High prevalence of thyroid peroxidase gene mutations in patients with thyroid dyshormonogenesis

in European Journal of Endocrinology
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  • 1 University Medical Centre, University Children’s Hospital, Vrazov trg 1, SI-1000 Ljubljana, Slovenia 1Department of Pediatrics, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina, and 21st Department of Paediatrics, University Children’s Hospital, 04001 Kosice, Slovakia

(Correspondence should be addressed to T Battelino; Email: tadej.battelino@mf.uni-lj.si)

Objective: Thyroid dyshormonogenesis is a genetically heterogeneous group of inherited disorders in the enzymatic cascade of thyroid hormone synthesis that result in congenital hypothyroidism (CH). Thyroid peroxidase gene (TPO) mutations are one of the most common causes of thyroid dyshormonogenesis. The aim of this study was to identify TPO gene defects in a cohort of patients with thyroid dyshormonogenesis from Slovenia, Bosnia, and Slovakia.

Design and methods: Forty-three patients with permanent CH and orthoptic thyroid glands from 39 unrelated families participated in the study. Mutational analysis of the TPO gene and part of its promoter consisted of single-stranded conformation polymorphism analysis, sequencing, and restriction fragment length polymorphism (RFLP) analysis.

Results: TPO gene mutations were identified in 46% of participants. Seven different mutations were identified, four mutations of these being novel, namely 613C > T (R175X), 1519_1539del (A477_N483del), 2089G > A (G667S), and 2669G > A (G860R). Only a single allele mutation was identified in 65% of the TPO mutation carriers.

Conclusions: The results showed a higher prevalence of TPO gene mutations in thyroid dyshormonogenesis when compared with published studies. The high percentage of single allele mutations implied possible intronic or regulatory TPO gene mutations or monoallelic expression.

Abstract

Objective: Thyroid dyshormonogenesis is a genetically heterogeneous group of inherited disorders in the enzymatic cascade of thyroid hormone synthesis that result in congenital hypothyroidism (CH). Thyroid peroxidase gene (TPO) mutations are one of the most common causes of thyroid dyshormonogenesis. The aim of this study was to identify TPO gene defects in a cohort of patients with thyroid dyshormonogenesis from Slovenia, Bosnia, and Slovakia.

Design and methods: Forty-three patients with permanent CH and orthoptic thyroid glands from 39 unrelated families participated in the study. Mutational analysis of the TPO gene and part of its promoter consisted of single-stranded conformation polymorphism analysis, sequencing, and restriction fragment length polymorphism (RFLP) analysis.

Results: TPO gene mutations were identified in 46% of participants. Seven different mutations were identified, four mutations of these being novel, namely 613C > T (R175X), 1519_1539del (A477_N483del), 2089G > A (G667S), and 2669G > A (G860R). Only a single allele mutation was identified in 65% of the TPO mutation carriers.

Conclusions: The results showed a higher prevalence of TPO gene mutations in thyroid dyshormonogenesis when compared with published studies. The high percentage of single allele mutations implied possible intronic or regulatory TPO gene mutations or monoallelic expression.

Introduction

Congenital hypothyroidism (CH) is the most common congenital endocrine disorder, occurring in 1:3000–4000 newborns (1). The serious detrimental effect on the child’s cognitive and motor development, which used to be a major feature of the disease, is now mostly prevented by newborn screening detection and early treatment (2).

In Slovenia, neonatal screening for CH was introduced in 1981 (3). The present incidence of permanent CH in Slovenia is approximately 1:3100 newborns, based on 58 patients identified among 181 264 newborns in a 10-year period from 1994 to 2003 (data obtained from the National Registry of the Department of Endocrinology, Diabetes and Metabolism, University Children’s Hospital, Ljubljana, which is the nationwide referral center for CH). The neonatal thyroid-stimulating hormone (TSH) screening program in the Federation of Bosnia and Herzegovina (major part of Bosnia and Herzegovina) has been implemented since March 2005. The Federal Minister of Health accredited the implementation of the neonatal screening program for CH and phenylketonuria to the Laboratory for the Detection of Congenital Metabolic Diseases at the Department of Pediatrics, University Hospital, Tuzla (4). There were 30 068 newborns screened and 12 patients identified with CH from 1st March 2005 to 31st December 2006 (data obtained from the Federal Registry for CH of the Division for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, University Hospital, Tuzla). The recent population-based studies showed Slovene adolescents and Bosnian schoolchildren to be iodine sufficient (5, 6).

The majority of sporadic CH is due to developmental disorders, referred to as thyroid dysgenesis, which include the complete absence of thyroid tissue (agenesis) and a small-sized thyroid (hypoplasia) with or without associated ectopy. The less common causes of CH are hereditary defects in the enzymatic cascade of thyroid hormone synthesis, which share a common name, thyroid dyshormonogenesis. In this entity, the thyroid gland is found in the normal anatomical position; it is often enlarged, but with adequate levothyroxine (LT4) substitution therapy it may also be of normal size. In a 10-year period from 1994 to 2003, 34% of Slovene patients with permanent CH showed clinical characteristics indicative of thyroid dyshormonogenesis, which is a considerably higher proportion than reported by other groups (2, 7).

Thyroid peroxidase (TPO) enzyme is a thyroid-specific glycosylated hemoprotein with a short trans-membrane domain that binds it to the apical membrane of the thyrocyte (2), with the catalytic part facing inside the follicle. It consists of 933 amino acids that are encoded by an mRNA of 3048 nucleotides (8). The TPO gene spans over 150 kb on the short arm of chromosome 2, locus 2p25, and consists of 17 exons (9, 10). Published molecular genetic studies suggest that TPO gene mutations are one of the most common causes of thyroid dyshormonogenesis, with several different inactivating mutations being identified in patients with total iodide organification defects (TIOD; (7, 1128)). The inheritance is autosomal recessive (16, 29). TPO gene mutations are also infrequently reported in patients with milder thyroid hormone insufficiency or partial iodide organification defects (PIOD; (30, 31)). In the present study, the results of TPO gene mutational analysis in 43 patients with thyroid dyshormonogenesis from Slovenia, Bosnia, and Slovakia and their major clinical characteristics are presented.

