Measurement of Reverse Triiodothyronine Level and the Triiodothyronine to Reverse Triiodothyronine Ratio in Dried Blood Spot Samples at Birth May Facilitate Early Detection of Monocarboxylate Transporter 8 Deficiency

Thyroid. 2021 Sep;31(9):1316-1321. doi: 10.1089/thy.2020.0696. Epub 2021 Jul 2.


Background: Monocarboxylate transporter 8 (MCT8) deficiency is an X-chromosome-linked neurodevelopmental disorder resulting from impaired thyroid hormone transport across the cell membrane. The diagnosis of MCT8 deficiency is typically delayed owing to the late appearance of signs and symptoms as well as the inability of standard biomarkers of neonatal screening to provide early detection. In this study, we report, for the first time, the ability to detect MCT8 deficiency at birth using dried blood spot (DBS) samples. Methods: We retrospectively measured triiodothyronine (T3), thyroxine (T4), and reverse T3 (rT3) levels in DBS samples obtained at 4-5 days of life from 6 infants with genetically confirmed MCT8 deficiency and from 110 controls. The latter consisted of 58 healthy term neonates obtained at the same time, 16 were stored for more than 1 year before measurement to match samples from the MCT8-deficient infants. Ten DBS samples were collected at day 1 of life and 42 samples were from prematurely born neonates. Measurements were carried out in extract from eight millimeters diameter DBS using liquid chromatography-tandem mass spectrometry. Results: Contrary to characteristic iodothyronine abnormalities of MCT8 deficiency during later life, T3 and T4 values were not discriminatory from those of other study groups. In contrast, rT3 was significantly lower. The T3/rT3 ratio was higher in the DBS samples from the MCT8-deficient infants compared with all other groups with no overlap (p < 0.0001). Conclusions: rT3 and T3/rT3 ratio in DBS samples obtained from neonates can serve as biomarkers to detect MCT8 deficiency at birth.

Keywords: LC-MS/MS; MCT8 deficiency; dried blood spot; newborn screening; reverse T3.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / blood
  • Dried Blood Spot Testing*
  • Early Diagnosis
  • Female
  • Genetic Predisposition to Disease
  • Humans
  • Infant, Newborn
  • Male
  • Mental Retardation, X-Linked / blood
  • Mental Retardation, X-Linked / diagnosis*
  • Mental Retardation, X-Linked / genetics
  • Monocarboxylic Acid Transporters / blood
  • Monocarboxylic Acid Transporters / deficiency
  • Monocarboxylic Acid Transporters / genetics*
  • Muscle Hypotonia / blood
  • Muscle Hypotonia / diagnosis*
  • Muscle Hypotonia / genetics
  • Muscular Atrophy / blood
  • Muscular Atrophy / diagnosis*
  • Muscular Atrophy / genetics
  • Mutation*
  • Neonatal Screening*
  • Phenotype
  • Predictive Value of Tests
  • Retrospective Studies
  • Symporters / blood
  • Symporters / deficiency
  • Symporters / genetics*
  • Triiodothyronine / blood*
  • Triiodothyronine, Reverse / blood*


  • Biomarkers
  • Monocarboxylic Acid Transporters
  • SLC16A2 protein, human
  • Symporters
  • Triiodothyronine
  • Triiodothyronine, Reverse

Supplementary concepts

  • Allan-Herndon-Dudley syndrome