Allen D B, Hendricks S A, Sieger J, Hassemer D J, Katcher M L, Maby S L, Duck S C
Department of Pediatrics, University of Wisconsin, Madison.
Am J Dis Child. 1988 Feb;142(2):232-6. doi: 10.1001/archpedi.1988.02150020134049.
High-sensitivity neonatal hypothyroid screening tests are used throughout the country. Because of low specificity, primary care physicians are faced with an abundance of false-positive results that challenge the interpreting physician with clinical, economic, and medicolegal considerations. We surveyed 154 physicians caring for Wisconsin-born infants with the highest newborn-screen thyrotropin values in a two-year period. Our results indicated that (1) confirmation of thyroid normalcy is often delayed beyond 6 weeks of age; (2) there is wide variation among physicians regarding therapeutic goals if hypothyroidism is confirmed; and (3) physicians prefer autonomy in the management of congenital hypothyroidism. Modifications in hypothyroid screening programs may include confirmatory tests by a central laboratory (that distributes filter paper with all abnormal results), provision of a management decision tree for primary care physicians, and a one-time subsidy for a visit to a pediatric endocrinologist. We suggest that these modifications may improve the long-term outcome of hypothyroid infants identified by the screening program.
高灵敏度新生儿甲状腺功能减退筛查测试在全国范围内使用。由于特异性较低，初级保健医生面临大量假阳性结果，这给解读医生带来了临床、经济和法医学方面的考量。我们调查了154名在两年期间为威斯康星州出生的新生儿筛查促甲状腺激素值最高的婴儿提供护理的医生。我们的结果表明：（1）甲状腺功能正常的确认通常会延迟到6周龄以后；（2）如果确诊甲状腺功能减退，医生在治疗目标上存在很大差异；（3）医生在先天性甲状腺功能减退的管理中倾向于自主决策。甲状腺功能减退筛查项目的改进措施可能包括由中央实验室进行确认测试（该实验室会分发所有异常结果的滤纸），为初级保健医生提供管理决策树，以及为看儿科内分泌专家的一次就诊提供一次性补贴。我们认为这些改进措施可能会改善通过筛查项目发现的甲状腺功能减退婴儿的长期预后。