Subjects and methods

Patients

Patients with permanent CH with morphological characteristics of dyshormonogenesis, except for those with low thyroglobulin (Tg) levels, were invited to participate in the study. The diagnosis of CH was based on elevated TSH levels in heel puncture blood samples collected on filter paper between days 3 and 5 of life (cutoff limit 8 mU/l; DELFIA Neonatal hTSH, Perkin–Elmer Life and Analytical Sciences, Wallac Oy, Finland) and confirmation by subsequent determination of TSH, T4, triiodothyronine, and Tg levels in venous blood between days 7 and 14 of life, when again for TSH the cutoff limit 8 mU/l was used. Patients started replacement therapy with LT4 within the first 2 weeks of life and continued therapy for at least 2 years. The condition was reevaluated at the age of 2 years, after 4 weeks of therapy withdrawal. Patients with repeatedly elevated TSH above the upper-normal limit 5.50 mU/l (normal values 0.35–5.50 mU/l) were considered to have permanent CH. At the reevaluation at the age of 2 years, thyroid size was evaluated by ultrasound and/or 99Tc pertechnetate scan. Patients with in situ thyroid gland of normal size or enlarged (thyroid volume (32) more than > 0.7 cm3 or thyroid width (33) more than > 1.4 cm) were considered to have dyshormonogenesis. Patients with permanent CH and in situ normal or enlarged thyroid gland, but with lower than normal Tg level (normal values 2–70 ng/ml) were not invited to participate. The perchlorate discharge test was not performed; therefore, patients with iodide organification defects were not preselected. The study protocol was approved by the local ethics committees.

A total of 43 patients from 39 apparently unrelated families consented to participate in the study. At the time of genetic analysis, the mean age of participants was 11.07 years (range 2–23 years). Written informed consent was obtained from the participants and parents in the case of minors. Thirty patients from 27 families were Slovene, 11 patients from 10 families were Bosnian, and two unrelated patients were Slovak. Six participants had neonatal total or free T4 within the normal range and serum TSH level above the cutoff but < 20 mU/l. However, all of these patients required permanent replacement therapy, as confirmed at the age of 2 years.

DNA isolation and amplification

Genomic DNA was isolated from peripheral blood using the salting out procedure in all participants. Each of the 17 exons of the TPO gene, including the splicing regions, was amplified by PCR. Primers and amplification conditions are available upon request from the corresponding author. Exon 8 was amplified using two pairs of primers, due to its length. Fifty microliters of PCR mixture were composed of 1 × Gold PCR buffer, MgCl2, 200 μ M each deoxyNTP, 0.4 μ M each primer, 0.4 U AmpliTaq Gold DNA polymerase (Applied Biosystems, Foster City, CA, USA), and 200 ng DNA. Five percent of dimethyl sulfoxide were added for amplification of exon 8b. Thermal cycling conditions were as follows: initial denaturation at 95 ° C for 10 min, followed by 32 cycles of denaturation at 94 ° C for 30 s, annealing for 30 s and extension at 72 ° C for 30 s. Cycling was followed by a final 7-min extension at 72 ° C.

Single-stranded conformation polymorphism (SSCP) analysis and sequencing mutational analysis

The PCR fragments were further analyzed by SSCP analysis using the DCodeTM Universal Mutation Detection System (Bio-Rad Laboratories, Inc.). The gel matrix for SSCP contained 8, 10 or 12% polyacrylamide gel (37.5:1; Bio-Rad Laboratories, Inc.) with or without 5% glycerol. Samples were electrophoresed for up to 20 h at a constant temperature of 5 ° C. The gel was stained using the GelCode Color Silver Stain Kit (Pierce, Rockford, IL, USA) according to the manufacturer’s instructions. Fragments with aberrant electrophoretic mobility were subsequently sequenced using the Big Dye terminator cycle sequencing kit and ABI PRISM 310 automated sequencer (PE Applied Biosystems). Exons 3, 7 8, 9, 11 and 12 were directly sequenced in all patients, except in the three patients (nos 9, 10 and 11 in Table 1) where homozygosity for the common 1273_1276dupGGCC mutation (A397PfsX76) was discovered using NaeI RFLP analysis. In 16 patients, all exons were sequenced. Sequences were compared with the normal TPO gene sequence (GenBank access no. AH003466).

Genetic analysis of the TPO promoter

In participants, where only a single allele mutation was identified in the reading frame after the sequencing of all amplified exons, 873 bp of the promoter region were analyzed (GenBank access no. M25701:1727–2599) to examine for the presence of regulatory mutations. The region examined included the TATA box, CpG island, and the proximal promoter TTF-1- and PAX-8-binding sites, according to previous TPO promoter descriptions (34, 35). Three pairs of primers were designed for promoter region analysis, as listed: TP_P1F, 5′-ttctgaagcctttgcatcg-3′ ; TP_P1R, 5′-cagagatgttctgtaggaaggtca-3′ ; TP_P2F, 5′-tgaaagca-gatcacccatga-3′ ; TP_P2R, 5′-cctctggccgaatgagttag-3′ ; TP_P3F, 5′-agttggtttattctttctccctgt-3′ ; and TP_P3R, 5′-cggctgtaactcttctgaaatg-3′ . Specific amplification conditions are available upon request at the corresponding author. The amplicons obtained by PCR were directly sequenced and the sequences were compared with the normal TPO promoter (GenBank access no. M25701).

RFLP analysis

Screening for the common 1273_1276dupGGCC mutation (A397PfsX76) was performed using NaeI RFLP analysis on a 2% agarose gel (11).

One hundred healthy controls (approximately 80% of Slovene ethnic origin and 20% of Bosnian ethnic origin) and examined healthy family members were screened for the novel mutations by RFLP on a 2% agarose gel. The novel point mutation in exon 6 (613C > T (R175X)) and a 1519_1539del mutation (A477_N483del) in exon 9 each eliminated one restriction site for endonuclease BsaXI. A silent mutation in exon 8 (930G > A (P280P or p.=)) eliminated the restriction site for endonuclease NaeI and the mutation in exon 11 (2089G > A (G667S)) eliminated the restriction site for HphI. However, a single nucleotide polymorphism placed immediately next to the mutation in exon 11 disturbed proper HphI digestions, therefore DNA samples with incomplete digestion were subsequently sequenced. A point mutation in exon 15 (2669G > A (G860R)) created a novel restriction site for BclI. Restriction enzymes used are summarized in Table 2. All restriction enzymes used were purchased from New England Biolabs, Inc., Beverly, MA, USA.

Specific data analysis

For the novel mutations, phylogenetic conservation of the affected amino acid sequences among the human and mammalian TPO homologues was determined with the help of CLUSTAL program (http://www.ebi.ac.uk/clustalw/). For the silent alteration in exon 8, 930G > A (P280P or p.=), the possible effect on exonic splicing enhancers was assessed using the ESEfinder program (http://rulai.cshl.edu/tools/ESE/).

Results

TPO gene mutations were detected in 20 out of 43 patients (46%) with thyroid dyshormonogenesis from 18 out of 39 families (46%). A similar prevalence was observed in Slovenians and Bosnians. Considering the incidence of 1:3100 of permanent CH in Slovenia, the percentage of dyshormonogenesis of 34%, and the prevalence of TPO mutations of 46% from the present study, the calculated incidence of CH due to TPO gene mutations in the Slovene population is approximately 1:20 000 newborns.

