Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference

October 31 - November 1, 2012 

GEOGRAPHIC DISTRIBUTION PATTERN OF CONGENITAL
HYPOTHYROIDISM AND ENVIRONMENTAL RELATED FACTORS IN
NAKHON PATHOM PROVINCE THAILAND
Ratsida Saithong*, Kitiphong Harncharoen1, Mathuros Tipayamongkholgul1
and Sangsom Sinawat2
*Master of Science (Public Health) Programme in Infectious Diseases and Epidemiology
1
Department of Epidemiology
Faculty of Public Health, Mahidol University, Bangkok, Thailand
2
Department of Health, Ministry of Public Health, Nonthaburi, Thailand
*E-mail: ratsida@gmail.com

ABSTRACT
This study was performed to analyze the distribution pattern of congenital hypothyroidism
(CH) and risk factors as display of spatial data in all subdistricts of Nakhon Pathom province.
Geographic information systems (GIS) of provincial data had been used for studying a situation
of CH. CH-screening program on the newborn baby was necessary for diagnosis and treatment
of a defected case. It was usually done and obtained from community hospitals. Agriculture
areas and factory distribution data were obtained from District Agriculture Offices and
Department of Industry Works during years 2007 – 2011.
Over all prevalence of CH in Nakhon Pathom was 0.68 per 1,000 newborns. It varied from
0.13 per 1,000 to 0.78 per 1,000 during these 5 years peroid. Results revealed that prevalence of
CH was significantly associated with a prevalence of factories (p-value <0.01) equal more than
17 factories in the same subdistrict (compared with less than 17 factories), industrial type of
chemical and plastics production plants were associated at the prevalence equal or more than 3
plants (p-value <0.01). CH was also associated with a number of agricultural areas (p-value
<0.01) equal or more than 6,105 rai in the same area, compared with less than 6,105 rai.
Prevalence of CH was not associated with coverage of an antenatal care (along a criterion of at
least four times with iodine supplementing per pregnant woman). Prediction of these three
factors for five years was about 91.5% of all CH cases in Nakhon Pathom. During five years,
provincial data indicated that the number of factorial plants and the rate of chemical consuming
in agricultural sectors are rising up in each year.
These data show for further studies have to be done with CH not only in the way of chemical
used in industry and agriculture but also in the socioeconomic mobilization of employees
especially in high risk areas.
Keywords: Congenital hypothyroidism, GIS
INTRODUCTION
Congenital hypothyroidism (CH) is defined as thyroid hormone deficiency present at birth.
Thyroid hormone deficiency present at birth is most commonly caused by developmental
abnormalities of the thyroid gland or or by thyroid hormone itself that related with mutation of
genes involved in hormonogenesis (Beardsall & Amanda L, 2004; Rastogi & LaFranchi, 2010).
CH is a major health problem of many countries including Thailand.
The prevalence rate of CH as worldwide affects about 1:2,000 – 4,000 newborns (Rastogi &
LaFranchi, 2010). The prevalence rate in Thailand affects about 1:4,000 newborns that is health
problem of country. It is expected that patient found 250 - 400 person per year (Department of
Medical Sciences Thailand Ministry of Public Health 2511). Around 4.8 million baht were
spent in treating people who have mental retardation and total loses revenue from their work
was around 3.6 million baht per person. Therefore, state loses economic income from these
causes around 8.4 millon baht per person. If state have new patient in one year 400 people, state
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fishery and factory. They was disrupted endocrine and thyroid disease.19.Congenital hypothyroidism screening program on the newborns was necessary for diagnosis of a defected case begins with serum TSH level as or above 25 mU/L. 2008).82. RESEARCH METHODS Study design The present research is design as an ecological study that explore distribution pattern of prevalence rate of congenital hypothyroidism and factors association in every subdistrict of Nakhon Pathom province. Nakhon Pathom province have many factory. Nakhon Pathom’s people have various of culture and behavious because they migrate to this province for living and working. & Tempalski. especially chemicals and plastics industries. & Mininstry of Public Health. Department of Health and Human Services & Centers for Disease Control and Prevention. 1996). 2008).November 1. According to the previously study. Data collection . in case agriculture if people use pesticide for occupation.9 % during years 2005-2006 in Nakhon Pathom province (Charoensiriwatana. The compounds of chemicals and plastics industries may affect thyroid function such as BisphenolA.The subdistrict of Nakhon Pathom provinces are 106 subdistricts. pesticide was risk factor for thyroid disease such as insecticides. The people in Nakhon Pathom province have many occupations such as farming. GIS was used in locate high prevalence areas and populations at risk through monitor intervention and control programs in areas that affected disease (Clarke.Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 . Population study The unit of study is subdistrict of Nakhon Pathom provinces. et al. this study use GIS tool for study about CH. Thailand has newborn screening programs by Department of Medical Sciences.00 – 39. leading to Mahidol University Graduate Research 2012 P a g e | 283 . study distribution pattern of CH and risk factors as display of spatial data. & Hasan. binding to transport proteins and increased clearance of thyroid hormone (Whitney. To explore distribution pattern of prevalence rate of congenital hypothyroidism in every subdistrict of Nakhon Pathom province. 2. The prevalence of neonatal TSH levels above 5 mU/L were 20. Styrenes. respectively (Center of Epidemiological Information. GIS and epidemiological methods can use identify that locate environmental risk factor associated disease. OBJECTIVE/RESEARCH QUESTION 1. So. Mclafferty. interference with thyroid hormone receptor. Janejai. 2012  will loses costs around 3. So. CHscreening is performed by heel – prick collected on special filter paper cards and measuring a total TSH and T4 that obtained shortly after birth (U.360 millon baht (สถาบันวิจัยวิทยาศาสตรสาธารณสุข กรมวิทยาศาสตรการแพทย 2511). The result about morbidity rate of pesticide poisoning in Nakhon Pathom Province during 2009 . Trends in the incidence of these disease in Nakhon Pathom Province increase every year.2011 were 1. interference with iodothyronine deiodinases . 2552). It was direct actions on the thyroid hormone receptor and associated with low serum T4 levels (Pearce & Braverman. 2009).S. Especially. behavior of prevation is very important for healthly. Nakhon Pathom province has a geographic variation. Especially. 2. herbicides and fungicides have been endocrine disruptors and related thyroid disruptors through diverse mechanisms such as inhibition of thyroid iodine uptake.51 and 3.. 2010). To determine association factors of distribution pattern of prevalence rate congenital hypothyroidism every subdistrict in Nakhon Pathom province. Srijantr. For example. polychlorinated biphenyls (PCBs). Bureau of Epidemiology. agriculture. CH is still a major health problem in Thailand.

