[Cretinism mass-screening study by solid phase TSH-RIA method (author's transl)].
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Biomedical subjects
Publications and source records attributed to T Oura.
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The seasonal distribution of birth dates of 31 patients with sporadic cretinism due to thyroid dysgenesis was analyzed in Osaka area for 14 years. The incidence was statistically high in the summer months. A hypothesis that some environmental factors such as viral infection may cause the disease is proposed.
A case of transient hyperthyrotropinaemia was found by mass screening for neonatal hypothyroidism using the paired TSH assay method. The patient was a baby boy born at term after a normal pregnancy who grew without any abnormal signs or symptoms. For the first 7 months after birth, his serum TSH was abnormally high while his total serum T4, T3, and free T4, T3 were within normal limits, exept for slightly low free T4 level at 7 months. The raised serum TSH decreased spontaneously to within normal limits after he was 9 months old.
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A simple and reliable method of paired TSH assay was developed and used in screening for neonatal primary hypothyroidism. In this method, a paired assay is first done. Equal parts of the extracts of dried blood spots on filter paper (9 mm diameter) from two infants 4-7 days old are combined and assayed for TSH by double antibody RIA. If the value obtained is over the cut-off point, the extracts are assayed separately for TSH in a second assay to identify the abnormal sample. Two systems, A and B, with different cut-off points were tested. On the basis of reference blood samples (serum levels of TSH, 80 microU/ml in system A and 40 microU/ml in system B), the cut-off point was selected as follows: upper 5 (A) or 4 (B) percentile in the paired assay and values of reference blood samples in the second individual assay. Four cases (2 in A and 2 in B) of neonatal primary hypothyroidism were found among 25 infants (23 in A and 2 in B) who were recalled from a general population 41,400 infants (24,200 in A and 17,200 in B) by 22,700 assays. This paired TSH neonatal hypothyroidism.
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A method for measuring thyrotropin (TSH) in eluates of dried blood samples on filter paper was evaluated and improved as a screening test for neonatal hypothyroidism. A linear relationship between the volume of eluate and the TSH value and good recoveries of endogenous TSH (104%) and added TSH (89%) were obtained, indicating that TSH in dried blood was extracted well by overnight elution and determined accurately by radioimmunoassay. The TSH content in the central portion of a spot was less (71%) than that in the peripheral portion. The TSH in dried blood samples on filter paper was stable at 4 degrees C, room temperature (about 25 degrees C) or 37 degrees C for 1 month. The TSH values of eluates were correlated with those of whole blood (r = 0.90) and serum (r = 0.81). Cases of primary hypothyroidism cound be readily differentiated from normal subjects by this method, even when eluates of their blood were combined with those of normal blood for assay of TSH.
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Marker chromosomes carried by unrelated 3 cases were identified as a part of No. 9 chromosome through the analysis of the chromatid fine structure after trypsin-giemsa treatment. They showed characteristic features of that 9p trisomic syndrome which were described by Rethoré et al. (1973). In addition to those features, some clinical and laboratory findings on growth hormon deficiency were disclosed in this report.
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