Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold

Korada, Srinivasa Murthy; Pearce, Mark; Platt, Martin Ward; Avis, Enid; Turner, Steve; Wastell, H.; Cheetham, Tim

doi:10.1136/adc.2008.147884

Cited by 83 publications

(70 citation statements)

References 18 publications

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“…Nevertheless, some recently reported data suggest that the incidence of CH has progressively increased in the past two decades both in the United States and Europe [1,2,3,4,5,6,7]. This substantial increase in cases almost doubling previous estimates has been discussed in the neonatal screening community, and several factors have been implicated.…”

Section: Introductionmentioning

confidence: 75%

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Prevalence and Etiology of Congenital Hypothyroidism Detected through an Argentine Neonatal Screening Program (1997-2010)

et al. 2013

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Introduction: We retrospectively assessed the incidence of congenital hypothyroidism (CH) detected through our neonatal screening program between 1997 and 2010. We describe the diagnostic characteristics of the detected population and verify the impact of a TSH cutoff (CO) change. Patients and Methods: Screening was based on TSH determination on dried blood spot on filter paper samples (IFMA) using a 15 mU/l blood CO until 12/2002 (P1) and 10 mU/l thereafter (P2). Patients were classified as having transient or permanent CH (athyreotic, ectopic, eutopic, with goiter and unknown etiology). Global and diagnostic-related incidences were calculated for the whole studied period with the same CO, and P1 and P2 were compared. Results: Incidences of permanent CH were 1:3,108 (P1) and 1:2,367 (P2). The lower CO detected 22 extra CH, 13 of them definitive (70% with eutopic glands). Only a significant increase (p < 0.05) in eutopic CH was found, partially related to the lower CO applied. A statistically significant association with time was seen for total definitive and ectopic cases (p < 0.05). Conclusion: Our findings revealed some changes in the detected population partially related to the CO applied, with only eutopic dysfunctional disorders being more prevalent in the later years. Total permanent CH and ectopic thyroid disorders showed a trend toward higher detection over time, but their prevalence has not changed significantly in our screening program.

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Section: Introductionmentioning

confidence: 75%

“…In recent years, several screening programs have lowered the TSH cutoff (CO) used, finding more affected children but increasing the recalled population [4,5,6]. This approach, however, raises questions on the benefits and objectives of screening strategies and underscores the importance of accurate diagnostic confirmation.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Etiology of Congenital Hypothyroidism Detected through an Argentine Neonatal Screening Program (1997-2010)

et al. 2013

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“…The use of a borderline cut-off point will increase the detection of CH [11,12] and will inevitably pick up less severe cases. There is no evidence of where the lower cut-off point should sit and the UKNSPC value of 10 mU/l has been set by expert personal opinion with no subsequent evidence to support or refute this standard.…”

Section: Resultsmentioning

confidence: 99%

Screening for Congenital Hypothyroidism: Comparison of Borderline Screening Cut-Off Points and the Effect on the Number of Children Treated with Levothyroxine

Langham¹,

Hindmarsh²,

Krywawych³

et al. 2013

Eur Thyroid J

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Background: The newborn screening programme for congenital hypothyroidism (CH) has led to the prevention of severe developmental delay associated with this condition. In the UK, thyroid-stimulating hormone (TSH) screening cut-off points have changed over time, in some instances prompted by changing methodological platforms. The use of borderline cut-off points varies throughout the country. Objective: To use discordance in cut-off points to assess the performance of the UK Newborn Screening Programme Centre (UKNSPC) definitions. Methods: Between January 2006 and December 2007, 223,658 newborn infants were screened by the Great Ormond Street Hospital (GOSH) for CH. All children with positive results and those with blood-spot TSH concentrations >6 mU/l on repeat screening were referred to GOSH. We compared the numbers of children detected and treated for CH using the GOSH cut-off points (>6 mU/l) and those of the national screening programme (>10 mU/l). Children were defined as transient CH if levothyroxine treatment had been discontinued by 3 years. Results: Of the children screened between January 2006 and December 2007, 167 out of 223,658 fulfilled the GOSH screening criteria; 136 of these required levothyroxine treatment, but 29 (21%) of the children treated would not have been detected by the current UKNSPC guidelines. Transient CH was found in 17/47 (36%) of the treated children detected with a cut-off point >6 mU/l. Raising the cut-off point to >10 mU/l reduced the number of children treated for transient CH to 4/18 (22%). Conclusion: A significant number of children with true and transient CH are missed with a screening cut-off point of >10 mU/l. Our data suggests that a cut-off point of 6 mU/l is appropriate.

