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Yu A, Alder N, Lain SJ, Wiley V, Nassar N, Jack M. Outcomes of lowered newborn screening thresholds for congenital hypothyroidism. J Paediatr Child Health 2023. [PMID: 37184332 DOI: 10.1111/jpc.16425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Newborn screening (NBS) has largely eliminated the physical and neurodevelopmental effects of untreated congenital hypothyroidism (CH). Many countries, including Australia, have progressively lowered NBS bloodspot thyroid-stimulating hormone (b-TSH) thresholds. The impact of these changes is still unclear. OBJECTIVES To evaluate the performance of CH NBS following the reduction of b-TSH thresholds in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia, from 15 to 8 mIU/L, and to determine the clinical outcomes of cases detected by these thresholds. METHODS NBS data of 346 849 infants born in NSW/ACT, Australia from 1 November, 2016-1 March, 2020 inclusive were analysed. A clinical audit was conducted on infants with a preliminary diagnosis of CH born between 1 January, 2016-1 December, 2020 inclusive. RESULTS The lowered b-TSH threshold (≥8 mIU/L, ~99.5th centile) detected 1668 infants (0.48%), representing an eight-fold increase in recall rate, of whom 212 of 1668 (12.7%) commenced thyroxine treatment. Of these 212 infants, 62 (29.2%) (including eight cases with a preliminary diagnosis of thyroid dysgenesis) had an initial b-TSH 8-14.9 mIU/L. The positive predictive value for a preliminary diagnosis of CH decreased from 74.3% to 12.8% with the lowered threshold. Proportionally, more pre-term infants received a preliminary CH diagnosis on screening with the lower threshold (16.1% of 62) than with the higher threshold (8.0% of 150). CONCLUSION Clinically relevant CH was detected using the lowered threshold, albeit at the cost of an eight-fold increase in recall rate. Further clinical and economic studies are required to determine whether benefits of lowered screening thresholds outweigh potential harms from false-positive results on infants, their families and NBS programs.
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Affiliation(s)
- Aolei Yu
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nelson Alder
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Samantha J Lain
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Veronica Wiley
- New South Wales Newborn Screening Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Disciplines of Genetic Medicine and Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Jack
- University Centre for Rural Health, Lismore, NSW 2480, University of Sydney, Lismore, Australia, Australia
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Marr A, Yokubynas N, Tang K, Saleh D, Wherrett DK, Stein R, Bassilious E, Chakraborty P, Lawrence SE. Transient vs Permanent Congenital Hypothyroidism in Ontario, Canada: Predictive Factors and Scoring System. J Clin Endocrinol Metab 2022; 107:638-648. [PMID: 34726229 PMCID: PMC8851917 DOI: 10.1210/clinem/dgab798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Indexed: 12/14/2022]
Abstract
CONTEXT The apparent increased incidence of congenital hypothyroidism (CH) is partly due to increased detection of transient disease. OBJECTIVE This work aims to identify predictors of transient CH (T-CH) and establish a predictive tool for its earlier differentiation from permanent CH (P-CH). METHODS A retrospective cohort study was conducted of patients diagnosed with CH from 2006 to 2015 through Newborn Screening Ontario (NSO). RESULTS Of 469 cases, 360 (76.8%) were diagnosed with P-CH vs 109 (23.2%) with T-CH. Doses of levothyroxine predicting T-CH were less than 3.9 μg/kg at age 6 months, less than 3.0 μg/kg at ages 1 and 2 years, and less than 2.5 μg/kg at age 3 years. Descriptive statistics and multivariable logistic modeling demonstrated several diverging key measures between patients with T-CH vs P-CH, with optimal stratification at age 1 year. Thyroid imaging was the strongest predictor (P < .001). Excluding imaging, significant predictors in the first year of life included thyroxine dose/kg (P < .001-.002), increase in thyrotropin (TSH) above the reference interval during treatment (P = .002), screening TSH (P = .03), and a history of maternal thyroid disease (P = .02). Based on the 1-year model without imaging, a risk score was developed to identify children with T-CH who may benefit from an earlier trial off therapy, to reduce excess medicalization and health care costs. CONCLUSION A levothyroxine dose of less than 3 μg/kg at ages 1 and 2 years and less than 2.5 μg/kg at age 3 years can be predictive of T-CH. A novel risk score was developed that can be clinically applied to predict the likelihood of a successful trial off therapy for a given patient at age 1 year.
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Affiliation(s)
- Alexa Marr
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, K1H 8M5, Canada
- Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, Ontario, K1H 8L1, Canada
| | - Nicole Yokubynas
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, K1H 8M5, Canada
| | - Ken Tang
- CHEO Research Institute, Ottawa, Ontario, K1H 5B2, Canada
| | - David Saleh
- Department of Pediatrics, Queen’s University, Kingston, Ontario, K7L 3N6, Canada
| | - Diane K Wherrett
- Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Robert Stein
- Division of Endocrinology and Metabolism, London Health Sciences Center, London, Ontario, N6A 5W9, Canada
| | - Ereny Bassilious
- Division of Endocrinology and Metabolism, McMaster Children’s Hospital, Hamilton, Ontario, L8N 3Z5, Canada
| | - Pranesh Chakraborty
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, K1H 8M5, Canada
- Division of Metabolics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada
- Newborn Screening Ontario, Ottawa, Ontario, K1H 8L1, Canada
| | - Sarah E Lawrence
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, K1H 8M5, Canada
- Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, Ontario, K1H 8L1, Canada
- Correspondence: Sarah E. Lawrence, MD, Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, 5109-401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
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