Improvement in screening performance and diagnosis of congenital hypothyroidism in Scotland 1979-2003

Jones, Jeremy; MacKenzie, J. F.; Croft, Grace; Beaton, Stephen; Young, David; Donaldson, Malcolm

doi:10.1136/adc.2005.088427

Cited by 40 publications

(61 citation statements)

References 19 publications

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“…10 A study in Scotland distinguished cases of true CH from transient TSH elevation, which encompassed cases of both transient hypothyroidism and transient hyperthyrotropinemia. 11 Therefore, depending on the definition of transient hypothyroidism, there are likely to be significant differences between the reported incidence rates of this condition. Although the definition of transient hypothyroidism varies, the crucial reliable distinguishing factor between true CH and transitory forms of hypothyroidism is withdrawal of treatment after 3 years of age and assessment of thyroid function.…”

Section: Definitions Of Transient Hypothyroidismmentioning

confidence: 99%

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The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States

et al. 2010

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The reported incidence rate of primary congenital hypothyroidism (CH) has been increasing in the United States over the past 2 decades. We have considered the possibility that the inclusion of cases of transient hypothyroidism has inflated the reported incidence rate of CH. Assessing the effects of cases of transient hypothyroidism on the incidence rate is problematic, because the definitions, diagnostic criteria, and differentiation from transient hyperthyrotropinemia vary widely among state newborn screening programs. Among the 4 etiologies for transient hypothyroidism (maternal thyrotropin receptor-blocking antibodies, exposure to maternal antithyroid medications, iodine deficiency, and iodine excess), there is little evidence of increases in the incidence rate from thyrotropin receptor-blocking antibodies. Exposure to antithyroid drugs could contribute significantly to the incidence rate of transient CH, given the high estimated incidence of active maternal hyperthyroidism. Iodine deficiency or excess in the United States seems unlikely to have contributed significantly to the incidence rate of CH, because the secular trend toward lower iodine intake among women of reproductive age in the 1980s and 1990s seems to have plateaued, and perinatal iodine exposure has presumably declined as a result of recommendations to discontinue using iodinecontaining disinfectants. Although the female-to-male sex ratio among newborns with thyroid agenesis or dysgenesis (the most common causes of CH) is typically 2:1, analysis of the sex ratio of newborns diagnosed with presumed CH in the United States suggests that a substantial proportion might have transient hypothyroidism or hyperthyrotropinemia, because the sex ratio has been well below the expected 2:1 ratio. Combined ultrasonography and 123 I scintigraphy of the thyroid gland are effective tools for identifying cases of thyroid agenesis and dysgenesis and can help to differentiate cases of transient hypothyroidism from true CH. Imaging is also a vital component in evaluating children who, at 3 years of age, undergo a trial of discontinuation of levothyroxine treatment to test for persistence of hypothyroidism. Ultimately, thyroid gland imaging, in conjunction with longterm follow-up studies that appropriately assess and report whether there was permanence of hypothyroidism, will be necessary to address the true incidence rate of CH and any contribution to the observed rate by transient cases of hypothyroidism or hyperthyrotropinemia.

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Section: Definitions Of Transient Hypothyroidismmentioning

confidence: 99%

“…The reported (from studies of European, Australian, and Canadian newborns 10,11,[39][40][41] ) female-to-male sex ratio among case infants with true CH is ϳ2:1. The ratio was even higher (2.4: 1.0) among newborns with CH caused specifically by thyroid aplasia or ectopy.…”

Section: Sex Ratios and Transient Hypothyroidismmentioning

confidence: 99%

The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States

et al. 2010

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“…Deve-se, no entanto, enfatizar que ainda é baixa a porcentagem de crianças que colhem o exame na primeira semana de vida na nossa região (em torno de 70%, quando o ideal seria a totalidade delas). Em uma análise recente da triagem do hipotireodismo congênito na Escócia 21 , a mediana da idade de coleta do teste de triagem neonatal foi de seis dias, sendo que 93,8% dos exames foram colhidos antes dos oito dias de vida.…”

