ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Eur J Endocrinol 2017;177:D1-D12

Newborn screening (NBS) is an invaluable tool for identification of CH; however almost 70% of newborns worldwide do not benefit from NBS at all. In countries with NBS, lowering of TSH cut-offs over the years led to major controversy on the optimal TSH screening cut-off. In this very interesting debate paper, arguments are presented for and against the lowering of TSH cutoffs at NBS. The arguments in support of lowering TSH cutoffs are based on: 1) the higher detection rate and consequent higher treatment rate of children with CH, and 2) the likelihood to improve health and developmental outcomes in early screened and treated infants. Arguments against lower TSH cut-offs are: 1) not all children detected by lower TSH cut-offs with mild CH would profit from treatment, and 2) an important proportion of mild CH detected by low TSH cut-offs were transient on re-evaluation at age 3 years.

The authors present all available data pro and contra TSH cut-off lowering. However, the debate remains unsolved in the absence of high-quality evidence and in light of studies with contradictory results, e.g. on developmental outcome in infants with mildly elevated TSH at NBS^1,2,3. All the authors agree on two further points: special attention should be given 1) to the iodine status of infants and mothers, and 2) to realize access to NBS programs and care for all newborns worldwide.

1. Trumpff C, De Schepper J, Vanderfaeillie J, Vercruysse N, Van Oyen H, Moreno-Reyes R, Tafforeau J, Vanderpas J, Vandevijvere S. Thyroid-Stimulating Hormone (TSH) Concentration at Birth in Belgian Neonates and Cognitive Development at Preschool Age. Nutrients 2015;7:9018-9032

2. Trumpff C, De Schepper J, Vanderfaeillie J, Vercruysse N, Van Oyen H, Moreno-Reyes R, Tafforeau J, Vandevijvere S. Neonatal thyroid-stimulating hormone concentration and psychomotor development at preschool age. Arch Dis Child 2016; 101:1100-1106

3. Lain SJ, Bentley JP, Wiley V, Roberts CL, Jack M, Wilcken B, Nassar N. Association between borderline neonatal thyroid-stimulating hormone concentrations and educational and developmental outcomes: a population-based record-linkage study. Lancet Diabetes Endocrinol 2016;4:756-765