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How Can They Be Improved?

David B. Allen, MD; S. Anne Hendricks, MD; Janice Sieger, RN; David J. Hassemer, MS; Murray L. Katcher, MD, PhD; Sharon L. Maby, MD; Stephen C. Duck, MD

Am J Dis Child. 1988;142(2):232-236.

Abstract
• High-sensitivity neonatal hypothyroid screening tests are used throughout the country. Because of low specificity, primary care physicians are faced with an abundance of false-positive results that challenge the interpreting physician with clinical, economic, and medicolegal considerations. We surveyed 154 physicians caring for Wisconsinborn infants with the highest newbornscreen thyrotropin values in a two-year period. Our results indicated that (1) confirmation of thyroid normalcy is often delayed beyond 6 weeks of age; (2) there is wide variation among physicians regarding therapeutic goals if hypothyroidism is confirmed; and (3) physicians prefer autonomy in the management of congenital hypothyroidism. Modifications in hypothyroid screening programs may include confirmatory tests by a central laboratory (that distributes filter paper with all abnormal results), provision of a management decision tree for primary care physicians, and a one-time subsidy for a visit to a pediatric endocrinologist. We suggest that these modifications may improve the long-term outcome of hypothyroid infants identified by the screening program.

(AJDC 1988;142:232-236)

Author Affiliations
From the Departments of Pediatrics, University of Wisconsin, Madison (Drs Allen, Hendricks, and Katcher), Medical College of Wisconsin, Milwaukee (Dr Duck), and the Marshfield Clinic, Marshfield, Wis (Dr Maby); the Wisconsin Division of Health (Ms Sieger and Dr Katcher); and the Wisconsin State Laboratory of Hygiene, Madison (Mr Hassemer).

Footnotes
Accepted for publication Oct 22, 1987.

Reprints not available.

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