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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:
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)
Sensitivity and Specificity
Standards
Thyroid
Thyroid gland
Thyroid gland function tests
Thyroid-stimulating hormone
Thyrotropin - blood
Thyroxine - therapeutic use
United Kingdom
Values
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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recordid: cdi_proquest_miscellaneous_733798155
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)
  • 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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1EISSN: 1468-2044
2DOI: 10.1136/adc.2008.147884
3PMID: 19679574
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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) ; 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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1Pearce, Mark
2Ward Platt, Martin P
3Avis, Enid
4Turner, Steve
5Wastell, Hilary
6Cheetham, Tim
title
0Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold
1Archives of disease in childhood
addtitleArch Dis Child
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)
34Sensitivity and Specificity
35Standards
36Thyroid
37Thyroid gland
38Thyroid gland function tests
39Thyroid-stimulating hormone
40Thyrotropin - blood
41Thyroxine - therapeutic use
42United Kingdom
43Values
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titleDifficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold
authorKorada, Srinivasa Murthy ; Pearce, Mark ; Ward Platt, Martin P ; Avis, Enid ; Turner, Steve ; Wastell, Hilary ; Cheetham, Tim
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0Abridged Index Medicus
1Babies
2Biological and medical sciences
3Biomarkers - blood
4Blood
5Congenital diseases
6Congenital hypothyroidism
7Congenital Hypothyroidism - diagnosis
8Congenital Hypothyroidism - drug therapy
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10Ethics
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12Humans
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14Immunoassay
15Infant, Newborn - blood
16Infant, Premature
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19Laboratories
20Medical examination
21Medical sciences
22Medical screening
23Miscellaneous
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26Newborn babies
27Pediatrics
28Prevention and actions
29Professional Practice - statistics & numerical data
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41Thyroxine - therapeutic use
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3Avis, Enid
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6Cheetham, Tim
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atitleDifficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold
jtitleArchives of disease in childhood
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date2010-03
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volume95
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pages169-173
issn0003-9888
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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.
copLondon
pubBMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
pmid19679574
doi10.1136/adc.2008.147884