show in the form of percentage. 2012  serum thyroid function tests (typically TSH and free T4) to confirm the diagnosis that were obtained from community hospital in Nakhon Pathom province that data during the years 2007 – 2011. varies from 0. The percentage of factories that located in each subdistrict are varies from place to place then quartiles of factories distribution were used in categorized this factor in four levels (<10. respectively.05:1. >24 person) were categorized by the same manner (Table 1).035. >4 factories).Environmental factors such as factories and industrial type of chemical and plastics production were obtained from Department of Industry Works. agriculture area in four levels (<2. 5. Data analysis Data were obtained from: 1.Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 . 1-2.068). probability to find CH baby was 0. Inferential statistic : Studied results were presented association between environmental factors. 0. Faculty of Public Health. >31 factories). it located in for study showed prevalence rate of subdistrict with congenital hypothyroidism (≥1 persons) during years 2007 – 2011 were 0. 2012. 3. Ethical This project have been reviewed and approved according to the Standard Operating Procedures of Ethical Review Committee for Human Research. industrial type of chemical and plastics production.Health service factors such as antenatal care ( at last four times with iodine supplementing) were obtained from community hospitals in Nakhon Pathom province. agriculture area. health service factors and congenital hypothyroidism The results from univariate analysis of poisson regression was used to examine congenital Mahidol University Graduate Research 2012 P a g e | 284 .66%. 3-4. 4.66% and 5. .105-12.13 to 1. Descriptive statistic : General characteristic such as factory. >12. 6.55%. 2.November 1.104. 15-24. Map data analysis by STATA version 8.443. 2. For subdistrict scale. The association among environmental factors. 7. antenatal care.443-6. Mahidol University during May 18.72%. 7-14. RESULTS This research aimed for study distribution pattern of prevalence rate of congenital hypothyroidism and determine association factors of distribution pattern of prevalence rate this disease in every subdistrict of Nakhon Pathom province. The number of CH cases that presented in subdistrict level are minimum 1 and maximum 4 cases. health servince and congenital hypothyroidism by poisson regression.05 (95%CI. industrial type of chemical and plastics production. Agriculture areas were obtained from department of District Agricultural Office. .000 newborns. 17-31. and antenatal care in four levels(<7.0.035 rai) . The percentage of industrial type of chemical and plastics production in four levels (<1. Prevalence rate of congenital hypothyroidism Prevalence rate of congenital hypothyroidism in Nakhon Pathom province during years 2007 – 2011 are. agriculture land and anternal care. 10-16. The studied results were presented as follows: General characteristics Units of analysis are 106 subdistricts in Nakhon Pathom province and variable factors are factory. The area reported to have congenital hypothyroidism repeatedly was 1. also.032-0.89% during five years (Table2).94%.

