Need for neonatal screening program in India: A national priority

Diagnosis and Management of Hypothyroidism: Addressing the Knowledge-Action Gaps

Hypothyroidism presents a large epidemiological burden in India. As a result of subtle and nonspecific clinical symptoms and signs, the condition often goes undiagnosed and is not adequately treated when it is detected. There is heterogeneity in the diagnostic and treatment approaches to hypothyroidism. As a result of the physiological changes in thyroid hormones with age and illness, it is important to tailor the diagnosis and management of this condition in specific populations including pregnant women, infants, children, geriatric patients, and those with comorbid conditions. Enhanced understanding and education of physicians and patients can help to improve the outcomes of treatment in hypothyroidism which should be focused on patient-centered care. Policies and reforms should be crafted and implemented at the national level to curb public health challenges of hypothyroidism. This publication summarizes the recommendations of a national advisory board meeting to identify and bridge the gaps in understanding of the diagnosis and treatment of hypothyroidism in India. As a complement to clinical judgment, these recommendations will foster the diagnosis and management of hypothyroidism in the community and clinics for the benefit of the patients.

FUNDING

Merck Ltd, India.

Effect of maternal and neonatal factors on cord blood thyroid stimulating hormone

BACKGROUND

Congenital hypothyroidism (CH) is most common preventable cause of mental retardation in children. Cord blood Thyroid Stimulating Hormone (CBTSH) level is an accepted screening tool for CH.

OBJECTIVES

To study CBTSH profile in neonates born at tertiary care referral center and to analyze the influence of maternal and neonatal factors on their levels.

DESIGN

Cross retrospective sectional study.

METHODS

Study population included 979 neonates (males = 506 to females = 473). The CBTSH levels were estimated using electrochemiluminescence immunoassay on Cobas analyzer. Kit based cut-offs of TSH level were used for analysis. All neonates with abnormal CBSTH levels, were started on levothyroxine supplementation 10 μg/Kg/day and TSH levels were reassessed as per departmental protocol.

RESULTS

The mean CBTSH was 7.82 μIU/mL (Range 0.112 to 81.4, SD = 5.48). The mean CBTSH level was significantly higher in first order neonates, neonates delivered by assisted vaginal delivery and normal delivery, delivered at term or preterm, neonates with APGAR score <5 and those needing advanced resuscitation after birth. The CBTSH level >16.10 and <1.0 μIU/mL was found in 4.39 % and 1.02 % neonates respectively. The prevalence rate of CBTSH level >16.1 μIU/mL was significantly higher in neonates delivered by assisted vaginal delivery and normal delivery, term and preterm neonates, APAGR score of <5, presence of fetal distress, need for resuscitation beyond initial steps and in those with birth weight of <1.5 Kg. Three neonates were confirmed to have CH after retesting of TSH level.

CONCLUSIONS

The CBTSH estimation is an easy, non-invasive method for screening for CH. The cutoff level of CB TSH (μIU/mL) >16.10 and <1.0 led to a recall of 5.41% of neonates which is practicable given the scenario in our Country. The mode of delivery and perinatal stress factors have a significant impact on CBTSH levels and any rise to be seen in the light of these factors. The prevalence rate of CH after recall was ~3 in 1000 live births.

Iodine Nutritional Status among Adolescent Girls in Uttarakhand, India

INTRODUCTION

Uttarakhand (UK) state is a known endemic region for Iodine deficiency.

OBJECTIVE

To assess iodine nutritional status among adolescent girls in districts: Udham Singh Nagar (USN), Nainital (N) and Pauri (P) of UK state.

METHODS

In each district, 30 clusters (schools) were identified by using population proportionate to size cluster sampling. In each school, 60 girls (12-18 years) attending the schools were included. Total of 5430 girls from USN (1823), N (1811) and P (1796) were studied. Clinical examination of thyroid of each girl was conducted. From each cluster, spot urine and salt samples were collected.

RESULTS

Total goiter rate was found to be 6.8% (USN), 8.2% (N) and 5.6% (P). Median urinary iodine concentration levels were 250 μg/l (USN), 200 μg/l (N) and 183 μg/l (P).

CONCLUSION

Findings of the study documented that adolescent girls had adequate iodine nutritional status in the three districts of UK.