Times of India
25 May 2011
By Umesh Isalkar
Pune, India

Newborn’s Cord Blood or Drop From Heel is Screened
Today is Thyroid Day
Most babies born in private nursing homes, government hospitals and civic bodyrun maternity homes are not put through a thyroid screening test which can help detect and curb the incidence of congenital hypothyroidism (CH), the inadequate thyroid hormone production in infants.

Thyroid hormone deficiency can lead to severe mental and growth retardation as well as heart problems. Since critical development of the nervous system takes place in the first few months after birth, the deficiency may cause irreversible damage.

At the most, babies are put through a physical check to rule out abnormalities. In developed countries, they are routinely tested for as many as 20 debilitating, lethal and congenital diseases at birth by taking a drop of blood from the heel during their stay in the hospital. The tests include genetic conditions like sickle–cell anaemia, congenital hypothyroidism and cystic fibrosis.

In India, the incidence of thyroid hormone deficiency at birth is one in 2,500 newborn babies, while it is one in 4,000 newborn babies in developed countries. The city witnesses 45,000 births every year that puts at least 18 babies in the affliction bracket every year.

Experts said inclusion of neonatal thyroid screening in the national health programme is necessary. Wednesday is Thyroid Day.

"If detected after birth and treated in the first month, congenital hypothyroidism can prevent mental retardation. The clinical manifestations of this condition are subtle and often missed in the neonatal stage. A high index of clinical suspicion is necessary to diagnose congenital hypothyroidism early. Late detection and treatment leads to irreversible brain damage," said paediatric endocrinologist Vaman Khadilkar.

Disorders of the thyroid gland are the most common endocrine disorders of childhood. "In India, the incidence of babies born with thyroid hormone deficiency is high. Barring a few big hospitals, a large number of nursing homes, government–run hospitals and municipal corporation–run maternity homes do not screen babies for thyroid disorder. Government and civic bodies must think of mandatory screening of babies for congenital hypothyroidism," Khadilkar said.

In the west,neonatal thyroid screening programmes have been going on for over three decades,but India does not have a uniform screening programme and hence most congenital hypothyroid babies are not detected early and suffer some permanent residual brain damage, Khadilkar added.

Senior paediatrician N G Kanade said government agencies or health insurance companies were at the forefront of such screening in the west.

"They fund the screening and hence there is acceptance from the patients' side. Therefore, most babies who would have otherwise suffered from thyroid deficiency and subsequent mental retardation are saved from disastrous complications," he said.

Early screening would prevent babies from irreversible brain damage and reduce the number of mentally challenged people, Kanade added. "If babies remain untreated even for a few weeks, it can produce irreversible brain damage that no treatment can reverse," he said.

The screening is not expensive. "It is not more than Rs 150 even in private hospitals. If the government or civic body takes up the cause and starts screening every new born for thyroid disorder, it can be done at a much lower cost. It will not add to the expenses of childbirth in any clinical set up," Kanade said.

"By the time the manifestations are evident it is already too late to prevent residual brain damage. This condition must be detected early in the neonatal period and treatment is started immediately," senior paediatrician Sharad Agarkhedkar said, Educating people and creating awareness about hypothyroidism is equally important, said endocrinologist Vaishali Deshmukh of Deenanath Mangeshkar Hospital.

"Since early diagnosis is the only solution, doctors must educate parents regarding the significance of TSH thyroid testing for their babies at birth. Any form of early diagnosis and treatment can save the child from developing serious health issues," she said.

"Where follow–ups at home post discharge is difficult, cord blood testing is the most practical solution. Heel blood testing of neonates is another way," said Deshmukh.

Thyroid disorders can be medically managed with effective treatment. This results not just in the management of symptoms, but also in improving the life of patients. "The challenge ahead is to increase awareness of effective diagnosis at the right time," said Deshmukh.

R V Jayakumar, president of the Indian Thyroid Society said lower IQ is often the direct result of undiagnosed and untreated thyroid conditions.

"A regular thyroid checkup is needed and expectant mothers should undergo thyroid testing once pregnancy is confirmed as thyroid disorder during pregnancy may affect the mother and the developing foetus."

Decoding Congenital Hypothyroidism
Congenital means present at birth. Hypothyroidism is a condition in which the person does not make enough thyroid hormone. The thyroid gland is a butterfly–shaped organ at the base of the throat. Its job is to make specific hormones that help the cells of the body function correctly.

It makes the hormone also called 'thyroxine', or T4. It is released by the thyroid gland into the bloodstream whenever needed by the body. It helps cells work more efficiently and raise our body temperature. In babies and young children, thyroid hormone is crucial for normal growth and development of the body and brain.

People with hypothyroidism have specific symptoms and health issues. Babies who do not have enough thyroid hormone are often slow to grow, are sluggish, and have learning delays and other specific health problems.

Causes
Missing or misplaced thyroid gland Hereditary causes Maternal iodine deficiency Maternal thyroid condition and medications

Children who remain untreated usually become mentally challenged and are much shorter than average. They may have spasticity and an unsteady gait. Most have speech delays and some have behaviour problems

Spot the Deficiency
Most babies do not have symptoms right away because they are protected by their mother’s thyroid hormone for a few weeks after birth. After about three to four weeks of age, babies must rely on their own production of the thyroid hormone. If they do not make enough, symptoms will show up. Babies with CH do show signs at birth. Some have a yellow tinge to their skin or the whites of their eyes. This is called jaundice

Other Signs
Babies sleep more than usual and do not move as much Poor feeding and poor suck; fewer bowel movements Floppy muscle tone (hypotonia) Swelling around the eyes Large swollen tongue Cool, pale, dry skin Large soft spot on the skull ( fontanelle) that closes late Large belly with protruding navel ('umbilical hernia')

If left untreated, babies may develop some or all of the following effects over time: Coarse, swollen facial features Breathing problems Hoarse–sounding cry Delayed milestones (sitting, crawling, walking, talking) Wide, short hands Poor weight gain and growth Goitre (enlarged thyroid gland causing a lump in the neck) Anaemia Slow heart rate Fluid build–up under the skin (called myxedema) Hearing loss