28. 27. 21. 25 during year 2010 were 24. 17-26.104. 28. 29. 29.60-30.Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 . 2. Chemical and plastics industries (3-4. 26 (Figure 3).57. 24.7. 25.40. 26 (Figure 4). compared with less than 1 factories) was significant with disease during years 2009 (pvalue<0. 30. 10-16.43-30. 6. 27.53) and during years 2010 (p-value < 0. 23. 26 during year 2008-2010 were 24. 23. 22 during year 2009 were29. >12. 8. 27. 95%CI: 25.26-29.>19 factorys) during year 2007 were 35.40-29.25-31. 31.29-29. health service factors The number of subdistrict with prevalence rate of congenital hypothyroidism (≥1 persons) during year 2007 – 2011 were 1. 31. 20 during year 2008 were 35. >12.443 rai) was adjust associated with congenital hypothyroidism during year 2009 (p-value < 0. 28. 25. compared with less than 10 factories) were significant in year 2010 (p-value<0.77. 27-35. The number of subdistrict with prevalence of antenatal care (<17. 26. 23. 95%CI: 23. 95%CI: 26. 95%CI: 24.46). >35 persons) during year 2007 were 29. >31 factorys) during year 2007 were 29.01. 2012  hypothyroidism and factories (>17-31. 21.035. compared with less than 1 factories) were significant with disease during years 2009 (p-value < 0.83-29.01. >4 factories.November 1. 21. 95%CI: 25. 30. 28. 26 (Figure 2). 25.443. 25.91. 6. 18 and during year 2011 were 21. Geographical distribution of congenital hypothyroidism and environmental factors .19). 6. 26. 28.19 during year 2008 were 37.443-6. The number of subdistrict with factory (<10.001.52). 17.105-12. 23 and during year 2011 were 26.20) Table4). Agricultural area and antenatal care was not significant with disease (Table3). 24 during year 2008 were 30. 23. compared with less than 2.22. >31 factories.105-12. The result from adjusted by multivariate technique of poisson regression was used to examine congenital hypothyroidism and chemical and plastics industry (3-4.1119.7.58. respectively (Figure 1). Mahidol University Graduate Research 2012 P a g e | 285 . 23 during year 2010 were 29.01. Agriculture area (6.15 during year 2009 were 26. 7. 21. 26 during year 2011 were 26.11. 31.48-30. 29.01. 20 (Figure 5).25-29.035 rai. 24. 18 during year 2009 were 34.035 rai) during year 2007 were 26.035.35-32. 17-31.50-29.>4 factories. 6. The number of subdistrict with prevalence of chemical and plastics industry (<5. 20 during year 2010 were 36. 95%CI: 26. 5.12) and during years 2010 (p-value < 0. 5-10.78. The number of subdistrict with agriculture area (<2.01. 26. 23 and during year 2011 were 25. 24. 26.61-29.

