School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
Best Pract Res Clin Endocrinol Metab. 2010 Feb;24(1):63-75. doi: 10.1016/j.beem.2009.08.007.
Iodine deficiency is the most common cause of preventable brain damage in the newborn. The indicators for assessing iodine nutritional status include urinary iodine excretion, thyroid size, thyroid stimulating hormone (TSH) and thyroglobulin (Tg) concentrations in the blood. Neonatal TSH concentration is increased when the supply of thyroid hormone and iodine from the maternal circulation to the foetus has been compromised. The World Health Organization (WHO) has suggested that when a sensitive assay is used on samples collected 3-4 days after birth, a <3% frequency of TSH concentrations >5 mIUl(-1) indicates iodine sufficiency in a population. However, many studies have attempted to apply the frequency of neonatal TSH values >5 mIUl(-1) in determining population iodine status and monitoring intervention programmes, and although some have proven to be successful, most have provided conflicting or uncertain data. This is due to the many technical issues that remain unresolved on the use of neonatal TSH screening for monitoring iodine status, making it doubtful as a sensitive and reliable quantitative tool. More research is required to resolve these issues. In the interim, WHO should consider withdrawing its current guidelines for neonatal TSH screening for monitoring iodine deficiency in populations.
碘缺乏是导致新生儿可预防脑损伤的最常见原因。评估碘营养状况的指标包括尿碘排泄量、甲状腺大小、血液中促甲状腺激素（TSH）和甲状腺球蛋白（Tg）浓度。当母体循环向胎儿供应甲状腺激素和碘受到影响时，新生儿 TSH 浓度会升高。世界卫生组织（WHO）建议，在出生后 3-4 天采集样本时使用敏感检测方法，如果 TSH 浓度>5mIU/L 的频率<3%，则表明人群中碘充足。然而，许多研究试图应用新生儿 TSH 值>5mIU/L 的频率来确定人群碘状况和监测干预计划，尽管其中一些已被证明是成功的，但大多数提供的数据相互矛盾或不确定。这是由于在使用新生儿 TSH 筛查监测碘状况方面仍存在许多悬而未决的技术问题，使得其作为一种敏感和可靠的定量工具值得怀疑。需要进一步的研究来解决这些问题。在此期间，世界卫生组织应考虑撤回其目前关于用新生儿 TSH 筛查监测人群碘缺乏的指南。
