Outcome of Congenitally Hypothyroid Screening Program in Isfahan: Iran From Prevention to Treatment

Abstract

Objectives: Early and proper treatment is crucial to prevent neuropsychologic
deficits in congenital hypothyroidism (CH). Considering
the high prevalence of CH in Isfahan, the aim of this
study was to evaluate the outcome of treatment in CH patients.
Methods: In this study CH neonates diagnosed during screening
program in Isfahan from May 2002 to September 2009 were studied.
Frequent visits were performed to CH patients to monitor
and follow their treatments. Quality of treatment was assessed by
evaluating mean age of treatment initiation and mean TSH and T4
levels before and after treatment and during the first and second
years according to their normal reference ranges.
Results: Of 225,224 screened neonates, 536 were diagnosed as CH
patients. The prevalence of CH was 1/420 live births. Mean age at
starting treatment was 22.9 ± 13.2 days. In 93.7% of patients,
treatment was begun before the 45th day of life. In the first measurement
after initiating the treatment, T4 and TSH were not in
their acceptable range in 3.9% and 9.8% of CH patients, respectively.
Mean T4 and TSH reached to normal range during the
treatment period. T4 reached the normal range earlier than TSH.
Conclusions: The mean age of treatment initiation was in acceptable
range but the findings suggest that both early and high-dose
treatments are crucial for optimal treatment, especially in patients
with severe CH. Further studies are needed to determine the outcome
of treatment specially regarding to different etiologies of CH.
Keywords: Congenital hypothyroidism; Treatment; Isfahan; Iran.