*The total of newborns using newborns during year 2011 and have missing data as follow.November 1.Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 . 2008-2011 (23.6%) Table 2 The prevalence rate of congenital hypothyroidism Mahidol University Graduate Research 2012 P a g e | 286 . year 2007 (37.7%). 2012  Table 1 The number and percent of general characteristics.

* statistical significance at α <0.7%).November 1.6%) *** The congenital hypothyroidism were in missing data of antenatal care. Set to zero because this parameter is redundant. Hessian matrix singularity is caused by this parameter. b. The parameter estimate at the last iteration is displayed. Set to zero because this parameter is redundant. 2008-2011 (23.7%).Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 .05 **The total of newborns using newborns during year 2011 and have missing data as follow.adjust by standardized coefficients **The total of newborns using newborns during year 2011 and have missing data as follow. The parameter estimate at the last iteration is displayed. b. 2012  Table 3 Factors associated with congenital hypothyroidism a.6%) *** The congenital hypothyroidism were in missing data of antenatal care. Hessian matrix singularity is caused by this parameter. year 2007 (37. year 2007 (37. * statistical significance at α <0.05 . Mahidol University Graduate Research 2012 P a g e | 287 . 2008-2011 (23. Table 4 Factors associated with congenital hypothyroidism by standardized coefficient a.

Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 .November 1. 2012  Figure 1 spatial distribution of prevalence rate of subdistrict with congenital hypothyroidism in Nakhon Pathom province during years 2007 – 2011 Figure 2 spatial distribution of subdistrict with factory in Nakhon Pathom province during years 2007 – 2011. Figure 3 spatial distribution of prevalence rate of subdistrict with chemical and plastics industry in Nakhon Pathom province during years 2007 – 2011. Mahidol University Graduate Research 2012 P a g e | 288 .

5%). antenatal care were <7 persons during year 2007-2011 (29. the prevalence rate of CH in Nakhon Pathom province more than prevalence rate in Thailand that year 2008-2011 (Department of medical Sciences Thailand Ministry of Public Health). In this study.5%) .2%.November 1. 40.94%.55%. the majority of subdistricts consisted of factory were <10 factorys during year 2007. Mahidol University Graduate Research 2012 P a g e | 289 .000 newborns.6%. Figure 5 spatial distribution of prevalence rate of subdistrict with antenatal care in Nakhon Pathom province during years 2007 – 2011.000 newborns by year 2011. 27. agriculture area ranged between 2. The prevalence rate of subdistrict with CH during years 2007 – 2011 were 0. 28.5%.7%.000 newborns and end up 0.4%) and ranging from 10 to 16 during year 2009 and 2011 (29. 2010 (27. 27. 5. 27. chemical and plastics industry ranged between 1-2 factories during year 2007-2011 (37.105-12.66% and 5.035 rai (25.104 rai during year 2009 and 2010 (29. DISCUSSION AND CONCLUSION The prevalence rate of CH in Nakhon Pathom province during five years study was approximately 0. 4.4%.4%.4%.78 : 1.66%. The problem was incerased in severity from year to year. respectively. 41. 7. The prevalence rate in Thailand affects about 1:4.Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 .13 : 1. 27.443-6. 42.443-6. 2008.2%. Therefore.104 and 6.3%. 2012  Figure 4 spatial distribution of agriculture area in every subdistrict of Nakhon Pathom province during years 2007 – 2011.4%) and year 2011 ranged between 2.2%). 39.6%.72%.