The TPO gene analysis results and patients’ clinical characteristics are presented in Table 1. Mutations were numbered according to Kimura (10) and named as proposed by den Dunnen and Antonarakis (36). Two of the mutation carriers (nos 6 and 17 in Table 1) had mild hypothyroidism, while in the remainder initial laboratory values and the subsequent clinical course were indicative of a severe defect in thyroid hormone synthesis. Three patients (nos 7, 17 and 18) developed nodular goiter, with patient no. 7 undergoing right lobe surgical resection at the age of 15 years. Histological examination revealed nodular hyperplasia and follicular adenoma.

Seven different mutations were identified in the reading frame of the TPO gene, four of these being novel (613C > T in exon 6 (R175X), 1519_1539del in exon 9 (A477_N483del), 2089G > A in exon 11 (G667S), and 2669G > A in exon 15 (G860R); Fig. 1). Of the previously known mutations, 1273_1276dupGGCC in exon 8 (A397PfsX76; (7, 11)), 2485G > A in exon 14 (E799K; (13)), and 2512delT in exon 14 (C808AfsX24; (7)) were detected. The most common mutation found in the examinees was the frequently reported inactivating mutation 1273_1276dupGGCC (A397PfsX76), which was found in patients from all three countries, in 70% of mutation carriers and in 32% of all 43 participants. The identified mutations are summarized in Table 2.

In addition, two novel silent substitutions were identified. A substitution 930G > A in exon 8 (P280P or p.=) was detected in a heterozygous state in a patient with no other mutations detected. A substitution 2565C > T in exon 14 (C825C or p.=) was detected in a heterozygous state in one out of the two siblings, both of whom had clinical signs of dyshormonogenesis. No mutations affecting the amino acid sequence were identified in any of the patients with silent mutations and these two patients were not included in the TPO gene mutation carriers. The 613T, 1519_1539del, 2089A, 2669A, and 930A variants were not detected in any of the 100 healthy controls, either by RFLP analysis using specific restriction enzymes or by sequencing, which was used for the 2089A detection since RFLP analysis was not accurate due to the polymorphism placed next to the mutation.

Taking into consideration all the detected mutations, except for the two silent substitutions, seven patients were found to be homozygous or compound heterozygous TPO gene mutation carriers, while in 13 patients (65% of mutation carriers) only a single allele mutation was identified. In these patients, including the patient with the 930G > A silent substitution (P280P or p.=), all the exons analyzed by SSCP analysis were reexamined by sequencing and the TPO promoter region was investigated, except in patient no. 16 where additional DNA was not available for further analysis. In patient no. 17 a novel heterozygous promoter alteration −540g > a was identified; however, the analysis of family members showed that both this and the mutation 2089G > A in exon 11 (G667S) were inherited from the same parent.

Five known single nucleotide polymorphisms were detected in the promoter region and in exon 1 (−799g > a, −706g > a, −95g > t, −35a > g, and 11G > A) and 9 known polymorphisms in the reading frame (102C > G, L4L; 298C > G, P70A; 859G > T, A257S; 1207G > T, A373S; 1283G > C, S398T; 2088C > T, D666D; 2235C > T, P715P; 2263A > C, T725P; and 2630T > C, V847A). Among numerous identified intronic polymorphisms, the 96–52t > g single nucleotide polymorphism in intron 2 was detected in the heterozygous state in all four heterozygous carriers of a novel 1519_1539del mutation in exon 9 (A477_N483del; nos 13, 14, 15 and 16), but was not detected in any of the other study participants. In the parents of patient no. 13 the 96-52t > g polymorphism was shown to be inherited from the same parent as the 1519_1539del mutation (A477_N483del).

Discussion

The prevalence of TPO gene mutations in the studied population (46%) was higher than that noted in a Portuguese study, where similar inclusion criteria, without the determination of the iodide organification defect, were used and mutations identified in 24% of patients (24). While the percentage of dyshormonogenesis (34%) in the Slovene population is higher than the 15% reported in other studies (2, 7), the estimated incidence of CH due to TPO gene mutations of 1:20 000 newborns is also considerably higher when compared with the published estimate in the Dutch population, where the calculated incidence of TIOD is 1:66 000 newborns (7). The data could be compared as the TPO gene mutations mainly result in TIOD, and most of the TIOD seem to be caused by TPO gene mutations (7).

In the present study, seven different TPO gene mutations were identified, four of these being novel. Mutations were also detected in two of the six participants with milder CH. In both patients (nos 6 and 17), only a single allele mutation was identified. In patient no. 6 the common 1273_1276dupGGCC inactivating mutation (A397PfsX76) was detected. In patient no. 17 a novel missense mutation 2089G > A was found in exon 11 that caused an amino acid change from glycine with a nonpolar, hydrophobic residue, to serine, which is a polar and hydrophilic amino acid (G667S). Glycine in this position is highly conserved in human and mammalian TPO homologues (Table 3), Umeki et al. (23) published a functional study of the nearby mutation R665W, which was detected in a patient with severe CH. The mutation is shown to disturb plasma membrane localization in the mutated TPO protein. Considering the crystal structure of myeloperoxidase, the glycine corresponding to glycine 667 in TPO forms part of an α-helix that interconnects two locally folded regions (37). Arginine 665 and glycine 667 form the same helical turn. Therefore, it is possible that this novel mutation reduces TPO enzyme function. However, in a recent publication, carriers of a single affected allele were not found to have any signs of thyroid dysfunction and they had normal iodide organification in vivo (29). Consequently, it is likely that undetected intron or regulatory mutations affected the other allele in these two patients.

The functional importance of the three novel mutations that were found in patients with severe hypothyroidism could be predicted from the putative TPO protein structure. The 613C > T mutation creates a termination signal in exon 6 (R175X), causing a loss of the catalytic part of the enzyme.

A novel 21 bp deletion in exon 9, 1519_1539del, causes a deletion of seven amino acids without a frame shift (A477_N483del). This short amino acid sequence is partly conserved among other mammalian peroxidases, as shown in Table 3. Several other mutations causing TIOD have been identified in close proximity by other groups – I447F, Y453D, L458P, R491H, G493S, and P499L (13, 19, 20, 22, 25). Exons 8, 9 and 10 encode for the catalytic part of the enzyme and are the most frequent locations of inactivating mutations. Histidine 494 in human TPO is, according to the known myeloperoxidase structure, the proximal heme-binding histidine (37). A nearby deletion of seven amino acids would be expected to disturb proper protein folding and the final structure. The 1519_1539del mutation was detected in four apparently unrelated patients. Two of these were Bosnians, nos 15 and 16, and the other two had Slovene citizenship, nos 13 and 14, but their families had previously migrated to Slovenia from the southern republics of the former Yugoslavia. The nucleotide sequence of a deleted oligonucleotide and the nucleotides that directly surround it did not show the properties of loop formation as a possible mechanism for a deletion that would arise de novo on multiple occasions. However, the linkage of the deletion with an intronic substitution 96-52t > g, detected only in these four patients, implies the same ancestral origin of the mutation.

