Universal screening of all neonates has for long been recognized as the most effective method to prevent the severe developmental and physical morbidities associated with congenital hypothyroidism(1). However, despite its proven community benefits, for health planners in India, this newborn screening program remains a low priority.

Screening of neonates for congenital hypo-thyroidism (CH) was commenced at the Malankara Orthodox Syrian Church Medical College, Kochi in October 2006. The blood is sampled between 72-120 hours of life by heel prick, on to ‘Three’ pre-marked circles of 1 cm diameter on Schleiecher and Schuell specimen collection filter paper, air dried and TSH levels estimated by Sandwich Enzyme Linked Immunoassay using Bio-rad® QuantaseTM kit. TSH levels less than 10 mU/L were considered normal, 10-20 mU/L considered borderline and >20 mU/L as abnormal(2). The cost per TSH screening test was Rs 85/-.

Infants with TSH values ³10 mU/L were reassessed by measuring a ‘formal’ serum T4 and TSH by ELISA (Lilac®). Those with formal serum TSH ³20 mU/L and T4 <7 µg/dL were considered as hypothyroid and included for the present analysis. These infants were immediately commenced on thyroxin replacement therapy of 10-15 µg/kg/day(3). Infants with borderline T4 or TSH values were followed up at biweekly to monthly intervals, until both T4 and TSH levels reached normal levels or serum T4 estimates dropped to hypothyroid levels. 2964 term babies were screened by heel prick over a 12 month period between 1st October 2006 and 30th September 2007. 2872 of these were inborn and were considered for calculating the hospital based incidence of CH. TSH values were ³10 mU/L in 106 infants. Serum T4 and TSH assay confirmed neonatal hypothyroidism in 6 of them. All of them were inborn infants. The study revealed congenital hypothyroidism incidence of 2.1 per 1000 (6/2872) amongst inborn term infants, much higher than the incidence of 1 in 4000 reported in Western literature and 1 in 1700 from other regions of India(4,5). The better pick up rate and the lower costs makes TSH assay a better screening tool than T4 assessment(2,4).

Despite the overwhelming evidence of a high prevalence of congenital hypothyroidism in India, this eminently treatable cause for developmental delay and mental retardation continues to await a credible universal screening program. We believe that the filter paper method for TSH assessment is a viable option for the ‘universal screening’ of newborns for congenital hypothyroidism in India. How long do we have to wait before a mandatory screening program is implemented in our country?

Urvi Sanghvi and KK Diwakar,
Department of Neonatology,
Malankara Orthodox Syrian Church
Medical College,
Kolenchery PO, Kochi 682311, Kerala, India.
E-mail: [email protected] 

1. Hulse JA, Grant DB, Clayton BE, Lilly P, Jackson D, Spracklan A, et al. Population screening for congenital hypothyroidism. Br Med J 1980; 280: 675-678.

2. American Academy of Pediatrics. AAP Section on Endocrinology and Committee on Genetics, and American Thyroid Association Committee on Public Health: Newborn screening for congenital hypothyroidism: recommended guidelines. Pediatrics 1993; 91: 1203-1209.

3. Rose SR, Brown RS, Foley T, Kaplowitz TP, Kaye CI, Sundararjan S, et al. Update of new- born screening and therapy for congenital hypo-thyroidism, Pediatrics 2006; 117: p. 2290-2303.

4. Lee MM, Moshang T Jr. Endocrine Disorders of the New Born. In: Macdonald MG, Seshia MMK, Mullett MD (Eds) Avery’s Neonatology Pathophysiology and Manage- ment of the Newborn. 6th Ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 914-939.

5. Devi AR, Naushad SM. Newborn screening in India. Indian Pediatr 2004; 71: 157-160.