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A primary TSH/backup T4 method A primary T4/backup TSH method In addition, an increasing number of programs use a combined primaryTSH plus T4 approach. Screening Methods With this approach, delayed TSH elevation in infants with TBG deficiency, central hypothyroidism, and hypothyroxinemia will be missed. Delayed TSH elevation is particularly common in infants with LBW<2500g and VLBW < 1500g. Early discharge of mothers and infants (before 48 hours of age) presents a problem because of the normal increase in TSH postnatally Recall rate is 0.05% Dussault JH, J Clin Endocrinol Metab. 1983;56:849–852 Andersen S, Thyroid. 2003;13:1069–1078 Primary TSH/backup T4 method An initial filter-paper blood-spot T4 measurement is followed by a measurement of TSH for filter-paper specimens with low T4 values. Can also identify infants with TBG deficiency (prevalence ranging from 1 in 5000 to 10 000 newborn infants) Central hypothyroidism (low or low-normal T4 with normal TSH concentration; prevalence: l in 50 000 newborn infants). Quantify high T4 values can identify infants with hyperthyroxinemia (1 in 20 000 to l in 40 000 newborn infants). But will miss the condition in an infant with an initially normal T4 concentration and delayed increase in TSH. Primary T4/backup TSH method This represents the ideal screening approach, especially once it is possible for FT4 to be measured accurately and cost-effectively in the eluates from filter-paper blood spots Until T4 and TSH determinations can be performed practically for all infants, physicians should be aware of the potential limitations of each method of screening for CH. Combined Primary TSH plus T4 method It is highly desirable that the blood be collected when the infant is between 2 and 4 days of age The additional incidence of CH based on a second screening at 2 weeks of age is approximately 1 in 30 00
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