Are lower TSH cutoffs in neonatal screening for congenital hypothyroidism warranted?

Samantha Lain, Caroline Trumpff, Scott D. Grosse, Antonella Olivieri, Guy Van Vliet

Research output: Contribution to journalArticle

Abstract

When newborn screening (NBS) for congenital hypothyroidism (CH) using thyroid-stimulating hormone (TSH) as a primary screening test was introduced, typical TSH screening cutoffs were 20–50U/L of whole blood. Over the years, lowering of TSH cutoffs has contributed to an increased prevalence of detected CH. However, a consensus on the benefit deriving from lowering TSH cutoffs at screening is lacking. The present paper outlines arguments both for and against the lowering of TSH cutoffs at NBS. It includes a review of recently published evidence from Australia, Belgium and Italy. A section focused on economic implications of lowering TSH cutoffs is also provided. One issue that bears further examination is the extent to which mild iodine deficiency at the population level might affect the association of neonatal TSH values with cognitive and developmental outcomes. A debate on TSH cutoffs provides the opportunity to reflect on how to make NBS for CH more effective and to guarantee optimum neurocognitive development and a good quality of life to babies with mild as well as with severe CH. All authors of this debate article agree on the need to establish optimal TSH cutoffs for screening programs in various settings and to ensure the benefits of screening and access to care for newborns worldwide.

Original languageEnglish
Pages (from-to)D1-D12
JournalEuropean Journal of Endocrinology
Volume177
Issue number5
DOIs
Publication statusPublished - Nov 1 2017

Keywords

  • TSH
  • hypothyroidism
  • neonatal screening

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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