Is Umbilical Cord Blood Total Thyroxin Measurement Effective in Newborn Screening for Hypothyroidism?

Abstract

Objective To assess the performance of the use of umbilical cord blood for screening of primary congenital hypothyroidism in the Saudi Aramco Medical Services Organization newborn thyroid screening programme. Methods Umbilical cord blood total thyroxin (CB-TT4) was measured. In samples with low T4 concentrations, an additional measurement of cord blood thyroid-stimulating hormone was made. Results A total of 96,015 newborn infants were screened in the period January 1990 -December 2007. Twenty-six cases of primary congenital hypothyroidism, six cases of transient hypothyroidism and 13 cases of central hypothyroidism were detected. This method of screening resulted in 100% sensitivity and 98% specificity (95% CI 84 -100, and 95% CI 98-98.2, respectively). However, there was a high mean recall rate of 1.9%. Conclusion The use of CB-TT4 is a valid screening strategy for primary congenital hypothyroidism. It meets the metabolic screening demands of early discharge policy and guarantees screening all newborns delivered in the hospital.

A 7-year study on the prevalence of congenital hypothyroidism in northern Iran

“…High prevalence rates have been reported for certain neighboring countries of Iran; however, these rates are lower than those in this study. For example, the CH prevalence rates are 1 per 650 births in Turkey ( 22 ), 1 per 1,600 births in Pakistan ( 23 ), and 1 per 3,692 births in Saudi Arabia ( 24 ). In recent decades, an increase in the prevalence of CH has been observed in some countries ( 25 , 26 ); however, the prevalence of CH in Iran is higher than in other countries ( 17 , 27 , 28 ).…”

Neonatal Screening for Congenital Hypothyroidism in Nicaragua: Audit of a Cord-blood Thyrotropin-based Program (2005-2015)

“…Taking into account that the PPV worsened, we suggest that the cut-off of 20 mU/l is the most efficient threshold for the cord-blood TSH-based CH screening Nicaraguan strategy. This is the most widely used cut-off in cord-blood based screening programs worldwide [6,23,24,32]. Our study indicates a possible limitation of using cord-blood (collected at birth) with respect to using heel-blood (collected after 24 h) when attempting to increase the detection of moderate and mild cases of congenital hypothyroidism, since heel-blood based programs truly achieved such goal by lowering cut-offs from 20 to 10-12 mU/l TSH.…”

“…A cut-off value of 20 mU/l TSH was chosen to consider a sample positive, a threshold frequently used in programs using cord-blood samples. [6,[22][23][24] Since a range of cut-offs from 15 to 40 mU/l TSH have been used by different programs and countries [3,8,24,25], a trial was conducted from 2009 to 2013 to define the most efficient threshold for our conditions by lowering the cut-off to 10 mU/l.…”

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“…This clinical picture underlines the importance of neonatal screening programs in diagnosing this treatable disorders. Abduljabar et al [22] conducted a study in the newborn screening for hypothyroidism. They found the cord blood level of thyroid hormone is enough to screen for primary hypothyroidism in newborns.…”