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Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold

Background The UK Newborn Screening Programme Centre recommends that a blood spot thyroid stimulating hormone (TSH) cut-off of 10 mU/l is used to detect congenital hypothyroidism (CHT). As the value used varies from 5 to 10 mU/l, we examined the implications of altering this threshold. Methods Our r... Full description

Journal Title: Archives of disease in childhood 2010-03, Vol.95 (3), p.169-173
Main Author: Korada, Srinivasa Murthy
Other Authors: Pearce, Mark , Ward Platt, Martin P , Avis, Enid , Turner, Steve , Wastell, Hilary , Cheetham, Tim
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
ID: ISSN: 0003-9888
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title: Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold
format: Article
creator:
  • Korada, Srinivasa Murthy
  • Pearce, Mark
  • Ward Platt, Martin P
  • Avis, Enid
  • Turner, Steve
  • Wastell, Hilary
  • Cheetham, Tim
subjects:
  • Abridged Index Medicus
  • Babies
  • Biological and medical sciences
  • Biomarkers - blood
  • Blood
  • Congenital diseases
  • Congenital hypothyroidism
  • Congenital Hypothyroidism - diagnosis
  • Congenital Hypothyroidism - drug therapy
  • Diagnosis
  • Ethics
  • General aspects
  • Humans
  • Hypothyroidism
  • Immunoassay
  • Infant, Newborn - blood
  • Infant, Premature
  • Infants
  • Infants (Newborn)
  • Laboratories
  • Medical examination
  • Medical sciences
  • Medical screening
  • Miscellaneous
  • Neonatal Screening - methods
  • Neonates
  • Newborn babies
  • Pediatrics
  • Prevention and actions
  • Professional Practice - statistics & numerical data
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Reference Values
  • Reference values (Medicine)
  • Research
  • Sensitivity and Specificity
  • Standards
  • Thyroid
  • Thyroid gland
  • Thyroid gland function tests
  • Thyroid-stimulating hormone
  • Thyrotropin - blood
  • Thyroxine - therapeutic use
  • United Kingdom
  • Values
ispartof: Archives of disease in childhood, 2010-03, Vol.95 (3), p.169-173
description: Background The UK Newborn Screening Programme Centre recommends that a blood spot thyroid stimulating hormone (TSH) cut-off of 10 mU/l is used to detect congenital hypothyroidism (CHT). As the value used varies from 5 to 10 mU/l, we examined the implications of altering this threshold. Methods Our regional blood spot TSH cut-off is 6 mU/l. Positive or suspected cases were defined as a TSH >6 mU/l throughout the study period (1 April 2005 to 1 March 2007). All term infants (>35 weeks) whose first TSH was 6–20 mU/l had a second TSH measured. The biochemical details of infants with a TSH between 6.1 and 10.0 mU/l and then >6 mU/l on second sampling were sent to paediatric endocrinologists to determine approaches to management. Results 148 of 65 446 infants (0.23%) had a first blood spot TSH >6.0 mU/l. 120 were term infants with 67 of these (0.1% of all infants tested) having a TSH between 6.1 and 10.0 mU/l and 53 a TSH >10.0 mU/l. Of the 67 term infants with a TSH between 6.1 and 10.0 mU/l on initial testing, four continued to have a TSH >6 mU/l. One with a TSH >10 mU/l and one infant with a TSH
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0003-9888
fulltext: fulltext
issn:
  • 0003-9888
  • 1468-2044
url: Link


