Prediction of congenital hypothyroidism based on initial screening thyroid-stimulating-hormone

• Published in: BMC pediatrics 2016-02, Vol.16 (1), p.24-24, Article 24
• Main Authors: Saleh, David S, Lawrence, Sarah, Geraghty, Michael T, Gallego, Patricia H, McAssey, Karen, Wherrett, Diane K, Chakraborty, Pranesh
• Format: Article
• Language: English
• Subjects: Age; Biomarkers - blood; Blood; Congenital diseases; Congenital Hypothyroidism - blood; Congenital Hypothyroidism - diagnosis; Female; Follow-Up Studies; Humans; Hypothyroidism; Infant, Newborn; Male; Medical screening; Multiple births; Neonatal Screening; Newborn babies; Ontario; Predictive Value of Tests; Studies; Thyroid gland; Thyrotropin - blood
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-016-0559-0

In thyroid-stimulating-hormone (TSH)-based newborn congenital hypothyroidism (CH) screening programs, the optimal screening-TSH cutoff level is critical to ensuring that true cases of CH are not missed. Screening-TSH results can also be used to predict the likelihood of CH and guide appropriate clinical management. The purpose of this study is to evaluate the predictive value of various screening-TSH levels in predicting a diagnosis of CH in the Ontario Newborn Screening Program (ONSP). The initial screening and follow-up data of 444,744 full term infants born in Ontario, Canada from April 1, 2006 to March 31, 2010 were analyzed. Confirmed CH cases were based on local endocrinologists' report and initiation of thyroxine treatment. There were a total of 541 positive screening tests (~1/822 live births) of which 296 were true positives (~1:1,500 live births). Subjects were further subdivided based on screening-TSH and positive predictive values (PPV) were calculated. Twenty four percent in the 17-19.9 mIU/L range were true positives. In the 17-30 mIU/L range, 29 % were true positives with a significantly higher PPV for those sampled after (43 %) rather than before (25 %) 28 h of age (p