School based screening for hypothyroidism in Down's syndrome by dried blood spot TSH measurement

Objective-To determine the feasibility of annual hypothyroid screening of c hildren with Down's syndrome by measuring thyroid stimulating hormone (TSH) on dried blood spots at school, and to describe the outcome in positive ch ildren. Design-Establishment of a register of school children with Down's syndrome, and procedures for obtaining permission from parents, annual capillary blo od samples, TSH measurement, and clinical assessment of children with TSH v alues > 10 mU/litre. Subjects-All school age children with Down's syndrome within Lanarkshire an d Glasgow Health Boards during 1996-7 and 1997-8. Results-200 of 214 school children with Down's syndrome were screened. Four of the unscreened children were receiving thyroxine treatment, and only 5 remained unscreened by default. 15 of the 200 children had capillary TSH > 10 mU/litre, and all but 1 had evidence of Hashimoto's thyroiditis. Seven o f the 15 children started thyroxine treatment immediately, 6 with a pronoun ced rise in venous TSH and subnormal free thyroxine (fT4), and one with mil dly raised TSH and normal fT4 but symptoms suggesting hypothyroidism. Fight children with mildly raised venous TSH and normal fT4 were left untreated; 1 year after testing positive, fT4 remained > 9 pmol/litre in all cases, b ut 4 children were started on thyroxine because of a rise in TSH. TSH fell in 3 of the 4 remaining children and there was a marginal rise in 1; all re main untreated. The prevalence of thyroid disease in this population is gre ater than or equal to 8.9%. Conclusion-Dried blood spot TSH measurement is effective for detecting hypo thyroidism in Down's syndrome and capillary sampling is easily performed at school. The existing programme could be extended to the whole of Scotland within a few years.