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A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants



To assess utility and accuracy of a gestational age-based screening targeting premature infants to detect congenital hypothyroidism.

Study design

A prospective cohort study was conducted in infants <35 weeks’ gestational age with clinical outcomes at 2–3 years of age. Patients received newborn screenings at 24 hours and 10–14 days of life. Free T4 (FT4) and thyroid-stimulating hormone (TSH) levels were measured at one month of life and repeated based on algorithm by corrected gestational age.


Among infants <35 weeks gestation (n = 938), the incidence of hypothyroidism requiring treatment was 1:58. TSH levels at one month of age was predictive of treatment (AUC 0.96, 95% CI 0.88–1). The optimal TSH threshold of 8 mIU/L (8 µU/ml) increased the specificity to 0.97 and sensitivity to 0.88. Following initiation of treatment for hypothyroidism during NICU hospitalization, 43.8% (n = 7) were diagnosed with permanent congenital hypothyroidism.


Our study supports a gestational age-based screening algorithm for early detection of hypothyroidism in premature infants.

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Authors and Affiliations



ANS, TOF contributed to the study’s conception, design, investigation, drafted, and revised the final manuscript. WL performed data curation, statistical analysis, drafted, and revised the manuscript. SL and DZ contributed to the study’s design, performed data curation, and reviewed the manuscript. DCK supervised, edited, and revised the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Avni N. Shah.

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Competing interests

Dinushan Kaluarachchi, MBBS serves as a consultant for ONY Biotech, Inc. Wen Li was partially supported by UL1TR003167.

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Shah, A.N., Li, W., Zheng, D. et al. A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants. J Perinatol (2024).

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