Section: Discussionunclassified

Programa de Triagem Neonatal do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil

et al. 2009

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“…Otra situación por considerar son las influencias que soporta la TSH, propias del neonato, de la madre y del medio, por lo que son motivo de estudio: el peso, la edad gestacional, el sexo, enfermedades graves y congénitas, modo de parto, gemelaridad, exposiciones a fármacos en el embarazo o período neonatal, sufrimiento fetal de diversas etiologías, enfermedades maternas y presencia de anticuerpos tiroideos. [7][8][9][10][11][12][13][14][15][16][17][18] Si bien no es el propósito de este trabajo, el estudio de niños prematuros merece una atención especial dado que el bajo peso de nacimiento ha sido señalado como un factor independiente que afecta los niveles de TSH en la pesquisa, con el agravante originado de posible sepsis, nutrición e hipoxemia. 19 La persistencia de TSH elevada en los RN de muy bajo peso (<1500g) ha permitido proponer una segunda evaluación al mes de vida en esta población, y a algunos autores preguntarse si se debería considerar un valor límite diferente para estos casos.…”

Section: Introductionunclassified

Intervalos de referencia para tirotropina sérica durante los primeros 14 días de vida

Yaniskowski

2012

Arch Argent Pediat

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Arch Argent Pediatr 2012;110(1):27-34 / 27 RESUMEN Introducción. La detección precoz del hipotiroidismo congénito evita la morbilidad física con retardo mental. En un esfuerzo para incrementar la especificidad del programa de pesquisa, nuestro objetivo fue definir intervalos de referencia para tirotropina sérica en recién nacidos (RN) de entre 2 y 14 días de vida. Población y métodos. Todos los recién nacidos (RN) de la pesquisa neonatal entre los años 2001 y 2007. Se determinó tirotropina sérica por electroquimioluminiscencia. Se excluyeron: niños con hipotiroidismo congénito confirmado, los fallecidos antes del mes, los menores de 1500 g, las muestras de otra institución, con TSH < 0,01 µU/ml y las tomadas con más de 14 días de vida. Herramientas estadísticas: pruebas t de Student, medidas de centralidad y dispersión, y transformaciones logarítmicas. Resultados. Población estudiada: 6772 RN (total 7869), el 50,48% fueron varones. La relación varón/ mujer fue similar durante los 14 días. La edad promedio al testeo fue 5,85 días (± 2,58) en el 75% de los RN, mientras que para TSH la media fue 4,42 µU/ml (± 4,17). Se encontró relación inversa entre edad y TSH (día 2 una media de 5,82 µU/ml y al día 14 de 2,58 µU/ml). Conclusión. Se encuentra evidencia estadísti-ca de relación negativa entre TSH y edad del RN. Los intervalos de referencia desarrollados para TSH contribuyen a una mejor evaluación del estado tiroideo en el RN y ayudan a definir una conducta terapéutica individual apropiada. Palabras clave: tirotropina sérica, intervalos de referencia, período neonatal. SUMMARY Introduction.Early detection of congenital hypothyroidism (CH) prevents impaired cognitive and motor development at problems. To increase the screening program specificity, we defined reference intervals for serum TSH in newborns between 2 and 14 days of life. Patients and methods. Newborn infants from our neonatal screening program between 2001 and 2007. Serum TSH was determined by electrochemiluminescence. There were excluded neonates who died before the first month of life or with less than 1500 grams at birth, samples with TSH <0,01 µU/ml., processed after 14 days of life and from other medical centers. Statistical tools: Student t-tests, measures of centrality and dispersion, and logarithmic transformations. Results. Studied population: 6772 newborn infants out of 7869, 50.49% were males. The male/ female ratio was similar during the 14 days. The mean age at testing was 5.85 days (± 2.58), and the mean of TSH value was 4.42 µU/ml (± 4.17). Inverse relationship was found between age and TSH (mean TSH at days 2 and 14 was 5.82 µU/ ml and 2.58 respectively). Conclusion. We found statistical evidence on an inverse relationship between TSH and age in newborn infants whit 14 days of age. Reference intervals for TSH contribute to a better assessment of thyroid status in neonates and to define an appropriate conduct for individual therapy.

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Improvement in screening performance and diagnosis of congenital hypothyroidism in Scotland 1979-2003

Cited by 40 publications

References 19 publications

The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States

The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States

Programa de Triagem Neonatal do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil

Intervalos de referencia para tirotropina sérica durante los primeros 14 días de vida

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