√Õß¡’ ®”π«π¡“°¢÷Èπ ·≈–¡“°°«à“®”π«π∑“√°‡°‘¥¡’™’æ ∑’˧≈Õ¥„π‚√ßæ¬“∫“≈¢Õπ·°àπ 2. º≈°“√µ√«®§—¥°√Õß∏—¬√Õ¬¥åŒÕ√å‚¡π º‘¥ª°µ‘ æ∫„π∑“√° 3.14 §πµàÕª√–™“°√ 1,000 §π ´÷ßË ‡ªìπÕ—µ√“∑’§Ë Õà π¢â“ß Ÿß ‚¥¬∑“√°∑’„Ë Àâº≈°“√µ√«® §—¥°√Õß∏—¬√Õ¬¥åŒÕ√å‚¡πº‘¥ª°µ‘ ®”π«π 59 §π ¡’∑“√° 8 §π ∑’˧≈Õ¥®“°¡“√¥“∑’Ë¡’¿“«–∏—¬√Õ¬¥å ‡ªìπæ‘…´÷Ëß®–∑”„Àâº≈°“√µ√«®§—¥°√Õß∏—¬√Õ¬¥å ŒÕ√å‚¡πº‘¥ª°µ‘‰¥â ¢Õπ·°àπ‡«™ “√ ªï∑’Ë 32 ©∫—∫摇»… 3 ‡¥◊Õπ‡¡…“¬π - 情¿“§¡ 2551 3. ∑“√°∑’Ë„Àâº≈°“√µ√«®§—¥°√Õß∏—¬√Õ¬¥å ŒÕ√å‚¡πº‘¥ª°µ‘ ®”π«π 59 §π ‡ªìπ∑“√°¡’¿“«– æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π·µà°”‡π‘¥ ®“°°“√µ√«® ¬◊π¬—π¡’®”π«π 13 §π (µ‘¥µ“¡∑“√°‰¡à‰¥â 1 §π) §‘¥‡ªìπ‚Õ°“ ∑’∑Ë “√°¡’¿“«–æ√àÕß∏—¬√Õ¬¥åŒÕ√å‚¡π ·µà°”‡π‘¥ (positive predictive valve) ®“°°“√µ√«® §—¥°√Õß∏—¬√Õ¬¥åŒÕ√å‚¡πº‘¥ª°µ‘ √âÕ¬≈– 22 ·≈– ¡’ Õÿ ∫— µ‘ ° “√≥å ¢ Õß¿“«–æ√à Õ ß∏— ¬ √Õ¬¥å Œ Õ√å ‚ ¡π ·µà°”‡π‘¥ª√–¡“≥ 1 §π µàÕ 1,501 ∑“√°‡°‘¥¡’™’æ ´÷Ë ß ‡ªì π Õÿ ∫— µ‘ ° “√≥å ∑’Ë §à Õ π¢â “ ß Ÿ ß ¡“°‡¡◊Ë Õ ‡∑’ ¬ ∫°— ∫ µà “ ߪ√–‡∑» (1 : 3,500 - 1 : 4,000)(5 - 10) ‚√ßæ¬“∫“≈√“™«‘∂’ (1 : 4,652)(11) ‚√ßæ¬“∫“≈√“¡“ (1 : 2,926) (12) ·≈–‚√ßæ¬“∫“≈®ÿ à “≈ß°√≥å (1 : 2,484)(13) ·µà¡’Õÿ∫—µ‘°“√≥å„°≈⇧’¬ß°—∫°√¡ «‘∑¬“»“ µ√å°“√·æ∑¬å∑∑’Ë ”°“√»÷°…“„π‚√ßæ¬“∫“≈ ¿“§µ–«—πÕÕ°‡©’¬ß‡Àπ◊Õ ·≈–¿“§‡Àπ◊Õ (1 : 1,792)(14) ∂“∫—π ÿ¢¿“懥Á°·Ààß™“µ‘¡À“√“™‘π’ (1 : 1,686)(11) ·≈–‚√ßæ¬“∫“≈™ÿ¡·æ (1 : 1,520)(15) 4. Õ“¬ÿ¢Õß∑“√°∑’ˇ√‘Ë¡∑”°“√√—°…“ À√◊Õ √–¬–‡«≈“„π°“√µ‘¥µ“¡∑“√°‚¥¬‡©≈’ˬª√–¡“≥ 49.54 ± 30.73 «—π ´÷Ë߇ªìπ√–¬–‡«≈“∑’˧àÕπ¢â“ßπ“π Õ“®∑”„Àâ¡’º≈¥â“πæ—≤π“°“√∑“ß ¡Õß °“√‡®√‘≠ ‡µ‘∫‚µ ·≈–°“√¥”√ß™’«‘µ¢Õß∑“√°‰¥â ∑“√°Õ“®¡’ √–¥—∫ µ‘ªí≠≠“µË”°«à“∑“√°∑’ˉ¥â√—∫°“√√—°…“Õ¬à“ß ∑—π∑«ß∑’¥ß— ∑’‰Ë ¥â°≈à“«¡“ ¥—ßπ—πÈ ªí®®ÿ∫π— ¡’°“√æ—≤π“ ·≈–ª√— ∫ ª√ÿ ß °“√µ‘ ¥ µ“¡∑“√°∑’Ë ¡’ º ≈°“√µ√«® §—¥°√Õß∏—¬√Õ¬¥åŒÕ√å‚¡πº‘¥ª°µ‘ ¡“µ√«®¬◊π¬—π ´È”Õ¬à“ß√«¥‡√Á« ‚¥¬°“√∫—π∑÷°∑’ËÕ¬Ÿà®√‘ßÀ≈—ß§≈Õ¥ ·≈–‡∫Õ√å‚∑√»—æ∑嵑¥µàÕ°≈—∫ ‡æ◊ËÕ„™â„π°“√µ‘¥µ“¡ ∑“√°‰¥âÕ¬à“ß√«¥‡√Á«¡“°¬‘Ëߢ÷Èπ ‡Õ° “√Õâ“ßÕ‘ß 1. Bongers - Schokking JJ, Koot HM, Wiersma D, et al. Influence of timing and dose of thyroid hormone replacement on development in infants with congenital hypothyroidismism. J Pediatri 2000;136 : 292 - 7. Khon Kaen Hospital Medical Journal Vol. 32 Supplement 3 April - May 2008 171 2. Isher DA. The importance of early management is optimizing IQ in infants with congenital hypothyroidismism. J Pediatr 2000 ; 136 : 273 - 4. 3. Glorieux J, Dussault J, Van Vliet G. 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