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An input on the incidence of congenital hypothyroidism (CH) is welcome. Studies vary a lot in their estimation of incidence of CH; depending largely on the geographical area with highest being reported from Southern States of India [1]. Prevalence of iodine deficiency too may influence TSH levels [2]. Furthermore, in areas of high incidence of CH, the cost burden due to recall rates would actually be lower for each positive case than in those with a lesser incidence.

With the policy of early discharge after delivery, there is always a possibility to lose subjects in follow up. Parents too are not always receptive to allow pricking the newborn to screen for a non-apparent problem. For screening of a relatively common and treatable condition like congenital hypothyroidism a slightly higher costing due to recall in better than losing of subjects. Nevertheless, we agree that 3rd/ 4th day blood sample is ideal, if collection is ensured and multiple disorders are being screened.

1. Reddy PA, Rajagopal G, Harinarayan CV, Vanaja V, Rajasekhar D, Suresh V, et al. High prevalence of associated birth defects in congenital hypothyroidism. Int J Pediatr Endocrinol. 2010;2010:940980.