THYROTROPIN SCREENING FOR CONGENITAL HYPOTHYROIDISM IN THE QUEEN SIRIKIT NATIONAL INSTITUTE OF CHILD HEALTH DURING YEAR 2007-2018

Abstract

National congenital hypothyroidism screening program for neonates in Thailand started since 1996. Queen Sirikit National Institute of Child Health started this screening program in 1995. The coverage of screening and confirmatory test rate were low which needs to improve. The purpose of this research was to study the incidence of congenital hypothyroidism in the neonate born in Rajavithi’s hospital during the 1st of October, 2007 and the 30th of September, 2018 and to evaluate the successful model of neonatal screening program of the Queen Sirikit National Institute of Child Health. Data was abstracted from the medical records of 67,323 neonates who included in the screening program. Descriptive statistics were used to calculate the incidence of congenital hypothyroidism and the screening program management was evaluated.

The results founded that there were 67,801 neonates born at Rajavithi’s hospital during this 12-year-study period. The neonatal screening program included 67,323 neonates with the coverage rate of 99.3%. Four hundred sixteen neonates who have thyroid stimulating hormone (TSH) level > 25 μU/L were called for confirmatory blood test, the recall rate was 0.62. Four hundred and five neonates repeated blood test for FT4 and TSH to confirm the diagnosis (response rate of 97.4%). Abnormal confirmatory test were found in 53 neonates with the incidence of congenital hypothyroidism of 1: 1,270 livebirth. Mean age of neonates who confirmed blood test was 12.63 days and mean age of treatment with levothyroxine was 14.8 days. The percentage of neonates who got treatment within 14 days was 50.9. Eighteen patients did not complete 3-year treatment (33.96%): loss to follow up 7 cases (13.2%), refer to other hospitals finally loss follow-up 7 cases (13.2%), dead from severe pneumonia after 1 year 1 case (1.89%) and loss follow up after 2-year 3 cases (5.7%). During 1997-2015 period, thyroid scan was done in 22 of 30 neonates who complete 3-year treatment (76.3%). Eleven neonates found abnormal thyroid scan (50.0%): ectopic thyroid 7 cases (31.82%), absence of thyroid gland 3 cases (13.27%), thyroid hypoplasia 1 case (4.54%). Others 11 neonates (50.0%) were normal scan and were diagnosed as transient hypothyroidism. According to the guideline for management of thyrotropin screening in neonate by Thai Society for Pediatric Endocrinology in 2015, thyroid scan was discarded from our protocol.

Although the thyrotropin screening for congenital hypothyroidism was a National program. A lot of patients still lost to continue treatment. All medical personnel should be concern. The village health volunteers might play important role to persuade parent for continuity treatment.