The 2669G > A (G860R) is, to our knowledge, the first mutation resulting in an amino acid substitution in the TPO transmembrane region (38). It is very likely that the change from the hydrophobic glycine to the positively charged arginine disturbs the insertion of the TPO enzyme into the plasma membrane.

The functional importance of the previously known mutations was investigated by other groups. The 1273_1276dupGGCC mutation is a frame shift mutation that creates a premature termination signal in exon 9 (A397PfsX76), but is also shown to unmask a cryptic acceptor splice site in exon 9. Through the mechanism of alternative splicing normal reading frame is restored in the carboxy-terminal half of the protein (11). The 2485G > A mutation (E799K) results in enzymatically inactive TPO, while the cellular distribution of this mutant is normal (20). The 2515delT frame shift mutation in exon 14 generates a premature termination signal in the same exon (C808AfsX24; (7)). Expression analysis showed that the mutated TPO is smaller and cannot translocate to the cell surface (39).

A novel heterozygous substitution 930G > A (P280P or p.=), situated 20 bp inside exon 8 seems to be functionally silent. It lies 20 bp inside the exon. The computer program ESEfinder’s calculations showed that this alteration eliminated two high-score exonic splicing enhancer sites, Sf2/Asf (score 4.175) and Sc35 (score 3.234). This mutation was not detected in 100 healthy controls. However, the possible effect on exon splicing could not be verified, because no thyroid tissue from this patient was available for mRNA analysis. The other novel silent substitution, 2565C > T (C825C or p.=), was shown not to segregate with the disease.

In an unexpectedly high percentage of patients (65%), only single allele mutations were identified, despite the fact that all 17 exons were analyzed in these patients, the normal SSCP analysis results were confirmed by subsequent sequencing and, in addition, 873 bp of the proximal promoter were analyzed. In other studies, single TPO mutations were detected in only about 20% of patients with TIOD (7, 22, 40, 41). One report of mRNA analysis after thyroidectomy in a patient with TIOD and a single allele mutation proved a lack of expression of the other allele with a normal reading frame. No proximal promoter mutation was found in this patient (40).

TPO gene mutations are mostly inactivating (7). However, there are reports about TPO gene mutations that only partly diminish TPO function and result in milder clinical presentation (30). No phenotype–genotype correlation was appreciated in patients with mutations identified on both alleles. Two patients with a single allele mutation had milder clinical presentation of CH, however, additional mutations in intronic regions or unexamined parts of regulatory regions were possible.

In conclusion, the prevalence of TPO gene mutations was considerably higher when compared with other published data. Four novel TPO gene mutations were identified in the examined population. Considering the high prevalence of single allele TPO mutations, the overall prevalence of TPO mutations with possible unidentified cryptic mutations could be even higher.

Acknowledgements

This work was supported by grants from the Ministry of Higher Education, Science and Technology and ARRS # J3-6072 and # J3-9663. We thank Dr Dianne Jones for reading the manuscript, Vita Dolzan, MD, PhD for her expert advice, Katarina Trebusak Podkrajsek, PhD and Maja Zadel, BSc for their kind, expert help using the automatic sequencer, and Ms Jurka Ferran and Ms Ema Dalic for their expert technical assistance. We also thank all the patients and parents for their kind participation in our study.

Table 1

Clinical characteristics of mutation carriers and identified TPO gene mutations.

Family/patientYear of birthOriginTSH (mU/l)aFreeT4 (pmol/l)aTotal T4 (nmol/l)aTg (ng/ml)aTSH (mU/l) at reevaluationTg (ng/ml) at reevaluationThyroid glandbTPOgene analysis resultsc
ND, not determined; NA, not available; WT, wild type.
aThe serum was obtained on days 7–14 of life except in patient 3/a, where it was obtained at the age of 2.5 months.
bUltrasound was performed at the age of 2 years unless indicated otherwise.
cMutations in bold are novel.
dUltrasound was performed in neonatal period.
eUltrasound was performed at the age of 15 years.
fUltrasound was performed at the age of 18 years.
gUltrasound was performed at the age of 16 years.
11999Bosnia> 80ND2.6NDNANAGoiter613C > T/1273_1276dupGGCC
22003Slovenia1862.4ND> 50070.637.59Congenital goiterd1273_1276dupGGCC/WT
3/a1983Slovenia> 80NDNot detectableNDNANDGoiter1273_1276dupGGCC/WT
3/b1985Slovenia> 120ND16ND472NDGoiter1273_1276dupGGCC/WT
41995Slovenia3612.7ND20940.20102Goiter1273_1276dupGGCC/WT
52004Slovenia255.54.14ND18053.5975Normal1273_1276dupGGCC/WT
61996Slovenia13.116.2NDND16.710Normal1273_1276dupGGCC/WT
71990Slovakia64.4ND19.7NDNANANodular goiter, follicular adenomae1273_1276dupGGCC/WT
81999Bosnia35.3ND0.00888NANAGoiter1273_1276dupGGCC/WT
91998Slovenia4000.54ND203631.1540Goiter1273_1276dupGGCC/1273_1276dupGGCC
101995Slovenia4222.4ND664122.60530Goiter1273_1276dupGGCC/1273_1276dupGGCC
111996Slovenia60313.9NDND78.90231Goiter1273_1276dupGGCC/1273_1276dupGGCC
12/a1986Bosnia> 60ND3.2348NANAGoiter1273_1276dupGGCC/2512delT
12/b1998Bosnia> 60ND3.298NANAGoiter1273_1276dupGGCC/2512delT
131991Slovenia> 500ND3362062.76276Goiter1519_1539del/WT
141986Slovenia481ND10ND95.88NDGoiter1519_1539del/WT
152003Bosnia306ND2.6NDNANAGoiter1519_1539del/WT
162003Bosnia99ND3.8626NANAGoiter1519_1539del/WT
171987Slovenia14.2ND1553687.40NDNodular goiterf2089G > A/WT
181990Slovenia433.1ND16ND24.88NDNodular goiterg2485G > A/2669G > A
Normal values< 811.7–28.059–1632–700.35–5.502–70
Table 2

Mutations identified at the DNA and protein level, and restriction endonucleases used for RFLP.

