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Neonatal thyroid screening of a multi-racial population
J A van Eekelen1, W H Stokvis-Brantsma
1Panaga Hospital, Brunei Darussalam.
Insights
Neonatal thyroid screening in Brunei using fixed reference intervals led to inaccurate congenital hypothyroidism (CHT) diagnoses across ethnic groups. New ethnic-specific intervals are recommended for reliable CHT screening in all infants.
Area of Science:
- Endocrinology
- Neonatal screening
- Public health
Background:
- Congenital hypothyroidism (CHT) screening is crucial for infant health.
- Existing CHT screening protocols may not account for ethnic variations in thyroid hormone levels.
- Panaga Hospital in Brunei utilized a fixed reference interval for T4 and TSH, based on Malay infants, for screening a diverse population.
Purpose of the Study:
- To evaluate the reliability of fixed T4 and TSH reference intervals for neonatal thyroid screening in a multi-ethnic infant population.
- To determine new, ethnic-specific reference intervals for T4 and TSH.
- To identify ethnic disparities in thyroid-stimulating hormone (TSH) and thyroxine (T4) levels among neonates.
Main Methods:
- Retrospective analysis of thyroid status in 832 infants born at Panaga Hospital.
- Comparison of T4 and TSH levels across different ethnic groups.
- Determination and comparison of new ethnic-specific T4 and TSH reference intervals.
Main Results:
- Significant differences in T4 and TSH serum levels were observed among ethnic groups.
- Caucasian infants exhibited higher T4 and TSH levels compared to other groups.
- The use of fixed intervals resulted in false positive diagnoses (primarily in Malay infants) and false negative diagnoses (notably in Caucasian female infants).
Conclusions:
- Fixed reference intervals for neonatal thyroid screening are unreliable in ethnically diverse populations.
- Ethnic-specific reference intervals are necessary for accurate congenital hypothyroidism screening.
- Implementation of a new, inclusive reference scheme is recommended for all infants at Panaga Hospital to improve screening accuracy.
Abstract:
A retrospective study on the thyroid status of 832 infants, born in Panaga Hospital in Brunei, was conducted. Despite a high degree of ethnic variability, screening for congenital hypothyroidism (CHT) included a fixed T4 and a TSH reference interval, based on a population of Malay infants. We tested their reliability for this heterologous group of infants. New T4 and TSH intervals were determined for each ethnic group and compared, revealing false positive and false negative judgements made during the period of study. Caucasian infants showed significantly higher T4 and TSH serum levels than all other ethnic groups. Regarding T4, most false positive judgements were found among the Malay infants. False negative judgements were detected among the Caucasian female infants. A new reference scheme was recommended, consisting of reference values that are applicable in neonatal thyroid screening of all infants in Panaga Hospital, regardless of their ethnic origin.