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titleDifficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold
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creatorKorada, Srinivasa Murthy ; Pearce, Mark ; Ward Platt, Martin P ; Avis, Enid ; Turner, Steve ; Wastell, Hilary ; Cheetham, Tim
creatorcontribKorada, Srinivasa Murthy ; Pearce, Mark ; Ward Platt, Martin P ; Avis, Enid ; Turner, Steve ; Wastell, Hilary ; Cheetham, Tim
descriptionBackground The UK Newborn Screening Programme Centre recommends that a blood spot thyroid stimulating hormone (TSH) cut-off of 10 mU/l is used to detect congenital hypothyroidism (CHT). As the value used varies from 5 to 10 mU/l, we examined the implications of altering this threshold. Methods Our regional blood spot TSH cut-off is 6 mU/l. Positive or suspected cases were defined as a TSH >6 mU/l throughout the study period (1 April 2005 to 1 March 2007). All term infants (>35 weeks) whose first TSH was 6–20 mU/l had a second TSH measured. The biochemical details of infants with a TSH between 6.1 and 10.0 mU/l and then >6 mU/l on second sampling were sent to paediatric endocrinologists to determine approaches to management. Results 148 of 65 446 infants (0.23%) had a first blood spot TSH >6.0 mU/l. 120 were term infants with 67 of these (0.1% of all infants tested) having a TSH between 6.1 and 10.0 mU/l and 53 a TSH >10.0 mU/l. Of the 67 term infants with a TSH between 6.1 and 10.0 mU/l on initial testing, four continued to have a TSH >6 mU/l. One with a TSH >10 mU/l and one infant with a TSH <10 mU/l on the second blood spot have been diagnosed with CHT. The survey of endocrinologists highlighted significant differences in practice. Conclusions A reduced threshold of 6 mU/l will increase the number of false positive term infants by 126%, but abnormalities of thyroid function requiring treatment will be detected. We suspect that the additional expense involved in setting a lower threshold is justified.
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languageeng
publisherLondon: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
subjectAbridged Index Medicus ; Babies ; Biological and medical sciences ; Biomarkers - blood ; Blood ; Congenital diseases ; Congenital hypothyroidism ; Congenital Hypothyroidism - diagnosis ; Congenital Hypothyroidism - drug therapy ; Diagnosis ; Ethics ; General aspects ; Humans ; Hypothyroidism ; Immunoassay ; Infant, Newborn - blood ; Infant, Premature ; Infants ; Infants (Newborn) ; Laboratories ; Medical examination ; Medical sciences ; Medical screening ; Miscellaneous ; Neonatal Screening - methods ; Neonates ; Newborn babies ; Pediatrics ; Prevention and actions ; Professional Practice - statistics & numerical data ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Reference Values ; Reference values (Medicine) ; Research ; Sensitivity and Specificity ; Standards ; Thyroid ; Thyroid gland ; Thyroid gland function tests ; Thyroid-stimulating hormone ; Thyrotropin - blood ; Thyroxine - therapeutic use ; United Kingdom ; Values
ispartofArchives of disease in childhood, 2010-03, Vol.95 (3), p.169-173
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2Ward Platt, Martin P
3Avis, Enid
4Turner, Steve
5Wastell, Hilary
6Cheetham, Tim
title
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descriptionBackground The UK Newborn Screening Programme Centre recommends that a blood spot thyroid stimulating hormone (TSH) cut-off of 10 mU/l is used to detect congenital hypothyroidism (CHT). As the value used varies from 5 to 10 mU/l, we examined the implications of altering this threshold. Methods Our regional blood spot TSH cut-off is 6 mU/l. Positive or suspected cases were defined as a TSH >6 mU/l throughout the study period (1 April 2005 to 1 March 2007). All term infants (>35 weeks) whose first TSH was 6–20 mU/l had a second TSH measured. The biochemical details of infants with a TSH between 6.1 and 10.0 mU/l and then >6 mU/l on second sampling were sent to paediatric endocrinologists to determine approaches to management. Results 148 of 65 446 infants (0.23%) had a first blood spot TSH >6.0 mU/l. 120 were term infants with 67 of these (0.1% of all infants tested) having a TSH between 6.1 and 10.0 mU/l and 53 a TSH >10.0 mU/l. Of the 67 term infants with a TSH between 6.1 and 10.0 mU/l on initial testing, four continued to have a TSH >6 mU/l. One with a TSH >10 mU/l and one infant with a TSH <10 mU/l on the second blood spot have been diagnosed with CHT. The survey of endocrinologists highlighted significant differences in practice. Conclusions A reduced threshold of 6 mU/l will increase the number of false positive term infants by 126%, but abnormalities of thyroid function requiring treatment will be detected. We suspect that the additional expense involved in setting a lower threshold is justified.
subject
0Abridged Index Medicus
1Babies
2Biological and medical sciences
3Biomarkers - blood
4Blood
5Congenital diseases
6Congenital hypothyroidism
7Congenital Hypothyroidism - diagnosis
8Congenital Hypothyroidism - drug therapy
9Diagnosis
10Ethics
11General aspects
12Humans
13Hypothyroidism
14Immunoassay
15Infant, Newborn - blood
16Infant, Premature
17Infants
18Infants (Newborn)
19Laboratories
20Medical examination
21Medical sciences
22Medical screening
23Miscellaneous
24Neonatal Screening - methods
25Neonates
26Newborn babies
27Pediatrics
28Prevention and actions
29Professional Practice - statistics & numerical data
30Public health. Hygiene
31Public health. Hygiene-occupational medicine
32Reference Values
33Reference values (Medicine)
34Research
35Sensitivity and Specificity
36Standards
37Thyroid
38Thyroid gland
39Thyroid gland function tests
40Thyroid-stimulating hormone
41Thyrotropin - blood
42Thyroxine - therapeutic use
43United Kingdom
44Values
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1Babies
2Biological and medical sciences
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7Congenital Hypothyroidism - diagnosis
8Congenital Hypothyroidism - drug therapy
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abstractBackground The UK Newborn Screening Programme Centre recommends that a blood spot thyroid stimulating hormone (TSH) cut-off of 10 mU/l is used to detect congenital hypothyroidism (CHT). As the value used varies from 5 to 10 mU/l, we examined the implications of altering this threshold. Methods Our regional blood spot TSH cut-off is 6 mU/l. Positive or suspected cases were defined as a TSH >6 mU/l throughout the study period (1 April 2005 to 1 March 2007). All term infants (>35 weeks) whose first TSH was 6–20 mU/l had a second TSH measured. The biochemical details of infants with a TSH between 6.1 and 10.0 mU/l and then >6 mU/l on second sampling were sent to paediatric endocrinologists to determine approaches to management. Results 148 of 65 446 infants (0.23%) had a first blood spot TSH >6.0 mU/l. 120 were term infants with 67 of these (0.1% of all infants tested) having a TSH between 6.1 and 10.0 mU/l and 53 a TSH >10.0 mU/l. Of the 67 term infants with a TSH between 6.1 and 10.0 mU/l on initial testing, four continued to have a TSH >6 mU/l. One with a TSH >10 mU/l and one infant with a TSH <10 mU/l on the second blood spot have been diagnosed with CHT. The survey of endocrinologists highlighted significant differences in practice. Conclusions A reduced threshold of 6 mU/l will increase the number of false positive term infants by 126%, but abnormalities of thyroid function requiring treatment will be detected. We suspect that the additional expense involved in setting a lower threshold is justified.
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pubBMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
pmid19679574
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