ExonMutationaEffect on TPO protein sequenceReferenceRestriction endonucleaseFrequency of mutant alleles
aNucleotide numbering according to Kimura (10).
bMutation eliminates restriction site.
cMutation creates restriction site.
6613C > TR175XPresent studyBsaXIb1/86
81273_1276dupGGCCA397PfsX76(11)NaeIc17/86
91519_1539delA477_N483delPresent studyBsaXIc4/86
112089G > AG667SPresent studyHphIb1/86
142485G > AE799K(14)1/86
142512delTC808AfsX24(12)2/86
152669G > AG860RPresent studyBclIb1/86
Table 3

Comparison of amino acid sequences neighboring novel mutations A447_N483del and G667S in various human and mammalian peroxidases.

Mutant TPODST_______VFSLRDS667DWF
TPO, thyroid peroxidase; MPO, myeloperoxidase; EPO, eosinophil peroxidase; LPO, lactoperoxidase.
Human TPODSTA477NPTVSN483VFSLRDG667DWF
Pig TPODPAV476DPTVSN482VFSLRDG665DRF
Mouse TPONPTV465NPTVSN471IFSLRDG655DRF
Rat TPONPTV465NPTVSN471VFSLRDG655DRF
Human MPONDSV486DPRIAN492VF_LRDG675DRF
Mouse MPONDSV460DPRIAN466VF_LRDG649DRF
Human EPOCSNV458DPRVAN465VF_ARDG647DRF
Mouse EPOCSNV459DPRVAN465VF_ARDG648DRF
Human LPOSESV453DPRISN459VF_LRDG642DRF
Mouse LPONESV451DPRISN457VF_LRDG640DRF
Figure 1
Figure 1

Novel TPO gene mutations. (A) Heterozygous 613C > T mutation (R175X), wild-type exon 6 sequence. (B) Heterozygous 2089G > A mutation (G667S) and heterozygous 2088C > T single nucleotide polymorphism, wild-type exon 11 sequence. (C) Heterozygous 2669G > A mutation (G860R), wild-type exon 15 sequence. (D) Heterozygous 1519_1539del mutation (A477_N483del), wild-type exon 9 sequence.

Citation: European Journal of Endocrinology eur j endocrinol 156, 5; 10.1530/EJE-07-0037

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  • 8

    Kimura S, Kotani T, McBride OW, Umeki K, Hirai K, Nakayama T & Ohtaki S. Human thyroid peroxidase: complete cDNA and protein sequence, chromosome mapping, and identification of two alternately spliced mRNAs. PNAS 1987 84 5555–5559.

    • Search Google Scholar
    • Export Citation
  • 9

    Endo Y, Onogi S, Umeki K, Yamamoto I, Kotani T, Ohtaki S & Fujita T. Regional localization of the gene for thyroid peroxidase to human chromosome 2p25 and mouse chromosome 12C. Genomics 1995 25 760–761.

    • Search Google Scholar
    • Export Citation
  • 10

    Kimura S, Hong YS, Kotani T, Ohtaki S & Kikkawa F. Structure of the human thyroid peroxidase gene: comparison and relationship to the human myeloperoxidase gene. Biochemistry 1989 28 4481–4489.

    • Search Google Scholar
    • Export Citation
  • 11

    Abramowicz MJ, Targovnik HM, Varela V, Cochaux P, Krawiec L, Pisarev MA, Propato FV, Juvenal G, Chester HA & Vassart G. Identification of a mutation in the coding sequence of the human thyroid peroxidase gene causing congenital goiter. Journal of Clinical Investigation 1992 90 1200–1204.

    • Search Google Scholar
    • Export Citation
  • 12

    Bikker H, den Hartog MT, Baas F, Gons MH, Vulsma T & de Vijlder JJ. A 20-basepair duplication in the human thyroid peroxidase gene results in a total iodide organification defect and congenital hypothyroidism. Journal of Clinical Endocrinology and Metabolism 1994 79 248–252.

    • Search Google Scholar
    • Export Citation
  • 13

    Bikker H, Vulsma T, Baas F & de Vijlder JJ. Identification of five novel inactivating mutations in the human thyroid peroxidase gene by denaturing gradient gel electrophoresis. Human Mutation 1995 6 9–16.

    • Search Google Scholar
    • Export Citation
  • 14

    Bikker H, Waelkens JJ, Bravenboer B & de Vijlder JJ. Congenital hypothyroidism caused by a premature termination signal in exon 10 of the human thyroid peroxidase gene. Journal of Clinical Endocrinology and Metabolism 1996 81 2076–2079.

    • Search Google Scholar
    • Export Citation
  • 15

    Niu DM, Hwang B, Chu YK, Liao CJ, Wang PL & Lin CY. High prevalence of a novel mutation (2268 insT) of the thyroid peroxidase gene in Taiwanese patients with total iodide organification defect, and evidence for a founder effect. Journal of Clinical Endocrinology and Metabolism 2002 87 4208–4212.

    • Search Google Scholar
    • Export Citation
  • 16

    Pannain S, Weiss RE, Jackson CE, Dian D, Beck JC, Sheffield VC, Cox N & Refetoff S. Two different mutations in the thyroid peroxidase gene of a large inbred Amish kindred: power and limits of homozygosity mapping. Journal of Clinical Endocrinology and Metabolism 1999 84 1061–1071.

    • Search Google Scholar
    • Export Citation
  • 17

    Santos CL, Bikker H, Rego KG, Nascimento AC, Tambascia M, De Vijlder JJ & Medeiros-Neto G. A novel mutation in the TPO gene in goitrous hypothyroid patients with iodide organification defect. Clinical Endocrinology 1999 51 165–172.

    • Search Google Scholar
    • Export Citation
  • 18

    Tajima T, Tsubaki J & Fujieda K. Two novel mutations in the thyroid peroxidase gene with goitrous hypothyroidism. Endocrine Journal 2005 52 643–645.

    • Search Google Scholar
    • Export Citation
  • 19

    Ambrugger P, Stoeva I, Biebermann H, Torresani T, Leitner C & Gruters A. Novel mutations of the thyroid peroxidase gene in patients with permanent congenital hypothyroidism. European Journal of Endocrinology 2001 145 19–24.

    • Search Google Scholar
    • Export Citation
  • 20

    Bikker H, Baas F & De Vijlder JJ. Molecular analysis of mutated thyroid peroxidase detected in patients with total iodide organification defects. Journal of Clinical Endocrinology and Metabolism 1997 82 649–653.

