Impact of Lowering TSH Cut-Off on Neonatal Screening for Congenital Hypothyroidism in Minas Gerais, Brazil.

A higher incidence of primary congenital hypothyroidism (CH) has been related to increased sensitivity in neonatal screening tests. The benefit of treatment in mild cases remains a topic of debate. We evaluated the impact of reducing the blood-spot TSH cut-off (b-TSH) from 10 (Group 2) to 6 mIU/L (Group 1) in a public neonatal screening program. During the study period, 40% of 123 newborns with CH (n = 162,729; incidence = 1:1323) had b-TSH between 6 and 10 mIU/L. Group 1 patients had fewer clinical signs (p = 0.02), lower serum TSH (p < 0.01), and higher free T4 (p < 0.01) compared to those in Group 2 at diagnosis. Reducing the b-TSH cut-off from 10 to 6 mIU/L increased screening sensitivity, allowing a third of diagnoses, mainly mild cases, not being missed. However, when evaluating the performances of b-TSH cut-offs (6, 7, 8, 9, and 10 mIU/L), the lower values were associated with low positive predictive values (PPVs) and unacceptable increased recall rates (0.57%) for a public health care program. A proposed strategy is to adopt a higher b-TSH cut-off in the first sample and a lower one in the subsequent samples from the same child, which yields a greater number of diagnoses with an acceptable PPV.

Temporal trend of newly diagnosed type 1 diabetes children and adolescents identified over a 35-year period in a Brazilian institution.

AIMS: To evaluate the temporal trend of newly diagnosed Type 1 Diabetes cases over a 35-year period in a reference Pediatric Endocrinology service in the city of Belo Horizonte, Brazil. METHODS: Subjects were all children and adolescents diagnosed with Type 1 Diabetes in the Federal University of Minas Gerais Hospital. Information collected included: gender, age and date of Type 1 diabetes diagnosis. Temporal trends were analyzed between 1980 and 2014 and divided in 5-year intervals. RESULTS: During this period 642 children and adolescents were diagnosed with Type 1 diabetes. From 1980 to 1994 there was an increase in the proportion of children diagnosed between 0 and 4 years old, followed by progressive decrease in the subsequent decades (47% in 1990-1994 to 20% in 2010-2014; p = 0.01). There was an increase in the proportion of children diagnosed between 10 and 18 years old (13% in 1990-1994 to 54% in 2010-2014; p = 0.01). There was no statistical difference in the proportion of children diagnosed between 5 and 9 years old through the studied time. CONCLUSIONS: In the studied population Type 1 Diabetes in infants and toddlers seems to be decreasing throughout the years while in the age group older than 10 years, it seems to be increasing.