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Neonatal thyrotropin profile as an index for severity of iodine deficiency and surveillance of iodine prophylactic
R Rajatanavin1, K Unachak, P Winichakoon
1Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
Insights
Neonatal serum thyrotropin (TSH) levels effectively monitor iodine deficiency. Higher TSH in Chiangmai and Nan compared to Bangkok indicates program success in these iodine-deficient areas.
Area of Science:
- Endocrinology
- Public Health
- Pediatrics
Background:
- Neonatal screening for thyroid function is crucial for monitoring public health interventions.
- Iodine deficiency disorders remain a significant global health concern, necessitating effective surveillance strategies.
- Thyroid-stimulating hormone (TSH) levels in neonates have been proposed as a biomarker for assessing iodine status.
Purpose of the Study:
- To evaluate the utility of neonatal serum TSH levels as an index for monitoring iodine prophylaxis programs.
- To compare neonatal TSH levels in iodine-deficient regions with a control area.
Main Methods:
- Neonatal serum TSH and free thyroxine (FT4) levels were measured from umbilical cord blood in Chiangmai, Nan (iodine-deficient), and Bangkok (control).
- Odds ratios for elevated TSH were calculated using Bangkok's 95th percentile as a cutoff.
- Data from district and provincial hospitals were analyzed in the second phase.
Main Results:
- Median neonatal TSH levels were significantly higher in Chiangmai (5.8 microU/mL) and Nan (5.1 microU/mL) than in Bangkok (3.7 microU/mL).
- Neonatal TSH levels were inversely correlated with FT4 levels between Nan and Bangkok.
- A significant correlation (r = 0.67, p < .001) was found between goiter rate and the odds ratio of TSH profiles.
Conclusions:
- Neonatal serum TSH profile is a practical and effective biological index for assessing and monitoring iodine prophylaxis programs.
- The study confirms the utility of this method in district hospitals within developing countries.
- TSH monitoring provides valuable insights into the success of iodine supplementation initiatives.
Abstract:
Neonatal serum thyrotropin (TSH) level has been proposed as an index for the monitoring and surveillance of an iodine prophylactic program. We have determined an effective way to put this idea into practice. During the first phase of our study, neonatal serum TSH levels were obtained from umbilical cord blood of neonates born in Chiangmai and Nan provinces, where several districts were areas of severe iodine deficiency, and were compared with those of neonates born in Bangkok, which was a control area. The median and (95% CI [confidence interval]) of serum TSH level of neonates born in Chiangmai 5.8 (5.7-5.9) microU/mL was significantly higher than in Nan 5.1 (5.0-5.2) microU/mL, and in Bangkok 3.7 (3.7-3.8) microU/mL. Neonatal serum free thyroxine (FT4) concentration in Bangkok was higher than in Nan; while the reciprocal was true for neonatal TSH concentration in randomly selected samples (FT4 1.6 [1.6-1.7] ng/dL vs. 1.5 [1.5-1.6] ng/dL and TSH 3.5 [3.3-3.9] microU/mL vs. 5.5 [5.2-5.9] microU/mL, respectively.) When odds ratio of the likelihood of having neonatal TSH level higher than in Bangkok was calculated using 95th percentile value of neonatal TSH level in Bangkok as a cut-off point, the odds ratio of TSH profile in all districts in Chiangmai and Nan were greater than unity. In the second phase of our study, data were collected from 32 district and 10 provincial hospitals. The optimum number of samples in each hospital derived from the first phase of our study was at least 178. Discrepancy between goiter rate and odds ratio of TSH profile was observed, but there was a significant correlation between the two indices (r = 0.67, p < .001). Our study confirmed the practical utility of neonatal TSH profile as a biological index for assessment and monitoring and surveillance of an iodine prophylactic program at a district hospital in a developing country.
