{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T05:04:48Z","timestamp":1787461488549,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T00:00:00Z","timestamp":1684108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Newborn screening (NBS) has largely eliminated the physical and neurodevelopmental effects of untreated congenital hypothyroidism (CH). Many countries, including Australia, have progressively lowered NBS bloodspot thyroid\u2010stimulating hormone (b\u2010TSH) thresholds. The impact of these changes is still unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the performance of CH NBS following the reduction of b\u2010TSH thresholds in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia, from 15 to 8 mIU\/L, and to determine the clinical outcomes of cases detected by these thresholds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>NBS data of 346\u2009849 infants born in NSW\/ACT, Australia from 1 November, 2016\u20131 March, 2020 inclusive were analysed. A clinical audit was conducted on infants with a preliminary diagnosis of CH born between 1 January, 2016\u20131 December, 2020 inclusive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The lowered b\u2010TSH threshold (\u22658 mIU\/L, ~99.5th centile) detected 1668 infants (0.48%), representing an eight\u2010fold increase in recall rate, of whom 212 of 1668 (12.7%) commenced thyroxine treatment. Of these 212 infants, 62 (29.2%) (including eight cases with a preliminary diagnosis of thyroid dysgenesis) had an initial b\u2010TSH 8\u201314.9 mIU\/L. The positive predictive value for a preliminary diagnosis of CH decreased from 74.3% to 12.8% with the lowered threshold. Proportionally, more pre\u2010term infants received a preliminary CH diagnosis on screening with the lower threshold (16.1% of 62) than with the higher threshold (8.0% of 150).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Clinically relevant CH was detected using the lowered threshold, albeit at the cost of an eight\u2010fold increase in recall rate. Further clinical and economic studies are required to determine whether benefits of lowered screening thresholds outweigh potential harms from false\u2010positive results on infants, their families and NBS programs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.16425","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T13:34:22Z","timestamp":1684157662000},"page":"955-961","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Outcomes of lowered newborn screening thresholds for congenital hypothyroidism"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6385-0123","authenticated-orcid":false,"given":"Aolei","family":"Yu","sequence":"first","affiliation":[{"name":"Sydney Medical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Alder","sequence":"additional","affiliation":[{"name":"Sydney Medical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha J","family":"Lain","sequence":"additional","affiliation":[{"name":"Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Wiley","sequence":"additional","affiliation":[{"name":"New South Wales Newborn Screening Program, The Children's Hospital at Westmead  Sydney New South Wales Australia"},{"name":"Disciplines of Genetic Medicine and Paediatrics and Child Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Nassar","sequence":"additional","affiliation":[{"name":"Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5582-1098","authenticated-orcid":false,"given":"Michelle","family":"Jack","sequence":"additional","affiliation":[{"name":"University Centre for Rural Health, Lismore, NSW 2480 University of Sydney  Lismore Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-5-17"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2013.05.008"},{"key":"e_1_2_7_4_1","volume-title":"Guidelines for Management of Congenital Hypothyroidism","author":"Australasian Paediatric Endocrine Group","year":"2007"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-0915"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2020.0333"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0107"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14562"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(16)30122-X"},{"key":"e_1_2_7_10_1","volume-title":"Monitoring the Health Impacts of Mandatory Folic Acid and Iodine Fortification","author":"Australian Institute of Health and Welfare","year":"2016"},{"key":"e_1_2_7_11_1","volume-title":"Iodine Supplementation for Pregnant and Breastfeeding Women","author":"NHMRC","year":"2010"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2022-0403"},{"key":"e_1_2_7_13_1","article-title":"Worldwide recall rate in newborn screening programs for congenital hypothyroidism","volume":"15","author":"Mehran L","year":"2017","journal-title":"Int. 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