    • Search Google Scholar
    • Export Citation
  • 21

    Kotani T, Umeki K, Yamamoto I, Maesaka H, Tachibana K & Ohtaki S. A novel mutation in the human thyroid peroxidase gene resulting in a total iodide organification defect. Journal of Endocrinology 1999 160 267–273.

    • Search Google Scholar
    • Export Citation
  • 22

    Rivolta CM, Esperante SA, Gruneiro-Papendieck L, Chiesa A, Moya CM, Domene S, Varela V & Targovnik HM. Five novel inactivating mutations in the thyroid peroxidase gene responsible for congenital goiter and iodide organification defect. Human Mutation 2003 22 259.

    • Search Google Scholar
    • Export Citation
  • 23

    Umeki K, Kotani T, Kawano J, Suganuma T, Yamamoto I, Aratake Y, Furujo M & Ichiba Y. Two novel missense mutations in the thyroid peroxidase gene, R665W and G771R, result in a localization defect and cause congenital hypothyroidism. European Journal of Endocrinology 2002 146 491–498.

    • Search Google Scholar
    • Export Citation
  • 24

    Rodrigues C, Jorge P, Soares JP, Santos I, Salomao R, Madeira M, Osorio RV & Santos R. Mutation screening of the thyroid peroxidase gene in a cohort of 55 Portuguese patients with congenital hypothyroidism. European Journal of Endocrinology 2005 152 193–198.

    • Search Google Scholar
    • Export Citation
  • 25

    Wu JY, Shu SG, Yang CF, Lee CC & Tsai FJ. Mutation analysis of thyroid peroxidase gene in Chinese patients with total iodide organification defect: identification of five novel mutations. Journal of Endocrinology 2002 172 627–635.

    • Search Google Scholar
    • Export Citation
  • 26

    Pfarr N, Borck G, Turk A, Napiontek U, Keilmann A, Muller-Forell W, Kopp P & Pohlenz J. Goitrous congenital hypothyroidism and hearing impairment associated with mutations in the TPO and SLC26A4/PDS genes. Journal of Clinical Endocrinology and Metabolism 2006 91 2678–2681.

    • Search Google Scholar
    • Export Citation
  • 27

    Pfarr N, Musholt TJ, Musholt PB, Brzezinska R & Pohlenz J. Congenital primary hypothyroidism with subsequent adenomatous goiter in a Turkish patient caused by a homozygous 10-bp deletion in the thyroid peroxidase (TPO) gene. Clinical Endocrinology 2006 64 514–518.

    • Search Google Scholar
    • Export Citation
  • 28

    Calaciura F, Miscio G, Coco A, Leonardi D, Cisternino C, Regalbuto C, Bozzali M, Maiorana R, Ranieri A, Carta A, Buscema M, Trischitta V, Sava L & Tassi V. Genetics of specific phenotypes of congenital hypothyroidism: a population-based approach. Thyroid 2002 12 945–951.

    • Search Google Scholar
    • Export Citation
  • 29

    Fugazzola L, Mannavola D, Vigone MC, Cirello V, Weber G, Beck-Peccoz P & Persani L. Total iodide organification defect: clinical and molecular characterization of an Italian family. Thyroid 2005 15 1085–1088.

    • Search Google Scholar
    • Export Citation
  • 30

    Kotani T, Umeki K, Kawano J, Suganuma T, Hishinuma A, Ieiri T & Harada S. Partial iodide organification defect caused by a novel mutation of the thyroid peroxidase gene in three siblings. Clinical Endocrinology 2003 59 198–206.

    • Search Google Scholar
    • Export Citation
  • 31

    Nascimento AC, Guedes DR, Santos CS, Knobel M, Rubio IG & Medeiros-Neto G. Thyroperoxidase gene mutations in congenital goitrous hypothyroidism with total and partial iodide organification defect. Thyroid 2003 13 1145–1151.

    • Search Google Scholar
    • Export Citation
  • 32

    Chanoine JP, Toppet V, Lagasse R, Spehl M & Delange F. Determination of thyroid volume by ultrasound from the neonatal period to late adolescence. European Journal of Pediatrics 1991 150 395–399.

    • Search Google Scholar
    • Export Citation
  • 33

    Yasumoto M, Inoue H, Ohashi I, Shibuya H & Onishi T. Simple new technique for sonographic measurement of the thyroid in neonates and small children. Journal of Clinical Ultrasound 2004 32 82–85.

    • Search Google Scholar
    • Export Citation
  • 34

    Abramowicz MJ, Vassart G & Christophe D. Functional study of the human thyroid peroxidase gene promoter. European Journal of Biochemistry 1992 203 467–473.

    • Search Google Scholar
    • Export Citation
  • 35

    Zannini M, Francis-Lang H, Plachov D & Di Lauro R. Pax-8, a paired domain-containing protein, binds to a sequence overlapping the recognition site of a homeodomain and activates transcription from two thyroid-specific promoters. Molecular and Cellular Biology 1992 12 4230–4241.

    • Search Google Scholar
    • Export Citation
  • 36

    den Dunnen JT & Antonarakis SE. Nomenclature for the description of human sequence variations. Human Genetics 2001 109 121–124.

  • 37

    Zeng J & Fenna RE. X-ray crystal structure of canine myeloperoxidase at 3 A resolution. Journal of Molecular Biology 1992 226 185–207.

  • 38

    Libert F, Ruel J, Ludgate M, Swillens S, Alexander N, Vassart G & Dinsart C. Complete nucleotide sequence of the human thyroperoxidase-microsomal antigen cDNA. Nucleic Acids Research 1987 15 6735.

    • Search Google Scholar
    • Export Citation
  • 39

    Kotani T, Umeki K, Yamamoto I, Ohtaki S, Adachi M & Tachibana K. Iodide organification defects resulting from cosegregation of mutated and null thyroid peroxidase alleles. Molecular and Cellular Endocrinology 2001 182 61–68.

    • Search Google Scholar
    • Export Citation
  • 40

    Fugazzola L, Cerutti N, Mannavola D, Vannucchi G, Fallini C, Persani L & Beck-Peccoz P. Monoallelic expression of mutant thyroid peroxidase allele causing total iodide organification defect. Journal of Clinical Endocrinology and Metabolism 2003 88 3264–3271.

    • Search Google Scholar
    • Export Citation
  • 41

    Medeiros-Neto G, Gil-Da-Costa MJ, Santos CL, Medina AM, Silva JC, Tsou RM & Sobrinho-Simoes M. Metastatic thyroid carcinoma arising from congenital goiter due to mutation in the thyroperoxidase gene. Journal of Clinical Endocrinology and Metabolism 1998 83 4162–4166.

