Screening programs for congenital hypothyroidism. How can they be improved?
D. B. Allen, S. A. Hendricks, J. Sieger, D. J. Hassemer, M. L. Katcher, S. L. Maby and S. C. Duck
Department of Pediatrics, University of Wisconsin, Madison.
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 Wisconsin-born infants with the highest
newborn-screen 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.
