Endocrine Abstracts

Aim: To evaluate current practices relating to diagnosis and treatment of congenital hypothyroidism (CHT) in Aneurin Bevan University Health Board (ABUHB) compared to national guidelines and the use of radioisotope scanning in improving etiological diagnosis.

Method: This service evaluation used a database of paediatric hypothyroid patients in ABUHB. Only children with CHT were included and any children born before January 2014 were excluded. 30 children met these criteria. Clinical notes from Clinical Workstation (CWS) were evaluated on the 30 children. This included how a diagnosis of CHT was made, time from referral to paediatric review, repeat TFTs for the infant, TFTs for the mother, time from diagnosis to commencement of treatment with levothyroxine and whether ultrasound scanning (USS) or radioisotope scanning of the thyroid was performed.

Results: All infants met guidelines for receiving newborn blood spot screening (NBS), further testing and paediatric review following referral. 94.44% of mothers had evidence of TFTs. 94.44% of infants were started on levothyroxine within an appropriate timeframe. All infants received an USS of thyroid and results demonstrated 19 eutopic thyroids, 4 ectopic, 6 absent and 1 unknown. 23 (76.67%) infants had a radioisotope scan performed which showed 10 thyroids with normal uptake, 8 ectopic, 2 agenesis, 1 dysplasia and 1 other. Radioisotope scan detected 4 ectopic thyroids that were missed following USS alone.

Conclusion: Radioisotope scanning was found to be better at detecting ectopic thyroid tissue than USS. Therefore, it is recommended that radioisotope scanning is performed in a greater number of children with CHT to improve the accuracy of etiological diagnosis and to ensure ectopic thyroid tissue is not missed.