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Evolution to permanent or transient conditions in children with positive neonatal TSH screening tests in Sergipe,
Diana M Matos1, Roberto J R Ramalho1, Bruno M Carvalho1
1Departamento de Medicina, Hospital Universitário, Universidade Federal de Sergipe (UFS), Aracaju, SE, Brasil.
Insights
Follow-up is crucial for children with elevated neonatal TSH tests to distinguish permanent congenital hypothyroidism from transient conditions. Predicting the outcome is challenging, necessitating ongoing monitoring.
Area of Science:
- Endocrinology
- Neonatal screening
- Public health
Background:
- Neonatal screening programs identify infants with potential thyroid dysfunction.
- Early detection of congenital hypothyroidism (CH) is vital for neurodevelopmental outcomes.
- Distinguishing permanent CH from transient TSH elevation is essential for appropriate management.
Purpose of the Study:
- To evaluate the long-term outcomes of infants with positive neonatal TSH screening in Sergipe, Brazil.
- To determine the incidence of permanent CH, hyperthyrotropinemia, and transient TSH elevation.
- To assess the necessity of follow-up for accurate diagnosis.
Main Methods:
- Analysis of 193,794 screened newborns with elevated TSH levels (≥5.2 µU/mL).
- Classification of infants into initial diagnoses of CH or suspect CH based on confirmatory TSH.
- Categorization into permanent CH, hyperthyrotropinemia, or transient TSH elevation after follow-up.
Main Results:
- Of 713 infants with elevated TSH, 37 had initial CH (18.1%) and 167 had suspect CH (81.9%).
- Final diagnoses included 46 permanent CH (22.5%), 56 hyperthyrotropinemia (27.5%), and 102 transient TSH elevation (50.0%).
- Incidence rates were 1:4,166 for permanent CH, 1:3,448 for hyperthyrotropinemia, and 1:1,887 for transient TSH elevation.
Conclusions:
- Follow-up is essential for accurate diagnosis in infants with abnormal neonatal TSH screening.
- Predicting the evolution to permanent or transient thyroid dysfunction is difficult.
- Ongoing monitoring ensures appropriate management of congenital hypothyroidism and related conditions.
Objectives:
To assess the evolution to permanent or transient conditions in children with positive neonatal TSH tests in Sergipe, Brazil, from 2004 to 2010.
Subjects And Methods:
Out of 193,794 screened newborns, 713 presented a neonatal TSH level higher than the local cutoff (5.2 µU/mL). From the confirmatory serum TSH values, the children were diagnosed with initial congenital hypothyroidism (CH) or suspect CH. From the evolution, they were classified as permanent CH, hyperthyrotropinemia, or transient TSH elevation. The mean incidence of each final condition was calculated for the total period of time.
Results:
The initial diagnosis included 37 CH (18.1%) and 167 suspect CH (81.9%) cases. The final diagnosis included 46 cases of permanent CH (22.5%), 56 of hyperthyrotropinemia (27.5%), and 102 of transient TSH elevation (50.0%). Out of the 37 cases of initial CH, 23 (62.2%) had permanent CH, nine (24.3%) had hyperthyrotropinemia, and five (13.5%) had transient TSH elevation. Out of the 167 suspect CH cases, 23 (13.8%) had permanent CH, 47 (28.1%) had hyperthyrotropinemia and 97 (58.1%) had transient TSH elevation. The mean incidence after the follow up was 1:4,166 for permanent CH, 1:3,448 for hyperthyrotropinemia, and 1:1,887 for transient TSH elevation. Eighty-six percent of the children with an initial diagnosis of CH and 41.9% with suspect CH had a permanent condition (CH or hyperthyrotropinemia).
Conclusions:
The follow-up of children with an initial diagnosis of CH or suspect CH is necessary to determine whether the disorder is permanent because predicting the evolution of the condition is difficult.
