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...
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| Veröffentlicht in: | Archives of disease in childhood 2010-03, Vol.95 (3), p.169-173 |
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| creator | Korada, Srinivasa Murthy Pearce, Mark Ward Platt, Martin P Avis, Enid Turner, Steve Wastell, Hilary Cheetham, Tim |
| 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 |
| doi_str_mv | 10.1136/adc.2008.147884 |
| format | Article |
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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.</description><identifier>ISSN: 0003-9888</identifier><identifier>EISSN: 1468-2044</identifier><identifier>DOI: 10.1136/adc.2008.147884</identifier><identifier>PMID: 19679574</identifier><identifier>CODEN: ADCHAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher><subject>Anatomy ; Babies ; Biological and medical sciences ; Biomarkers - blood ; Blood ; Body Weight ; Congenital diseases ; Congenital Hypothyroidism - diagnosis ; Congenital Hypothyroidism - drug therapy ; Ethics ; General aspects ; Humans ; Hypothyroidism ; Immunoassay ; Infant, Newborn - blood ; Infant, Premature ; Infants ; Laboratories ; Measurement Techniques ; Medical sciences ; Medical screening ; Miscellaneous ; Neonatal Screening - methods ; Neonates ; Newborn babies ; Pediatrics ; Pregnancy ; Prevention and actions ; Professional Practice - statistics & numerical data ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Reference Values ; Sampling ; Sensitivity and Specificity ; Thyroid ; Thyroid gland ; Thyroid-stimulating hormone ; Thyrotropin - blood ; Thyroxine - therapeutic use ; United Kingdom ; Young Children</subject><ispartof>Archives of disease in childhood, 2010-03, Vol.95 (3), p.169-173</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2010 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b493t-eab5951a8cbd4b4affa1375afdd466c097bfb93554a47206c51d711d1227a7c23</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://adc.bmj.com/content/95/3/169.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://adc.bmj.com/content/95/3/169.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3187,23562,27915,27916,77361,77392</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22733296$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19679574$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Korada, Srinivasa Murthy</creatorcontrib><creatorcontrib>Pearce, Mark</creatorcontrib><creatorcontrib>Ward Platt, Martin P</creatorcontrib><creatorcontrib>Avis, Enid</creatorcontrib><creatorcontrib>Turner, Steve</creatorcontrib><creatorcontrib>Wastell, Hilary</creatorcontrib><creatorcontrib>Cheetham, Tim</creatorcontrib><title>Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold</title><title>Archives of disease in childhood</title><addtitle>Arch Dis Child</addtitle><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 <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.</description><subject>Anatomy</subject><subject>Babies</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Blood</subject><subject>Body Weight</subject><subject>Congenital diseases</subject><subject>Congenital Hypothyroidism - diagnosis</subject><subject>Congenital Hypothyroidism - drug therapy</subject><subject>Ethics</subject><subject>General aspects</subject><subject>Humans</subject><subject>Hypothyroidism</subject><subject>Immunoassay</subject><subject>Infant, Newborn - blood</subject><subject>Infant, Premature</subject><subject>Infants</subject><subject>Laboratories</subject><subject>Measurement Techniques</subject><subject>Medical sciences</subject><subject>Medical screening</subject><subject>Miscellaneous</subject><subject>Neonatal Screening - methods</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Pediatrics</subject><subject>Pregnancy</subject><subject>Prevention and actions</subject><subject>Professional Practice - statistics & numerical data</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Reference Values</subject><subject>Sampling</subject><subject>Sensitivity and Specificity</subject><subject>Thyroid</subject><subject>Thyroid gland</subject><subject>Thyroid-stimulating hormone</subject><subject>Thyrotropin - blood</subject><subject>Thyroxine - therapeutic use</subject><subject>United Kingdom</subject><subject>Young Children</subject><issn>0003-9888</issn><issn>1468-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqFkcFrFDEYxYNY7Fo9e5MBEbUw22SSmSRHWbVbKHpoLb2Fb5JMN-tMZptkwP73Zp2lBS-eAsnve3nfewi9IXhJCG3OwOhlhbFYEsaFYM_QgrBGlBVm7DlaYIxpKYUQx-hljFuMSSUEfYGOiWy4rDlboLsvruucnvrkbCycL6LtrU7O3xXgC9jtwrgLDpItvB09JOiLtHkIozNFTG6YevjLbsYwjN4WH6-v1p-KqIO1fn-fNsHGzdibV-iogz7a14fzBP389vV6tS4vf5xfrD5fli2TNJUW2lrWBIRuDWsZdB0QymvojGFNo7HkbddKWtcMGK9wo2tiOCGGVBUHrit6gj7Mutn4_WRjUoOL2vY9ZP9TVJxSLgWp60y--4fcjlPw2ZwiIueEOa-aTJ3NlA5jjMF2KscxQHhQBKt9BSpXoPYVqLmCPPH2oDu1gzVP_CHzDLw_ABA19F0Ar1185PImlFZy_3U5cy4m-_vxHcIv1fAcivp-s1L05lzeXt2u1SrzpzPfDtv_uvwD23Cr3A</recordid><startdate>20100301</startdate><enddate>20100301</enddate><creator>Korada, Srinivasa