Prediction of congenital hypothyroidism based on initial screening thyroid-stimulating-hormone
| Autor: | Sarah Lawrence, David S Saleh, Michael T. Geraghty, Karen McAssey, Diane K. Wherrett, Pranesh Chakraborty, Patricia H. Gallego |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Newborn screening Pediatrics medicine.medical_specialty endocrine system endocrine system diseases Thyrotropin 030209 endocrinology & metabolism 03 medical and health sciences Elevated TSH 0302 clinical medicine Neonatal Screening Thyroid-stimulating hormone Predictive Value of Tests 030225 pediatrics Thyroid stimulating hormone medicine Humans Pediatrics Perinatology and Child Health Significant risk Ontario business.industry Thyroid Infant Newborn medicine.disease Congenital hypothyroidism Thyroid hormone medicine.anatomical_structure Predictive value of tests Pediatrics Perinatology and Child Health Female business True positive rate Biomarkers hormones hormone substitutes and hormone antagonists Follow-Up Studies Research Article |
| Zdroj: | Paediatrics Publications BMC Pediatrics |
| Popis: | Background: 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). Methods: 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. Results: 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 < 0.02). Seventy three percent of neonates with an initial screening-TSH of ≥ 30 mIU/L and 97 % of those with ≥ 40 mIU/L were later confirmed to have CH. Conclusions: Infants with modestly elevated screening positive TSH levels between 17 and 19.9 mIU/L have a significant risk (24 %) of having CH. The very high frequency of true positives in term newborns with initial TSH values ≥ 30mIU/L suggests that this group should be referred directly to a pediatric endocrinologist in an effort to expedite further assessment and treatment. Screen positives with a modestly elevated TSH values (17-19.9 mIU/L) need to be examined in more detail with extended follow-up data to determine if they have transient or permanent CH. |
| Databáze: | OpenAIRE |
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