    • Search Google Scholar
    • Export Citation

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    Novel TPO gene mutations. (A) Heterozygous 613C > T mutation (R175X), wild-type exon 6 sequence. (B) Heterozygous 2089G > A mutation (G667S) and heterozygous 2088C > T single nucleotide polymorphism, wild-type exon 11 sequence. (C) Heterozygous 2669G > A mutation (G860R), wild-type exon 15 sequence. (D) Heterozygous 1519_1539del mutation (A477_N483del), wild-type exon 9 sequence.

  • 1

    Toublanc JE. Comparison of epidemiological data on congenital hypothyroidism in Europe with those of other parts in the world. Hormone Research 1992 38 230–235.

    • Search Google Scholar
    • Export Citation
  • 2

    Park SM & Chatterjee VK. Genetics of congenital hypothyroidism. Journal of Medical Genetics 2005 42 379–389.

  • 3

    Krzisnik C, Battelino T, Bratanic N, Hojker S, Pavlin K, Zerjav Tansek M, Bratina Ursic N, Frelih J, Zemva B, Bratanic B, Vatovec J & Kolar G. Results of screening for congenital hypothyroidism during the ten-year period (1981–1991) in Slovenia. Zdravniski Vestnik 1994 63 29–31.

    • Search Google Scholar
    • Export Citation
  • 4

    Tahirovic H & Toromanovic A. History, present and future of laboratory for detection of congenital metabolic diseases of the department of pediatrics in Tuzla. Pedijatrija Danas 2005 1 1–9.

    • Search Google Scholar
    • Export Citation
  • 5

    Kotnik P, Sirca Campa A, Zupancic M, Stimec M, Smole K, Mis NF, Battelino T & Krzisnik C. Goiter prevalence and urinary iodine concentration in slovenian adolescents. Thyroid 2006 16 769–773.

    • Search Google Scholar
    • Export Citation
  • 6

    Tahirović H, Ims iragić-Zovko S, Toromanović A & Begić L. Assessment of the success of implementation of new rule book on salt iodination in federation of Bosnia and Herzegovina. Journal of Endocrinological Investigation 2007 30 9–12.

    • Search Google Scholar
    • Export Citation
  • 7

    Bakker B, Bikker H, Vulsma T, de Randamie JS, Wiedijk BM & De Vijlder JJ. Two decades of screening for congenital hypothyroidism in The Netherlands: TPO gene mutations in total iodide organification defects (an update). Journal of Clinical Endocrinology and Metabolism 2000 85 3708–3712.

    • Search Google Scholar
    • Export Citation
  • 8

    Kimura S, Kotani T, McBride OW, Umeki K, Hirai K, Nakayama T & Ohtaki S. Human thyroid peroxidase: complete cDNA and protein sequence, chromosome mapping, and identification of two alternately spliced mRNAs. PNAS 1987 84 5555–5559.

    • Search Google Scholar
    • Export Citation
  • 9

    Endo Y, Onogi S, Umeki K, Yamamoto I, Kotani T, Ohtaki S & Fujita T. Regional localization of the gene for thyroid peroxidase to human chromosome 2p25 and mouse chromosome 12C. Genomics 1995 25 760–761.

    • Search Google Scholar
    • Export Citation
  • 10

    Kimura S, Hong YS, Kotani T, Ohtaki S & Kikkawa F. Structure of the human thyroid peroxidase gene: comparison and relationship to the human myeloperoxidase gene. Biochemistry 1989 28 4481–4489.

    • Search Google Scholar
    • Export Citation
  • 11

    Abramowicz MJ, Targovnik HM, Varela V, Cochaux P, Krawiec L, Pisarev MA, Propato FV, Juvenal G, Chester HA & Vassart G. Identification of a mutation in the coding sequence of the human thyroid peroxidase gene causing congenital goiter. Journal of Clinical Investigation 1992 90 1200–1204.

    • Search Google Scholar
    • Export Citation
  • 12

    Bikker H, den Hartog MT, Baas F, Gons MH, Vulsma T & de Vijlder JJ. A 20-basepair duplication in the human thyroid peroxidase gene results in a total iodide organification defect and congenital hypothyroidism. Journal of Clinical Endocrinology and Metabolism 1994 79 248–252.

    • Search Google Scholar
    • Export Citation
  • 13

    Bikker H, Vulsma T, Baas F & de Vijlder JJ. Identification of five novel inactivating mutations in the human thyroid peroxidase gene by denaturing gradient gel electrophoresis. Human Mutation 1995 6 9–16.

    • Search Google Scholar
    • Export Citation
  • 14

    Bikker H, Waelkens JJ, Bravenboer B & de Vijlder JJ. Congenital hypothyroidism caused by a premature termination signal in exon 10 of the human thyroid peroxidase gene. Journal of Clinical Endocrinology and Metabolism 1996 81 2076–2079.

    • Search Google Scholar
    • Export Citation
  • 15

    Niu DM, Hwang B, Chu YK, Liao CJ, Wang PL & Lin CY. High prevalence of a novel mutation (2268 insT) of the thyroid peroxidase gene in Taiwanese patients with total iodide organification defect, and evidence for a founder effect. Journal of Clinical Endocrinology and Metabolism 2002 87 4208–4212.

    • Search Google Scholar
    • Export Citation
  • 16

    Pannain S, Weiss RE, Jackson CE, Dian D, Beck JC, Sheffield VC, Cox N & Refetoff S. Two different mutations in the thyroid peroxidase gene of a large inbred Amish kindred: power and limits of homozygosity mapping. Journal of Clinical Endocrinology and Metabolism 1999 84 1061–1071.

    • Search Google Scholar
    • Export Citation
  • 17

    Santos CL, Bikker H, Rego KG, Nascimento AC, Tambascia M, De Vijlder JJ & Medeiros-Neto G. A novel mutation in the TPO gene in goitrous hypothyroid patients with iodide organification defect. Clinical Endocrinology 1999 51 165–172.

    • Search Google Scholar
    • Export Citation
  • 18

    Tajima T, Tsubaki J & Fujieda K. Two novel mutations in the thyroid peroxidase gene with goitrous hypothyroidism. Endocrine Journal 2005 52 643–645.

    • Search Google Scholar
    • Export Citation
  • 19

    Ambrugger P, Stoeva I, Biebermann H, Torresani T, Leitner C & Gruters A. Novel mutations of the thyroid peroxidase gene in patients with permanent congenital hypothyroidism. European Journal of Endocrinology 2001 145 19–24.

    • Search Google Scholar
    • Export Citation
  • 20

    Bikker H, Baas F & De Vijlder JJ. Molecular analysis of mutated thyroid peroxidase detected in patients with total iodide organification defects. Journal of Clinical Endocrinology and Metabolism 1997 82 649–653.