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“…Korada and cols., 2010, decreased the limit for the TSH cutoff from 20 µU/mL to 6 µU/mL and observed that, in 67 children with TSH between 6.1 and 10 µU/mL, 4 continued to display TSH levels greater than 6 µU/mL (23). In the Brazilian state of Santa Catarina, the recommended cutoff point is 6 µU/mL because, at 10 µU/mL, some CH cases can be missed (20).…”

Section: Discussionmentioning

confidence: 99%

Evolution to permanent or transient conditions in children with positive neonatal TSH screening tests in Sergipe, Brazil

Matos

Ramalho

Carvalho

et al. 2016

Arch. Endocrinol. Metab.

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Objectives: To assess the evolution to permanent or transient conditions in children with positive neonatal TSH tests in Sergipe, Brazil, from 2004 to 2010. Subjects and methods: Out of 193,794 screened newborns, 713 presented a neonatal TSH level higher than the local cutoff (5.2 µU/mL). From the confirmatory serum TSH values, the children were diagnosed with initial congenital hypothyroidism (CH) or suspect CH. From the evolution, they were classified as permanent CH, hyperthyrotropinemia, or transient TSH elevation. The mean incidence of each final condition was calculated for the total period of time. Results: The initial diagnosis included 37 CH (18.1%) and 167 suspect CH (81.9%) cases. The final diagnosis included 46 cases of permanent CH (22.5%), 56 of hyperthyrotropinemia (27.5%), and 102 of transient TSH elevation (50.0%). Out of the 37 cases of initial CH, 23 (62.2%) had permanent CH, nine (24.3%) had hyperthyrotropinemia, and five (13.5%) had transient TSH elevation. Out of the 167 suspect CH cases, 23 (13.8%) had permanent CH, 47 (28.1%) had hyperthyrotropinemia and 97 (58.1%) had transient TSH elevation. The mean incidence after the follow up was 1:4,166 for permanent CH, 1:3,448 for hyperthyrotropinemia, and 1:1,887 for transient TSH elevation. Eighty-six percent of the children with an initial diagnosis of CH and 41.9% with suspect CH had a permanent condition (CH or hyperthyrotropinemia). Conclusions: The follow-up of children with an initial diagnosis of CH or suspect CH is necessary to determine whether the disorder is permanent because predicting the evolution of the condition is difficult. Arch Endocrinol Metab. 2016;60(5):

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Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold

Abstract: A reduced threshold of 6 mU/l will increase the number of false positive term infants by 126%, but abnormalities of thyroid function requiring treatment will be detected. We suspect that the additional expense involved in setting a lower threshold is justified.

Cited by 83 publications

References 18 publications

Prevalence and Etiology of Congenital Hypothyroidism Detected through an Argentine Neonatal Screening Program (1997-2010)

Prevalence and Etiology of Congenital Hypothyroidism Detected through an Argentine Neonatal Screening Program (1997-2010)

Screening for Congenital Hypothyroidism: Comparison of Borderline Screening Cut-Off Points and the Effect on the Number of Children Treated with Levothyroxine

Evolution to permanent or transient conditions in children with positive neonatal TSH screening tests in Sergipe, Brazil

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