Screening programs for congenital hypothyroidism. How can they be improved?
High-sensitivity neonatal hypothyroid screening tests are used throughout the country. Because of low specificity, primary care physicians are faced with an abundance of false-positive results that challenge the interpreting physician with clinical, economic, and medicolegal considerations. We surveyed 154 physicians caring for Wisconsin-born infants with the highest newborn-screen thyrotropin values in a two-year period. Our results indicated that (1) confirmation of thyroid normalcy is often delayed beyond 6 weeks of age; (2) there is wide variation among physicians regarding therapeutic goals if hypothyroidism is confirmed; and (3) physicians prefer autonomy in the management of congenital hypothyroidism. Modifications in hypothyroid screening programs may include confirmatory tests by a central laboratory (that distributes filter paper with all abnormal results), provision of a management decision tree for primary care physicians, and a one-time subsidy for a visit to a pediatric endocrinologist. We suggest that these modifications may improve the long-term outcome of hypothyroid infants identified by the screening program.
Allen
D B
DB
Department of Pediatrics, University of Wisconsin, Madison.
Hendricks
S A
SA
Sieger
J
J
Hassemer
D J
DJ
Katcher
M L
ML
Maby
S L
SL
Duck
S C
SC
D001291:Attitude of Health Personnel; D003409:Congenital Hypothyroidism; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology; D007231:Infant, Newborn; D008403:Mass Screening / Q000379:methods*; D010821:Physicians, Family; D011795:Surveys and Questionnaires; D014922:Wisconsin