title: Capillary TSH screening programme for Down's syndrome in Scotland, 1997-2009.
abstract: OBJECTIVE
  To assess uptake of community-based capillary thyroid stimulating hormone (TSH) screening in Scotland and determine the optimal frequency of screening, the justification for preschool screening and strategies for treatment.
  
  
  METHODS
  Subjects with Down's syndrome aged 1-19 years underwent capillary TSH measurement. Clinical and biochemical data were collected using proformas.
  
  
  RESULTS
  5742 capillary TSH tests were performed on 1329 children in 1997-2009, increasing from 183 children from two health boards tested in 1997 to 630 from 13 health boards tested in 2009. Of 132 children referred by the screening laboratory with elevated capillary TSH, 98 (M:F ratio 1:1.2, median (range) age 8.9 (0.9-17.9) years) had adequate documentation and 76 had thyroid dysfunction (defined as venous TSH >6 mU/l), giving a prevalence of not less than 5.7%. Fifty-six (57%) had tested negative during the previous year, 8 (8%) tested positive on their first screening test and 23/67 (34%) were thyroid peroxidase autoantibody negative on initial venous blood. Two of the 13 (13%) preschool children were severely hypothyroid (venous TSH 71 and 283 mU/l). Of patients with venous TSH 6-10.9 (n=27), 11.0-20.9 (n=25) and ≥ 21.0 mU/l (n=24) following referral, initial/subsequent treatment with thyroxine was given in 3/8, 15/5 and 21/1, respectively.
  
  
  CONCLUSIONS
  Capillary TSH screening in Down's syndrome is eminently feasible and should be performed annually from 1 year of age. Nearly all subjects with initial venous TSH ≥ 11.0 mU/l will require thyroxine treatment but most with TSH 6-10 mU/l only require surveillance initially.
authors.affiliation: Department of Child Health, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
authors.forename: Sheena
authors.initials: S
authors.lastname: McGowan
authors.forename: Jeremy
authors.initials: J
authors.lastname: Jones
authors.forename: Arlene
authors.initials: A
authors.lastname: Brown
authors.forename: Lucy
authors.initials: L
authors.lastname: Reynolds
authors.forename: Kath
authors.initials: K
authors.lastname: Leyland
authors.forename: Patricia
authors.initials: P
authors.lastname: Charleton
authors.forename: Mona
authors.initials: M
authors.lastname: Rahim
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mansor
authors.forename: Sawsan
authors.initials: S
authors.lastname: Ritha
authors.forename: Malcolm
authors.initials: M
authors.lastname: Donaldson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D015397:Program Evaluation; D012606:Scotland / Q000453:epidemiology; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D015415:Biomarkers; D013972:Thyrotropin; D013974:Thyroxine