53-29. This study showed industrial type of chemical and plastics production (1-2. surveillance the risk areas of CH in Nakhon Pathom province.1)) and fungicides (ORadj=1. >12. The association between organochlorine and thyroid hormone levels in cord serum: A study from northern Thailand. 22. Prakobvitayakit O. (2006). department of district office of agricultural and department of industry works for data collection. respectively.77.1%. Grant to Support Graduate Students in Academic Presentations in Thailand Academic Year 2012. >19 factories) and agriculture area (6. Mahidol University) for editing this research.20) and during years 2011 (1-2 factories. REFERENCES Asawasinsopon R.86. 6.8) (Whitney. The previous study about pesticide use and thyroid disease among women in the agricultural health study in 1993-1997 North Carolina. Center of Epidemiological Information. 3-4 factories) was adjust associated with CH during year 2010 (p-value< 0. 0.5%.63). The effects of PCBs and Bisphenol-A were direct actions on the thyroid hormone receptor.01.035.29-31.05. The result has found agriculture area and factory in all subdistrict.96-30. Vaneesorn Y. 2010). p-value< 0. 0. (2004).60. & Amanda L. Mangklabruks A. 8. The distribution map of CH in every subdistrict of Nakhon Pathom province had prevalence rate of CH during year 2007-2011 were 1. The present study shows that association factory. Beardsall.9-5.0%..035 rai) was adjust associated with CH during year 2009 (p-value< 0.443-6. Therefore. dichlorodiphenyl dichloroethane (DDD) and dierin in maternal serum were positively associated with levels in cord serum(r=0.6%). 95%CI: 25. especially chemical and plastics industry may cause some effects on CH. 25.2 (95%CI: 1.1-1. Further research is needed to correlate this disease with chemical and plastics industry and agriculture area.09-23. 2006). 554–559. the prevalence of subdistrict with CH was may correlation with compounds in industrial type of chemical and plastics production. bisphenol-A and styrenes.104. et al.105-12. 6 subdistricts and CH repeatedly was 1. 2012  33. chemical and plastics industry. The authours also wish to expess thanks to Dr. Agriculture area (2. Current Paediatrics.November 1. et al.035 rai). dichlorodiphenyl trichloroethane (DDT). Prapamontol T. Bureau of Epidemiology. 2009). ACKNOWLEDGEMENTS The authors would like to thank the community hospital.57). 14. 422– 429.01.Queen Sri Savarindira & Prince Mahidol Adulayadej Commemoration Conference October 31 .84-30. 31. p-value <0. 23. 6. & Mininstry of Public Mahidol University Graduate Research 2012 P a g e | 290 . The result of present study Nakhon Pathom province have CH all five years and have factorys in all subdistrict. K. And previous study that study association between organochlorine and thyroid hormone levels in cord serum: A study from north Thailand that found levels of dichlorodiphenyldichloroethylene (DDE).. The most of distribution pattern of prevalence rate of CH lived in prevalence rate of chemical and plastics industry (11-19. The previous study found the substances or compounds in this industry that may affect thyroid function such as polychlorinated biphenyls (PCBs).4 (95%CI: 1.66 and 0. The effects of styrenes was inhibit T4 and T3 (Pearce & Braverman. Kitiphong Harncharoen (Department of Epidemiology. Environment International 32.89% all five years.105-12. & Hock B..01.001) (Asawasinsopon R.16. 95%CI: 18. Congenital hypothyroidism. 95%CI:21. agriculture area and antenatal care with CH. 5. 23. Therefore. and was increased odds of hypothyroidism with ever use of organochlorine insecticides (ORadj=1. SUGGESTIONS The study showed CH in risk area.

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