{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:05:04Z","timestamp":1792512304198,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010614","name":"Putian University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010614","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To analyze the incidence of congenital hypothyroidism (CH) in Putian, optimize the thyroid-stimulating hormone (TSH) screening cut-off value, and improve diagnostic efficiency and accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on TSH screening data from 50,539 newborns in Putian between July 2020 and November 2022. TSH concentrations in dried blood spots were measured using time-resolved fluorescence immunoassay (TRFIA). The optimal cut-off value was evaluated using percentile analysis and receiver operating characteristic (ROC) curves. Confirmatory tests included serum TSH, free thyroxine (FT4), and thyroid ultrasound.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The detection rate of CH was 1:1,232 (41 cases), with an overall detection rate of 1:555 (including 50 cases of hyperthyrotropinemia). The P99 percentile method determined a TSH cut-off of 11.1 \u03bcIU\/mL, while ROC curve analysis indicated an optimal cut-off range of 9.33\u20139.43 \u03bcIU\/mL (sensitivity 100%, specificity 98.1%, area under the curve [AUC] = 0.997, <jats:italic>P<\/jats:italic> &amp;lt; 0.0001). Adopting a revised cut-off of 9.5 \u03bcIU\/mL reduced recall rates by 10.62% but missed 1 case of hyperthyrotropinemia. Initial TSH positivity exhibited seasonal fluctuations, with higher rates in winter than summer. Among 68 initially negative cases with subsequent elevated venous TSH, 2 were confirmed as CH, highlighting the need for secondary screening in high-risk groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A TSH cut-off of 9.5 \u03bcIU\/mL optimizes CH screening in Putian, balancing sensitivity (100%) and specificity (98.1%). Seasonal TSH variations and high-risk cases (e.g., preterm infants) highlight the need for tailored protocols. 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