Clinical Summary

Congenital Hypothyroidism: Screening

March 15, 2008

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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This document is a summary of the 2008 recommendation of the U.S. Preventive Services Task Force (USPSTF) on screening for congenital hypothyroidism in newborns. This summary is intended for use by primary care clinicians.

Population All Newborn Infants1
Recommendation Screening for Congenital Hypothyroidism (CH)
Grade: A
Screening Tests

Two methods of screening are used most frequently in the United States:

  • Primary TSH with backup T4.
  • Primary T4 with backup TSH.

Screening for congenital hypothyroidism (CH) is mandated in all 50 states and the District of Columbia.

Clinicians should become familiar with the tests used in their area and the limitations of the screening strategies employed.
Timing of Screening

Infants should be tested between 2 and 4 days of age.

Infants discharged from hospitals before 48 hours of life should be tested immediately before discharge.
Specimens obtained in the first 24-48 hours of age may be falsely elevated for TSH regardless of the screening method used.
Suggestions for Practice

Infants with abnormal screens should receive confirmatory testing and begin appropriate treatment with thyroid hormone replacement within 2 weeks after birth.

Children with positive confirmatory testing in whom no permanent cause of CH is found should undergo a 30-day trial of reduced or discontinued thyroid hormone replacement therapy to determine if the hypothyroidism is permanent or transient. This trial of reduced or discontinued therapy should take place at some time after the child reaches 3 years of age.
Other Relevant Recommendations from the USPSTF

Additional USPSTF recommendations regarding screening tests for newborns can be accessed at: http://www.uspreventiveservicestaskforce.org/Page/Name/focus-on-children-and-adolescents
1This recommendation applies to all infants born in the U.S. Premature, very low birth weight and ill infants may benefit from additional screening. These conditions are associated with decreased sensitivity and specificity of screening tests.

For a summary of the evidence systematically reviewed in making this recommendation, please go to the full recommendation statement, and supporting documents.