J Clin Res Pediatr Endocrinol. 2022; 14(2): 221-226 | DOI: 10.4274/jcrpe.galenos.2021.2020.0278

A Novel Mutation in the Thyroglobulin Gene Resulting in Neonatal Goiter and Congenital Hypothyroidism in an Eritrean Infant

Eve Stern¹, Nadia Schoenmakers², Adeline K. Nicholas², Eran Kassif³, Orit Pinhas Hamiel⁴, Yonatan Yeshayahu^5
1Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Pediatric Endocrine and Diabetes Unit, Ramat-Gan, Israel
²Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
³Sheba Medical Center, Department of Obstetrics and Gynecology, Tel Hashomer, Israel
⁴Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
⁵Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Assuta Medical Center, Pediatric Endocrine and Diabetes Unit, Ashdod, Israel

Congenital hypothyroidism (CH) due to dyshormonogenesis may occur due to mutations in any of the key genes involved in thyroid hormone biosynthesis (TG, TPO, DUOX2, DUOXA2, SLC5A5, IYD, SLC26A4 and SLC26A7). Mutations in the thyroglobulin gene (TG) are frequently associated with goiter, which may present fetally or neonatally, although a spectrum of phenotypes is reported. We present the case of a woman of Eritrean origin who presented in the third trimester of pregnancy in the early stages of labor. Ultrasound at presentation revealed a fetal neck swelling consistent with a goiter. Following delivery by Caesarian section with minimal respiratory support, the infant was found to be hypothyroid with undetectable serum levels of thyroglobulin. Sequencing of the TG revealed a homozygous donor splice site pathogenic variant (c.5686+1delG) not previously described in the literature. Levothyroxine treatment resulted in normal growth and psychomotor development. Goitrous CH with inappropriately low thyroglobulin has previously been reported in patients harbouring homozygous single nucleotide substitutions at the same TG donor splice site, which result in exon skipping and retention of malformed thyroglobulin by the endoplasmic reticulum. We conclude that the TG c.5686+1delG pathogenic variant is the likely basis for our patient’s fetal goiter and CH, and that the clinical phenotype associated with TG c.5686+1delG is comparable to that seen with single nucleotide substitutions at the same site.

Keywords: Congenital goiter, hypothyroidism, thyroglobulin, novel mutation, case report

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