The Blood Spot Thyrotropin Method is Not Adequate to Screen for Hypothyroidism in the Elderly Living in Abundant-Iodine Intake Areas: Comparison to Sensitive Thyrotropin Measurements

Takáts, I.; Peter, Frank; Rimanóczi, É.; Dohán, Orsolya; Földes, J; Vadász, János; Feldkamp, Joachim; Szilágyi, G.; Góth, Miklós; Kovács, László; Radácsi, Andrea; Szabolcs, I.

doi:10.1089/thy.2000.10.79

Cited by 6 publications

(5 citation statements)

References 43 publications

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“…The pattern of many cases of thyroid hyperfunction in mild or moderate iodine deficiency and many cases of thyroid hypofunction with high iodine intake has been found in many other studies (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55).…”

Section: Environmental Iodinementioning

confidence: 63%

Environmental Iodine Intake Affects the Type of Nonmalignant Thyroid Disease

Laurberg¹,

Pedersen²,

Knudsen³

et al. 2001

Thyroid

263

162

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The relationship between the iodine intake level of a population and the occurrence of thyroid diseases is U-shaped with an increase in risk from both low and high iodine intakes. Developmental brain disorders and endemic goiter caused by severe iodine deficiency may seriously deteriorate overall health status and economic performance of a population. Severe iodine deficiency with a median 24-hour urinary iodine excretion of the population below 25 microg needs immediate attention and correction. Less severe iodine deficiency with median urinary iodine excretion below 120 microg per 24 hours is associated with multinodular autonomous growth and function of the thyroid gland leading to goiter and hyperthyroidism in middle aged and elderly subjects. The lower the iodine intake, the earlier and more prominent are the abnormalities. At the other end of the spectrum, severely excessive iodine intake starting at median urinary iodine excretion levels around 800 microg per 24 hours is associated with a higher prevalence of thyroid hypofunction and goiter in children. A number of studies indicate that moderate and mild iodine excess (median urinary iodine >220 microg per 24 hours) are associated with a more frequent occurrence of hypothyroidism, especially in elderly subjects. The exact mechanism leading to this has not been clarified, and more studies are needed to define the limits of excessive iodine intake precisely. Due to the frequent occurrence of thyroid disorders, proper monitoring and control of the population iodine intake level is a cost-effective alternative to diagnosing, therapy and control of the many individual cases of thyroid diseases that might have been prevented.

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Section: Environmental Iodinementioning

confidence: 63%

Environmental Iodine Intake Affects the Type of Nonmalignant Thyroid Disease

Laurberg¹,

Pedersen²,

Knudsen³

et al. 2001

Thyroid

263

162

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“…Both of these studies therefore support the use of DBS TSH for detecting primary hypothyroidism in adults and children. However, a study by Takáts et al 2000 reported that a high diagnostic sensitivity of 94% for DBS TSH could only be achieved at the expense of a poor specificity of 72%. 27 Future work for us would therefore be to perform a study evaluating the diagnostic potential of the DBS TSH reference interval.…”

Section: Discussionmentioning

confidence: 99%

Adult and neonate TSH blood spot reference intervals

et al. 2022

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Background: Neonatal congenital hypothyroidism screening is performed by measuring thyroid-stimulating hormone (TSH) in a dried blood spot (DBS) sample, whereas acquired hypothyroidism uses serum TSH. There is no established DBS TSH reference interval, but knowing this is useful, as some patients cannot tolerate venepuncture, so DBS collection is seen as an acceptable alternative. The aim of this study was to establish DBS TSH reference intervals in adults and neonates (day 5-8), and determine the relationship between serum and DBS TSH. Methods: Euthyroid adults, not on thyroid medication and with a normal haematocrit, were selected. If they had a paired lithium heparin sample, DBS were prepared by spotting 50 µl of whole blood onto filter paper. DBS TSH was measured using the PerkinElmer Neonatal hTSH kit on the GSP instrument and serum using the Abbott Architect assay. The relationship between DBS and serum TSH was analysed using Passing-Bablok regression and the adult DBS TSH reference interval calculated using transformed data. The neonatal reference interval was calculated from screening results using the non-parametric method. Results: 109 adult samples were included in the study (61 female). The Passing-Bablok regression was: DBS TSH = 0.68 x serum TSH + 0.07, and reference interval was 0.49-3.07 mU/L. The neonatal DBS reference interval was 0.40-4.10 mU/L from 8,351 results. Conclusion: This study derived adult and neonate TSH DBS reference intervals using the GSP analyser and established the relationship between serum and DBS TSH. Knowing this information will allow for improved interpretation of DBS TSH results.

