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Performance metrics after changes in screening protocol for congenital hypothyroidism.

Steven J Korzeniewski1, Violanda Grigorescu, Mary Kleyn

  • 1Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Detroit, Michigan 48201, USA. sKorzeni@med.wayne.edu

Pediatrics
|October 10, 2012
PubMed
Summary

Michigan

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Published on: October 6, 2023

Area of Science:

  • Biochemistry
  • Pediatrics
  • Public Health

Background:

  • Congenital hypothyroidism (CH) screening is crucial for early intervention.
  • Michigan has evolved its newborn screening protocols over time.
  • Evaluating these changes is essential for optimizing CH detection.

Purpose of the Study:

  • To assess the effectiveness of Michigan's newborn screening protocol changes for congenital hypothyroidism (CH).
  • To compare screening performance across different testing methodologies and time periods.

Main Methods:

  • Population-based study of Michigan infants born between 1994 and 2010.
  • Comparison of four screening periods based on dried blood spot testing methods: T4/TSH, tandem T4/TSH, primary TSH, and primary TSH with serial testing for low birth weight infants.
  • Logistic regression analysis to identify significant differences in screening performance across periods.

Main Results:

  • Thyrotropin testing demonstrated higher specificity and detection rates with serial testing compared to primary thyroxine (T4) testing.
  • Tandem T4 and thyrotropin testing showed increased sensitivity but also more false-positives, potentially leading to overdiagnosis.
  • Central CH detection ceased after the discontinuation of T4 testing.

Conclusions:

  • Primary thyrotropin with serial testing for at-risk infants is superior for classic CH detection, despite rare false-negatives in normal birth weight NICU infants.
  • Tandem T4 and thyrotropin screening offers combined detection of classic and central CH but incurs higher operational costs.
  • Further research is needed to balance the benefits of enhanced sensitivity against increased program costs.