    • Search Google Scholar
    • Export Citation
  • 21

    Kotani T, Umeki K, Yamamoto I, Maesaka H, Tachibana K & Ohtaki S. A novel mutation in the human thyroid peroxidase gene resulting in a total iodide organification defect. Journal of Endocrinology 1999 160 267–273.

    • Search Google Scholar
    • Export Citation
  • 22

    Rivolta CM, Esperante SA, Gruneiro-Papendieck L, Chiesa A, Moya CM, Domene S, Varela V & Targovnik HM. Five novel inactivating mutations in the thyroid peroxidase gene responsible for congenital goiter and iodide organification defect. Human Mutation 2003 22 259.

    • Search Google Scholar
    • Export Citation
  • 23

    Umeki K, Kotani T, Kawano J, Suganuma T, Yamamoto I, Aratake Y, Furujo M & Ichiba Y. Two novel missense mutations in the thyroid peroxidase gene, R665W and G771R, result in a localization defect and cause congenital hypothyroidism. European Journal of Endocrinology 2002 146 491–498.

    • Search Google Scholar
    • Export Citation
  • 24

    Rodrigues C, Jorge P, Soares JP, Santos I, Salomao R, Madeira M, Osorio RV & Santos R. Mutation screening of the thyroid peroxidase gene in a cohort of 55 Portuguese patients with congenital hypothyroidism. European Journal of Endocrinology 2005 152 193–198.

    • Search Google Scholar
    • Export Citation
  • 25

    Wu JY, Shu SG, Yang CF, Lee CC & Tsai FJ. Mutation analysis of thyroid peroxidase gene in Chinese patients with total iodide organification defect: identification of five novel mutations. Journal of Endocrinology 2002 172 627–635.

    • Search Google Scholar
    • Export Citation
  • 26

    Pfarr N, Borck G, Turk A, Napiontek U, Keilmann A, Muller-Forell W, Kopp P & Pohlenz J. Goitrous congenital hypothyroidism and hearing impairment associated with mutations in the TPO and SLC26A4/PDS genes. Journal of Clinical Endocrinology and Metabolism 2006 91 2678–2681.

    • Search Google Scholar
    • Export Citation
  • 27

    Pfarr N, Musholt TJ, Musholt PB, Brzezinska R & Pohlenz J. Congenital primary hypothyroidism with subsequent adenomatous goiter in a Turkish patient caused by a homozygous 10-bp deletion in the thyroid peroxidase (TPO) gene. Clinical Endocrinology 2006 64 514–518.

    • Search Google Scholar
    • Export Citation
  • 28

    Calaciura F, Miscio G, Coco A, Leonardi D, Cisternino C, Regalbuto C, Bozzali M, Maiorana R, Ranieri A, Carta A, Buscema M, Trischitta V, Sava L & Tassi V. Genetics of specific phenotypes of congenital hypothyroidism: a population-based approach. Thyroid 2002 12 945–951.

    • Search Google Scholar
    • Export Citation
  • 29

    Fugazzola L, Mannavola D, Vigone MC, Cirello V, Weber G, Beck-Peccoz P & Persani L. Total iodide organification defect: clinical and molecular characterization of an Italian family. Thyroid 2005 15 1085–1088.

    • Search Google Scholar
    • Export Citation
  • 30

    Kotani T, Umeki K, Kawano J, Suganuma T, Hishinuma A, Ieiri T & Harada S. Partial iodide organification defect caused by a novel mutation of the thyroid peroxidase gene in three siblings. Clinical Endocrinology 2003 59 198–206.

    • Search Google Scholar
    • Export Citation
  • 31

    Nascimento AC, Guedes DR, Santos CS, Knobel M, Rubio IG & Medeiros-Neto G. Thyroperoxidase gene mutations in congenital goitrous hypothyroidism with total and partial iodide organification defect. Thyroid 2003 13 1145–1151.

    • Search Google Scholar
    • Export Citation
  • 32

    Chanoine JP, Toppet V, Lagasse R, Spehl M & Delange F. Determination of thyroid volume by ultrasound from the neonatal period to late adolescence. European Journal of Pediatrics 1991 150 395–399.

    • Search Google Scholar
    • Export Citation
  • 33

    Yasumoto M, Inoue H, Ohashi I, Shibuya H & Onishi T. Simple new technique for sonographic measurement of the thyroid in neonates and small children. Journal of Clinical Ultrasound 2004 32 82–85.

    • Search Google Scholar
    • Export Citation
  • 34

    Abramowicz MJ, Vassart G & Christophe D. Functional study of the human thyroid peroxidase gene promoter. European Journal of Biochemistry 1992 203 467–473.

    • Search Google Scholar
    • Export Citation
  • 35

    Zannini M, Francis-Lang H, Plachov D & Di Lauro R. Pax-8, a paired domain-containing protein, binds to a sequence overlapping the recognition site of a homeodomain and activates transcription from two thyroid-specific promoters. Molecular and Cellular Biology 1992 12 4230–4241.

    • Search Google Scholar
    • Export Citation
  • 36

    den Dunnen JT & Antonarakis SE. Nomenclature for the description of human sequence variations. Human Genetics 2001 109 121–124.

  • 37

    Zeng J & Fenna RE. X-ray crystal structure of canine myeloperoxidase at 3 A resolution. Journal of Molecular Biology 1992 226 185–207.

  • 38

    Libert F, Ruel J, Ludgate M, Swillens S, Alexander N, Vassart G & Dinsart C. Complete nucleotide sequence of the human thyroperoxidase-microsomal antigen cDNA. Nucleic Acids Research 1987 15 6735.

    • Search Google Scholar
    • Export Citation
  • 39

    Kotani T, Umeki K, Yamamoto I, Ohtaki S, Adachi M & Tachibana K. Iodide organification defects resulting from cosegregation of mutated and null thyroid peroxidase alleles. Molecular and Cellular Endocrinology 2001 182 61–68.

    • Search Google Scholar
    • Export Citation
  • 40

    Fugazzola L, Cerutti N, Mannavola D, Vannucchi G, Fallini C, Persani L & Beck-Peccoz P. Monoallelic expression of mutant thyroid peroxidase allele causing total iodide organification defect. Journal of Clinical Endocrinology and Metabolism 2003 88 3264–3271.

    • Search Google Scholar
    • Export Citation
  • 41

    Medeiros-Neto G, Gil-Da-Costa MJ, Santos CL, Medina AM, Silva JC, Tsou RM & Sobrinho-Simoes M. Metastatic thyroid carcinoma arising from congenital goiter due to mutation in the thyroperoxidase gene. Journal of Clinical Endocrinology and Metabolism 1998 83 4162–4166.

    • Search Google Scholar
    • Export Citation