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Arch Iran Med. 2019;22(6):310-317.
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  PDF Download: 185

Original Article

Audit of the Congenital Hypothyroidism Screening Program in 15 Provinces of Iran

Ladan Mehran 1, Shahin Yarahmadi 2, Davood Khalili 3, Mehdi Hedayati 4, Atieh Amouzegar 1, Pouria Mousapour 1, Nasrin Ajang 2, Fereydoun Azizi 1 *

1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, Tehran, Iran
3 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences & Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Cellular and Molecular Endocrine Research Center (CMERC), Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: The newborn screening (NBS) program for congenital hypothyroidism (CH) was launched on a national scale in Iran since 2005; we evaluated the program in 15 provinces, from 2011 to 2014.

Methods: Fifteen provinces, including 17 districts, were included in the study. Aggregated data of screening, diagnosis, and management of all neonates born in each district in 2011 were retrospectively gathered and collectively analyzed.

Results: Program coverage ranged from 77 to 100% in different districts. The positive predictive value was low and widely ranged from 1.3 to 15.5. Transient congenital hypothyroidism (TCH) distribution values were over 5 mU/L in more than 3% of the population and were reported in 9 out of 17 districts. Repeated screening test due to inappropriate sampling varied from 0.9% in Lorestan to 36% in Zabol. Recall rate varied from 0.16 in Ardebil to 1.58 in Zanjan. CH incidence was high, with the highest value being observed in Zanjan (1:241 newborns). Screening age at 3–5 days from birth were highly observed in Gonabad (95.2%) and Zanjan (94.5%), with the lowest values observed in Giroft, Zabol, Kerman and Tehran. CH treatment was initiated before 40 days of age in 90.6% of cases. Survival time for TSH normalization event varied among the districts from 25 to 163 days. After withholding treatment at 3 years of age, TCH was identified in 30%–60% of hypothyroid cases.

Conclusion: Main indicators of the screening program have reached the optimal goals defined by the Ministry of Health and Medical Education. However, high false positive rate and non-optimal neonatal TSH distribution values necessitate readdressing these challenging issues.

Keywords: Congenital hypothyroidism, Evaluation, Newborn, Screening
Cite this article as: Mehran L, Yarahmadi S, Davood Khalili D, Hedayati M, Amouzegar A, Mousapour P, Ajang N, et al. Audit of the congenital hypothyroidism screening program in 15 provinces of Iran. Arch Iran Med. 2019;22(6):310–317.
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Submitted: 28 Jun 2019
Accepted: 01 Dec 2018
First published online: 01 Jun 2019
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