Τίτλος:
Screening for Congenital Hypothyroidism: The Significance of Threshold
Limit in False-Negative Results
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Context: In our neonatal program, a number of infants with congenital
hypothyroidism (CH) had escaped diagnosis, when a spot RIA-TSH value of
20 mU/liter whole blood was used as a cutoff point.
Objective: The objective of the study was to find out prospectively the
additional number of newborns with CH if the TSH cutoff point is lowered
to 10 mU/liter.
Population and Methods: The study included 311,390 screened newborns.
The children with CH were followed up for a period of 3 yr.
Results: Twenty-eight percent of infants diagnosed with CH had neonatal
TSH values between 10 and 20 mU/liter (56 of 200). Forty of 47 infants,
who were reevaluated later on (85.1%), suffered permanent CH. A thyroid
scintiscan and/or echogram revealed that eight of 40 children (20.0%)
had a structural defect, and the remaining (32 of 40) had a functional
defect of the thyroid gland without anatomical abnormality; 14 of 32
cases were familial. Eighteen of the 47 reevaluated infants were
prematurely born (38.3%) and 15 of these 18 had permanent CH (83.3%).
The lowering of TSH cutoff point from 20 to 10 mU/liter resulted in a
10-fold increase of recall rate.
Conclusions: A significant number of cases with permanent CH are missed
when a TSH threshold of 20 mU/liter is applied. Almost 40% of the
missed CH cases were premature. A mild increase of TSH at screening is
not a predictor of transient CH. The increase in recall rate constitutes
a serious drawback and should be balanced against the possible
consequences of thyroid dysfunction at this important developmental
stage. (J Clin Endocrinol Metab 95: 4283-4290, 2010)
Συγγραφείς:
Mengreli, Chryssanthi
Kanaka-Gantenbein, Christina
Girginoudis,
Panagiotis
Magiakou, Maria-Alexandra
Christakopoulou, Ioulia and
Giannoulia-Karantana, Aglaia
Chrousos, George P. and
Dacou-Voutetakis, Catherine
Περιοδικό:
JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM
DOI:
10.1210/jc.2010-0057
