TY - JOUR
T1 - Screening for hypothyroidism in down syndrome using the capillary thyroid stimulating hormone method
AU - McGowan, Sheena
AU - Jones, Jeremy
AU - McMillan, Donald
AU - McLaughlin, Kirsty
AU - Smith, Sarah
AU - Leyland, Kath
AU - Charleton, Patricia
AU - Donaldson, Malcolm
AU - on behalf of the Scottish Down Syndrome Screening Group
AU - Greene, Stephen
PY - 2015/4
Y1 - 2015/4
N2 - Objectives To analyze data from the Scottish capillary thyroid stimulating hormone (TSH) screening program for hypothyroidism in Down syndrome to identify a threshold for capillary TSH elevation below which low venous free thyroxine (fT4) (<9 pmol/L) and/or frank venous TSH elevation (>10 mU/L) range is unlikely. Study design Review of proformas prospectively submitted on all children with Down syndrome referred via the screening program between 2003 and 2013. Results Ninety-nine patients with Down syndrome (50 females, 49 males) were identified, 76 school-age (≥5 years) and 23 preschool (<5 years), mean (range) age at referral 9.4 (0.9-18.1) years. Pearson correlation between capillary TSH and venous TSH was 0.814; between capillary TSH and venous fT4 -0.522 (P = .01). Receiver operator curve analysis showed that capillary TSH values of 4 and 6 mU/L were 95.9% and 73.5% sensitive, 5.8% and 80.8% specific, respectively, in predicting venous TSH >10 mU/L. Fifty-three children had capillary TSH values of 4-5.9 mU/L of whom only one, a boy of 15.8 years, had subnormal venous fT4 (<9 pmol/L), and venous TSH >10 mU/L was found in 13 (4 preschool). Conclusions Venous fT4 is normal in almost all patients with Down syndrome with capillary TSH 4-6 mU/L. We propose an algorithm incorporating rescreening by finger prick after 6 months, rather than venepuncture, in schoolaged children with borderline capillary TSH elevation. Further data are needed before this approach can be recommended for preschool children.
AB - Objectives To analyze data from the Scottish capillary thyroid stimulating hormone (TSH) screening program for hypothyroidism in Down syndrome to identify a threshold for capillary TSH elevation below which low venous free thyroxine (fT4) (<9 pmol/L) and/or frank venous TSH elevation (>10 mU/L) range is unlikely. Study design Review of proformas prospectively submitted on all children with Down syndrome referred via the screening program between 2003 and 2013. Results Ninety-nine patients with Down syndrome (50 females, 49 males) were identified, 76 school-age (≥5 years) and 23 preschool (<5 years), mean (range) age at referral 9.4 (0.9-18.1) years. Pearson correlation between capillary TSH and venous TSH was 0.814; between capillary TSH and venous fT4 -0.522 (P = .01). Receiver operator curve analysis showed that capillary TSH values of 4 and 6 mU/L were 95.9% and 73.5% sensitive, 5.8% and 80.8% specific, respectively, in predicting venous TSH >10 mU/L. Fifty-three children had capillary TSH values of 4-5.9 mU/L of whom only one, a boy of 15.8 years, had subnormal venous fT4 (<9 pmol/L), and venous TSH >10 mU/L was found in 13 (4 preschool). Conclusions Venous fT4 is normal in almost all patients with Down syndrome with capillary TSH 4-6 mU/L. We propose an algorithm incorporating rescreening by finger prick after 6 months, rather than venepuncture, in schoolaged children with borderline capillary TSH elevation. Further data are needed before this approach can be recommended for preschool children.
UR - http://www.scopus.com/inward/record.url?scp=84933280122&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2014.12.035
DO - 10.1016/j.jpeds.2014.12.035
M3 - Article
C2 - 25648292
AN - SCOPUS:84933280122
SN - 0022-3476
VL - 166
SP - 1013-1017.e2
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 4
ER -