Article
School based screening for hypothyroidism in Down's syndrome by
dried blood spot TSH measurement
S E Noblea, K Leylandc, C A Findlaye, C E Clarkb, J Redfernc, J M Mackenzied, R W A Girdwoodd, M D C Donaldsone
a Department of
Community Child Health, Lanarkshire Healthcare NHS Trust, Motherwell
ML1 1TB, UK, b Department of
Public Health, Lanarkshire Health Board, Hamilton ML3 0TA, UK, c Department of Community Child Health,
Glasgow G41 8QU, UK, d National
Screening Laboratory, Stobhill, Glasgow G21 3UW, UK, e Department of
Child Health, Royal Hospital for Sick Children, Yorkhill, Glasgow G3
8SJ, UK
Correspondence to: Dr Donaldson email: mdcd1t{at}clinmed.gla.ac.uk
Accepted 4 August 1999
OBJECTIVE
To determine
the feasibility of annual hypothyroid screening of children with
Down's syndrome by measuring thyroid stimulating hormone (TSH) on
dried blood spots at school, and to describe the outcome in positive children.
DESIGNEstablishment
of a register of school children with Down's syndrome, and procedures
for obtaining permission from parents, annual capillary blood samples,
TSH measurement, and clinical assessment of children with TSH values
> 10 mU/litre.
SUBJECTSAll school
age children with Down's syndrome within Lanarkshire and Glasgow
Health Boards during 1996-7 and 1997-8.
RESULTS200
of 214 school children with Down's syndrome were screened. Four of the
unscreened children were receiving thyroxine treatment, and only 5 remained unscreened by default. 15 of the 200 children had capillary
TSH > 10 mU/litre, and all but 1 had evidence of Hashimoto's
thyroiditis. Seven of the 15 children started thyroxine treatment
immediately, 6 with a pronounced rise in venous TSH and subnormal free
thyroxine (fT4), and one with mildly raised TSH and normal fT4 but
symptoms suggesting hypothyroidism. Eight children with mildly raised
venous TSH and normal fT4 were left untreated; 1 year after testing
positive, fT4 remained > 9 pmol/litre in all cases, but 4 children
were started on thyroxine because of a rise in TSH. TSH fell in 3 of
the 4 remaining children and there was a marginal rise in 1; all remain
untreated. The prevalence of thyroid disease in this population is
8.9%.
CONCLUSIONDried
blood spot TSH measurement is effective for detecting hypothyroidism in
Down's syndrome and capillary sampling is easily performed at school.
The existing programme could be extended to the whole of Scotland
within a few years.
Keywords: Down's syndrome; thyroid stimulating hormone; hypothyroidism; screening
© 2000 by Archives of Disease in Childhood
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