Murthy</creator><creator>Pearce, Mark</creator><creator>Ward Platt, Martin P</creator><creator>Avis, Enid</creator><creator>Turner, Steve</creator><creator>Wastell, Hilary</creator><creator>Cheetham, Tim</creator><general>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88B</scope><scope>88E</scope><scope>88I</scope><scope>8A4</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>CJNVE</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0P</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEDU</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20100301</creationdate><title>Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold</title><author>Korada, Srinivasa Murthy ; Pearce, Mark ; Ward Platt, Martin P ; Avis, Enid ; Turner, Steve ; Wastell, Hilary ; Cheetham, Tim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b493t-eab5951a8cbd4b4affa1375afdd466c097bfb93554a47206c51d711d1227a7c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Anatomy</topic><topic>Babies</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Blood</topic><topic>Body Weight</topic><topic>Congenital diseases</topic><topic>Congenital Hypothyroidism - diagnosis</topic><topic>Congenital Hypothyroidism - drug therapy</topic><topic>Ethics</topic><topic>General aspects</topic><topic>Humans</topic><topic>Hypothyroidism</topic><topic>Immunoassay</topic><topic>Infant, Newborn - blood</topic><topic>Infant, Premature</topic><topic>Infants</topic><topic>Laboratories</topic><topic>Measurement Techniques</topic><topic>Medical sciences</topic><topic>Medical screening</topic><topic>Miscellaneous</topic><topic>Neonatal Screening - methods</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Pediatrics</topic><topic>Pregnancy</topic><topic>Prevention and actions</topic><topic>Professional Practice - statistics & numerical data</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Reference Values</topic><topic>Sampling</topic><topic>Sensitivity and Specificity</topic><topic>Thyroid</topic><topic>Thyroid gland</topic><topic>Thyroid-stimulating hormone</topic><topic>Thyrotropin - blood</topic><topic>Thyroxine - therapeutic use</topic><topic>United Kingdom</topic><topic>Young Children</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Korada, Srinivasa Murthy</creatorcontrib><creatorcontrib>Pearce, Mark</creatorcontrib><creatorcontrib>Ward Platt, Martin P</creatorcontrib><creatorcontrib>Avis, Enid</creatorcontrib><creatorcontrib>Turner, Steve</creatorcontrib><creatorcontrib>Wastell, Hilary</creatorcontrib><creatorcontrib>Cheetham, Tim</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Education Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>Education Periodicals</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Education Collection</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biological Sciences</collection><collection>ProQuest Education Journals</collection><collection>ProQuest Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Science Journals</collection><collection>Biological Science Database</collection><collection>ProQuest One Education</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of disease in childhood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Korada, Srinivasa Murthy</au><au>Pearce, Mark</au><au>Ward Platt, Martin P</au><au>Avis, Enid</au><au>Turner, Steve</au><au>Wastell, Hilary</au><au>Cheetham, Tim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold</atitle><jtitle>Archives of disease in childhood</jtitle><addtitle>Arch Dis Child</addtitle><date>2010-03-01</date><risdate>2010</risdate><volume>95</volume><issue>3</issue><spage>169</spage><epage>173</epage><pages>169-173</pages><issn>0003-9888</issn><eissn>1468-2044</eissn><coden>ADCHAK</coden><abstract>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 <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.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</pub><pmid>19679574</pmid><doi>10.1136/adc.2008.147884</doi><tpages>5</tpages></addata></record> |
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| subjects | Anatomy Babies Biological and medical sciences Biomarkers - blood Blood Body Weight Congenital diseases Congenital Hypothyroidism - diagnosis Congenital Hypothyroidism - drug therapy Ethics General aspects Humans Hypothyroidism Immunoassay Infant, Newborn - blood Infant, Premature Infants Laboratories Measurement Techniques Medical sciences Medical screening Miscellaneous Neonatal Screening - methods Neonates Newborn babies Pediatrics Pregnancy Prevention and actions Professional Practice - statistics & numerical data Public health. Hygiene Public health. Hygiene-occupational medicine Reference Values Sampling Sensitivity and Specificity Thyroid Thyroid gland Thyroid-stimulating hormone Thyrotropin - blood Thyroxine - therapeutic use United Kingdom Young Children |
| title | Difficulties in selecting an appropriate neonatal thyroid stimulating hormone (TSH) screening threshold |
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