PEDIATRICS Vol. 76 No. 5 November 1985, pp. 734-740
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Screening for Congenital Hypothyroidism With Specimen Collection at Two Time Periods: Results of the Northwest Regional Screening Program

Stephen H. LaFranchi MD1, Cheryl E. Hanna MD1, Patricia L. Krainz MD1, Michael R. Skeels PhD1, Richard S. Miyahira BS1, and David E. Sesser BA1

1 From the Department of Pediatrics, Oregon Health Sciences University and Oregon State Public Health Laboratory, Portland

To determine the benefit of collecting two routine specimens to test for congenital hypothyroidism, we examined the results of our newborn screening program during the last 9.5 years. The Northwest Regional Screening Program (NWRSP) performs a primary thyroxine test with thyroid-stimulating hormone determinations on the lowest 10% of dried blood filter paper specimens. An initial specimen is obtained in the newborn period, and a routine second specimen is collected at approximately 4 to 6 weeks of age in all infants born in Oregon and 25% of infants born in Idaho, Montana, Alaska, and Nevada. Between May 1975 and October 1984, 182 infants with primary hypothyroidism were detected from 811,917 infants screened, a prevalence rate of 1:4,461. The routine second specimen led to the diagnosis of 19 infants of 484,604 infants screened, a detection rate of 1:25,505. When infants detected by the second screen were compared with those detected by the first screen, they had higher thyroxine and lower thyroidstimulating hormone concentrations on filter paper and serum specimens. When thyroid scanning was used, all but one infant detected by the second screen had some residual thyroid tissue, whereas 35% of infants detected by the first screen had thyroid aplasia. Skeletal maturation was more likely to be normal in infants detected by the second screen. These infants appear to have milder hypothyroidism due to a later age of onset or slower evolution of thyroid failure. At a cost of $31,881 per infant detected by the second screen, the NWRSP found it cost-effective to obtain a routine second specimen.

Key Words: congenital hypothyroidism • newborn screening • filter paper specimen • thyroxine • thyroid-stimulating hormone • thyroid scan

Submitted on January 14, 1985
Accepted on March 25, 1985




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