Screening programs for congenital hypothyroidism. How can they be improved?

Am J Dis Child. 1988 Feb;142(2):232-6. doi: 10.1001/archpedi.1988.02150020134049.

Abstract

High-sensitivity neonatal hypothyroid screening tests are used throughout the country. Because of low specificity, primary care physicians are faced with an abundance of false-positive results that challenge the interpreting physician with clinical, economic, and medicolegal considerations. We surveyed 154 physicians caring for Wisconsin-born infants with the highest newborn-screen thyrotropin values in a two-year period. Our results indicated that (1) confirmation of thyroid normalcy is often delayed beyond 6 weeks of age; (2) there is wide variation among physicians regarding therapeutic goals if hypothyroidism is confirmed; and (3) physicians prefer autonomy in the management of congenital hypothyroidism. Modifications in hypothyroid screening programs may include confirmatory tests by a central laboratory (that distributes filter paper with all abnormal results), provision of a management decision tree for primary care physicians, and a one-time subsidy for a visit to a pediatric endocrinologist. We suggest that these modifications may improve the long-term outcome of hypothyroid infants identified by the screening program.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Attitude of Health Personnel*
  • Congenital Hypothyroidism*
  • Humans
  • Hypothyroidism / epidemiology
  • Infant, Newborn
  • Mass Screening / methods*
  • Physicians, Family*
  • Surveys and Questionnaires
  • Wisconsin