Prashant Verma1, Seema Kapoor2, Mani Kalaivani3, Pallavi Vats1, Sangeeta Yadav1, Vandana Jain4, B K Thelma5. 1. Department of Pediatrics, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India. 2. Department of Pediatrics, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India. Correspondence to: Dr Seema Kapoor, Director-Professor, Department of Pediatrics, Maulana Azad Medical College, New Delhi, India. drseemakapoor@gmail.com. 3. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India. 4. Department of Pediatric Endocrinology, All India Institute of Medical Sciences, New Delhi, India. 5. Department of Genetics, University of Delhi (South Campus), New Delhi, India.
Abstract
OBJECTIVE: To determine an appropriate cut-off of capillary Thyroid stimulating hormone (TSH) for congenital hypothyroidism. STUDY DESIGN: Cross-sectional. PARTICIPANTS: 174,000 neonates born in different hospitals of Delhi, India, from November 2014 to October 2016. MAIN OUTCOME MEASURES: Correlation between initial and repeat capillary TSH level and subsequent venous free thyroxine (fT4) level. RESULTS: 102 newborns with initial/ repeat capillary TSH level of ≥20 mIU/L (n=174) were confirmed to have congenital hypothyroidism at mean (SD) age of 5 (4) days. A good correlation between capillary TSH level and confirmatory venous fT4 level and postnatal age of sampling was obtained (r -0.6, -0.4). The area under the ROC curve (AUC) was 0.81 (95%CI 0.75 to 0.88), indicating referral capillary TSH level of 20 mIU/L to be a good predictor of subsequent high venous TSH level. CONCLUSIONS: A cut off of ≥20 mIU/L for capillary TSH screening beyond 24 hours of life is optimal in the Indian setting for deciding further recall and workup, keeping a balance between sensitivity and recall rate.
OBJECTIVE: To determine an appropriate cut-off of capillary Thyroid stimulating hormone (TSH) for congenital hypothyroidism. STUDY DESIGN: Cross-sectional. PARTICIPANTS: 174,000 neonates born in different hospitals of Delhi, India, from November 2014 to October 2016. MAIN OUTCOME MEASURES: Correlation between initial and repeat capillary TSH level and subsequent venous free thyroxine (fT4) level. RESULTS: 102 newborns with initial/ repeat capillary TSH level of ≥20 mIU/L (n=174) were confirmed to have congenital hypothyroidism at mean (SD) age of 5 (4) days. A good correlation between capillary TSH level and confirmatory venous fT4 level and postnatal age of sampling was obtained (r -0.6, -0.4). The area under the ROC curve (AUC) was 0.81 (95%CI 0.75 to 0.88), indicating referral capillary TSH level of 20 mIU/L to be a good predictor of subsequent high venous TSH level. CONCLUSIONS: A cut off of ≥20 mIU/L for capillary TSH screening beyond 24 hours of life is optimal in the Indian setting for deciding further recall and workup, keeping a balance between sensitivity and recall rate.
Authors: Praveen G Paul; Grace Rebekah; Sophy Korula; Manish Kumar; Joseph D Bondu; Raghupathy Palany; Anna Simon; Sarah Mathai Journal: Indian J Endocrinol Metab Date: 2021-12-15