NEONATAL HYPOTHYROIDISM DETECTED BY THE OREGON REGIONAL SCREENING PROGRAM

Abstract

During the period from 5/75 to 12/76, 74,050 newborns were screened in the States of Oregon, Montana, and Alaska for neonatal hypothyroldism. Filter paper blood specimens were analyzed for T4 in the newborn period and in a follow-up sample at 6 weeks of age. The lowest 3% of dally T4 assays (<6.5 ug/dl) were then analyzed for TSH. The screening program detected 18 infants with neonatal hypothyroidism for an incidence of 1:4, 100. Each T4 screen cost $0.50. In the 18 infants detected, the mean T4 declined from 3.4 ug/dl in the newborn sample to 2.8 ug/dl in the 6 week sample. Maternal history, maternal thyroid function, and pregnancy were unremarkable; neonatal symptoms were generally absent, and only 1 infant was clinically suspected of being hypothyroid prior to detection. On exam at diagnosis, hypotonia (40%), mottling (33%), umbilical hernia (33%), macroglossia (27%), and large fontanelles and wide sutures (25%) were the most prominent findings; no goiters were seen. Tc^99m pertechnetate scans performed in 10 Infants showed no gland in 4, an ectopic gland in 3, decreased uptake in 2 and a normal gland in 1. Thyroid antibodies were demonstrated in 3 of 7 infants tested; 2 of these 3 had no uptake on scan and none of their mothers had antibodies. With treatment with L-thyroxine 0.050 mg a day, follow-up TSH measurements in 9 patients showed that TSH tended to reach normal 14-28 days after treatment was started, although one infants still had an elevated TSH at 28 days.

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