Neonatal hypothyroidism detected by the Northwest Regional Screening Program

Stephen Lafranchi, W. H. Murphey, T. P. Foley, P. R. Larsen, N. R. Buist

Research output: Contribution to journalArticle

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Abstract

The Northwest Regional Screening Program to detect congenital hypothyroidism in infants born in Oregon, Montana, Alaska, and Idaho (combined birthrate of 69,000/yr) was added to our ongoing screening program in 1975. The program utilizes dried blood filter paper specimens collected routinely in the first few days of life in all four states and again at about 6 wk of age in Oregon only. The screening tests consist of an initial thyroxine (T 4) measurement; a thyroid-stimulating hormone (TSH) determination is performed on those specimens with T 4 concentrations in the lowest 3% group. Serum samples obtained by venipuncture are requested for confirmation of the diagnosis. In the first two years of the program, 25 infants with primary hypothyroidism were detected among 110,667 infants screened, a frequency of 1:4,430. Fourteen cases of thyroxine-binding globulin deficiency were also detected, a frequency of 1:7,900. Using the T 4 followed by TSH testing approach, the frequency of requests for repeat specimens was 0.4% in Oregon and 0.05% in the other states. The cost per specimen was $1.96. The majority of infants lacked clinical signs or symptoms of hypothyroidism; only one infant was clinically suspected of having hypothyroidism prior to detection. The most common neonatal symptoms were constipation, lethargy, and prolonged jaundice, while the most common physical signs were hypotonia, umbilical hernia, and large fontanels. Thyroid scans showed the most common etiology to be thyroid aplasia, followed by an ectopic gland, hypoplasia, and goiter. Serum T 4 concentrations were lowest in those infants with aplasia, intermediate in infants with an ectopic gland or hypoplasia, and normal in the infant with the goiter. Neonatal hypothyroidism varies in degree and has several different causes; the capacity to secrete thyroid hormone, the duration before hypothyroidism becomes clinically manifest, and possibly the eventual prognosis for intellectual function depend on the nature of the underlying cause. While the mean age at treatment was 59 days, the goal of diagnosing congenital hypothyroidism and treating affected infants by 1 month of age seems realistic.

Original languageEnglish (US)
Pages (from-to)180-191
Number of pages12
JournalPediatrics
Volume63
Issue number2
StatePublished - 1979

Fingerprint

Hypothyroidism
Congenital Hypothyroidism
Goiter
Thyrotropin
Thyroid Gland
Umbilical Hernia
Lethargy
Muscle Hypotonia
Phlebotomy
Constipation
Jaundice
Serum
Thyroxine
Thyroid Hormones
Signs and Symptoms
Costs and Cost Analysis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Lafranchi, S., Murphey, W. H., Foley, T. P., Larsen, P. R., & Buist, N. R. (1979). Neonatal hypothyroidism detected by the Northwest Regional Screening Program. Pediatrics, 63(2), 180-191.

Neonatal hypothyroidism detected by the Northwest Regional Screening Program. / Lafranchi, Stephen; Murphey, W. H.; Foley, T. P.; Larsen, P. R.; Buist, N. R.

In: Pediatrics, Vol. 63, No. 2, 1979, p. 180-191.

Research output: Contribution to journalArticle

Lafranchi, S, Murphey, WH, Foley, TP, Larsen, PR & Buist, NR 1979, 'Neonatal hypothyroidism detected by the Northwest Regional Screening Program', Pediatrics, vol. 63, no. 2, pp. 180-191.
Lafranchi S, Murphey WH, Foley TP, Larsen PR, Buist NR. Neonatal hypothyroidism detected by the Northwest Regional Screening Program. Pediatrics. 1979;63(2):180-191.
Lafranchi, Stephen ; Murphey, W. H. ; Foley, T. P. ; Larsen, P. R. ; Buist, N. R. / Neonatal hypothyroidism detected by the Northwest Regional Screening Program. In: Pediatrics. 1979 ; Vol. 63, No. 2. pp. 180-191.
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