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“…25 When we compared serum and DBS results for 118 patients, only one patient was positive by the serum and negative by the DBS assay. The DBS method used by Takats et al was not described in detail, but the short incubation time suggests that there may have been a problem with extraction of TSH from the lter paper.…”

Section: Discussionmentioning

confidence: 99%

“…24 Iodine-de cient patients with mild hypothyroidism may be missed in adult screening programmes using TSH and might have contributed to the problems with DBS TSH screening reported by Takats et al in a population that may have had iodine de ciency. 25 Screening for thyroid disease in adults can be done accurately with DBS specimens. When specimens were collected simultaneously for serum and DBS testing for 118 individuals, only one specimen was positive by serum and negative by DBS.…”

Section: Discussionmentioning

confidence: 99%

“…Our data are in contrast with the report published by Takats et al, in which a signi cant number of elderly patients were positive by the serum assay but negative by the DBS assay. 25 When we compared serum and DBS results for 118 patients, only one patient was positive by the serum and negative by the DBS assay. The DBS method used by Takats et al was not described in detail, but the short incubation time suggests that there may have been a problem with extraction of TSH from the lter paper.…”

Section: Discussionmentioning

confidence: 99%

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Original Paper: Assays for thyroid-stimulating hormone using dried blood spotted filter paper specimens to screen for hypothyroidism in older children and adults

et al. 2003

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A lthough the cost-effectiveness of screening newborn babies for hypothyroidism using lter paper dried blood spot (DBS) specimens has been recognised worldwide, only recently has the technique been considered for screening other age groups. Primary hypothyroidism, for which every baby born in the US is screened, has a prevalence of 0.02% to 0.03% in newborn babies. 1 In adults, the incidence of primary hypothyroidism reported from the Whickham Survey from the UK was 4.1 per 1000 per year in women and 0.6 per 1000 per year in men.2 Previously unrecognised overt hypothyroidism in the general population has been reported to be approximately 1-2% in women and 0.1% in men.3,4 The risk of developing primary hypothyroidism increases with age, is greater in women than men at any age and is greater if tests for thyroid antibodies are positive or if the rise in serum thyroid-stimulating hormone (TSH) is above 2 mU/l. 5Another study suggested that 2.5% of women and 1.4% of men have undiagnosed overt hypothyroidism, and the prevalence of subclinical hypothyroidism was 17% for women and 14% for men. 6 Screening for primary hypothyroidism in adults was shown to be cost-effective when TSH was measured once every ve years after the age of 35 years, especially in women.7 Because the symptoms of hypothyroidism can be mistaken for medical and psychiatric diseases, as well as for general signs of ageing such as weakness, lethargy and fatigue, the diagnosis is often missed in older populations, as it is in newborn infants. 4 Several subsequent con rmatory studies have recommended screening with TSH for hypothyroidism in selected populations of adults. 4,[7][8][9] The American Thyroid Association, 10 the American College of Physicians, 11,12 and the National Academy of Clinical Biochemistry 13 recommend routine screening for hypothyroidism in women beginning in the fth decade of life. 4 The National Academy of Sciences (NAS) in the United States has been mandated by the US Congress to determine whether the Medicare programme should cover the cost of routine TSH screening and the Institute of Medicine of the NAS has selected a panel of experts to make recommendations by 2003. 14 Others have more recently advised a more aggressive approach to the detection of undiagnosed hypothyroidism and suggested that TSH testing is indicated in all individuals with goitre or other signs or symptoms of hypothyroidism. 4TSH screening is recommended for those individuals who have disorders with an increased risk for hypothyroidism, including in otherwise healthy women every ve years beginning at age 35 years, in men beginning at age 45 years 4 and in women who are contemplating pregnancy or are early in the rst trimester of pregnancy (to protect fetal brain development)15-18 and in postpartum women. 4,19Assays for TSH using DBS specimens are routinely used to screen newborn babies for primary hypothyroidism. 20 However, for several age-related reasons, these neonatal tests are not suitable for screening adult specimens. The ratio of red cells to ...

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The Blood Spot Thyrotropin Method is Not Adequate to Screen for Hypothyroidism in the Elderly Living in Abundant-Iodine Intake Areas: Comparison to Sensitive Thyrotropin Measurements

Cited by 6 publications

References 43 publications

Environmental Iodine Intake Affects the Type of Nonmalignant Thyroid Disease

Environmental Iodine Intake Affects the Type of Nonmalignant Thyroid Disease

Adult and neonate TSH blood spot reference intervals

Original Paper: Assays for thyroid-stimulating hormone using dried blood spotted filter paper specimens to screen for hypothyroidism in older children and adults

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