Neonatal screening program in Dakahlia: hypothyroidism in clinically suspected cases

ABSTRACT

In the line with the priorities of the national health services towards preventive medicine early diagnosis and treatment of CH is emphasized. The aim was to assess thyroid status in clinically suspected cases. Subjects and The present study included two groups, the first is a set of neonates [800] attending the general health units in some villages in Dakahlia complaining of prolonged jaundice, constipation, abdominal distention, chocking and/or umbilical hernia. Neonatal TSH levels in filter paper spots taken from heels were assessed for this group. The second group included 114 infants suspected clinically as congenital hypothyroidism by pediatricians. Serum TSH and T4 were estimated for this second group. In the first group 690 neonates [86.25%] had TSH less than 20 micro IU/ml, 88 neonates [11%] had TSH of between 20 and less than 40 micro IU/ml and 22 [2.75%] has TSH more than 40 micro IU/ml. All neonates [110] with TSH more than 20 micro IU/ml [13.75%] had to be recalled after two weeks for reevaluation by serum TSH and T4 levels estimation. Transient hypothyroidism were detected in 70 cases [8.8%] and their serum T4 and TSH levels two weeks after, were normal. Forty neonates [36.4%] were missed and did not respond to our call. Effect of storage on neonatal TSH levels were evaluated in blood spots collected on preserved filter papers. The results revealed that there were gradual increases in the missed cases as zero when estimated with prolonged period of preservation. The results of the second group Ninety cases [79%] were euthyroid with normal serum TSH and serum T4,17 cases [15%] were with mild elevated serum TSH [7-20 micro IU/ml] and normal serum T4. 7 cases [6.0%] were with elevated serum TSH [more than 20 micro IU/ml] and low serum T4 [less than 96 nmol/L]. second samples, two weeks after the first revealed normalized serum TSH and T4 in 23/24 case. One case presented with prolonged jaundice was diagnosed as overt congenital hypothyroidism. Prolonged jaundice is the presenting complain among 53/114 infants referred by pediatricians as suspected CH [46.49%]. One case Out of 114 studied infants was detected as true CH, while no case of true CH was detected among the neonatal cases. Serum confirmation tests [TSH and T4 levels] should be done in any infant who is suspected to have congenital hypothyroidism. The study assures the importance of public education and awareness in contributing to the cost effectiveness of screening program using filter paper blood spotting and supports the necessity of the rapid assay of filter paper spots within few days in large common collecting center for screening