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## Complete Summary

#### GUIDELINE TITLE

Screening for congenital hypothyroidism: U.S. Preventive Services Task
Force reaffirmation recommendation statement.

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Preventive Services Task Force (USPSTF). Screening for congenital
hypothyroidism: U.S. Preventive Services Task Force reaffirmation
recommendation statement. Rockville (MD): Agency for Healthcare Research
and Quality (AHRQ); 2008 Mar. 6 p. \[5 references\]

US Preventive Services Task Force. Screening for congenital
hypothyroidism: US Preventive Services Task Force reaffirmation
recommendation. Ann Fam Med 2008 Mar-Apr;6(2):166.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18332410)

#### GUIDELINE STATUS

This is the current release of the guideline.

This release updates a previously published guideline: U.S. Preventive
Services Task Force. Guide to clinical preventive services. 2nd ed.
Baltimore (MD): Williams & Wilkins; 1996. Chapter 45, Screening for
congenital hypothyroidism. p. 503-507. \[39 references\]

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Congenital hypothyroidism

#### GUIDELINE CATEGORY

Prevention\
Screening

#### CLINICAL SPECIALTY

Family Practice\
Medical Genetics\
Nursing\
Obstetrics and Gynecology\
Pediatrics\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Health Care Providers\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

-   To summarize the U.S. Preventive Services Task Force (USPSTF)
    recommendations and supporting scientific evidence on screening for
    congenital hypothyroidism

-   To reaffirm the 1996 USPSTF recommendations on screening for
    congenital hypothyroidism

#### TARGET POPULATION

All newborn infants

#### INTERVENTIONS AND PRACTICES CONSIDERED

Screening for congenital hypothyroidism by serum thyroxine (T~4~) and/or
thyroid-stimulating hormone (TSH) performed on capillary blood collected
from a heel stick and adsorbed onto filter paper

#### MAJOR OUTCOMES CONSIDERED

-   Benefits of screening for congenital hypothyroidism

-   Potential harms of screening for congenital hypothyroidism

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

**Note from the National Guideline Clearinghouse (NGC)**: A targeted
review of the literature was prepared by Agency for Healthcare Research
and Quality (AHRQ) staff for use by the U.S. Preventive Services Task
Force (USPSTF) (see the \"Availability of Companion Documents\" field).

In 2006, the USPSTF decided to update its recommendation statement on
screening for congenital hypothyroidism. Noting that the 1996
recommendation was made on a strong evidence base and that it would take
large, high-quality studies or evidence of substantial harms to overturn
the current recommendation, the USPSTF chose to perform a reaffirmation
update for this topic. The USPSTF performs reaffirmation updates for
older recommendation statements that remain USPSTF priorities, are
within the scope of the USPSTF, and for which there is compelling reason
for the USPSTF to have a current recommendation statement.

To assist the USPSTF in updating its 1996 recommendation on screening
for congenital hypothyroidism, staff at AHRQ performed a targeted search
of the medical literature from January 1, 1995, to September 14, 2006,
and consulted with subject area experts. The goal of this targeted
review was to find new, high-quality evidence regarding the benefits and
potential harms of screening for congenital hypothyroidism. Thirty-eight
studies were initially identified. No studies on benefits and three
studies relating to potential harms were found to meet review inclusion
criteria.

#### NUMBER OF SOURCE DOCUMENTS

Three studies relating to potential harms were found to meet review
inclusion criteria.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The U.S. Preventive Services Task Force (USPSTF) systematically reviews
the evidence concerning both the benefits and harms of widespread
implementation of a preventive service. It then assesses the certainty
of the evidence and the magnitude of the benefits and harms. On the
basis of this assessment, the USPSTF assigns a letter grade to each
preventive service signifying its recommendation about provision of the
service (see Table below). An important, but often challenging, step is
determining the balance between benefits and harms to estimate \"net
benefit\" (that is, benefits minus harms).

**Table 1. U.S. Preventive Services Task Force Recommendation Grid\***

  ------------------------------------------------------------------------------------------
  **Certainty of Net        **Magnitude of                               
  Benefit**                 Net Benefit**                                
  ------------------------- ----------------- -------------- ----------- -------------------
                            **Substantial**   **Moderate**   **Small**   **Zero/Negative**

  High                      A                 B              C           D

  Moderate                  B                 B              C           D

  Low                       Insufficient                                 
  ------------------------------------------------------------------------------------------

\**A*, *B*, *C*, *D*, and *Insufficient* represent the letter grades of
recommendation or statement of insufficient evidence assigned by the
U.S. Preventive Services Task Force after assessing certainty and
magnitude of net benefit of the service (see the \"Rating Scheme for the
Strength of the Recommendations\" field.

The overarching question that the Task Force seeks to answer for every
preventive service is whether evidence suggests that provision of the
service would improve health outcomes if implemented in a general
primary care population. For screening topics, this standard could be
met by a large randomized, controlled trial (RCT) in a representative
asymptomatic population with follow-up of all members of both the group
\"invited for screening\" and the group \"not invited for screening.\"

Direct RCT evidence about screening is often unavailable so when the
Task Force undertakes a full systematic review, it considers indirect
evidence. To guide its selection of indirect evidence, the Task Force
constructs a \"chain of evidence\" within an analytic framework. Each
arrow in the framework defines a key question, and each key question
represents a link in the chain of evidence. Rectangles in the framework
represent the intermediate outcomes (rounded corners) or the health
outcomes (square corners); ovals represent harms. To form an unbroken
chain, evidence must support each link in the chain, thereby connecting
the target population (far left side of the framework) to the improved
health outcome (far right side of the framework). For each key question,
the body of pertinent literature is critically appraised, focusing on
the following 6 questions:

1.  Do the studies have the appropriate research design to answer the
    key question(s)?

2.  To what extent are the existing studies of high quality? (i.e., what
    is the internal validity?)

3.  To what extent are the results of the studies generalizable to the
    general U.S. primary care population and situation? (i.e., what is
    the external validity?)

4.  How many studies have been conducted that address the key
    question(s)? How large are the studies? (i.e., what is the precision
    of the evidence?)

5.  How consistent are the results of the studies?

6.  Are there additional factors that assist us in drawing conclusions
    (e.g., presence or absence of dose--response effects, fit within a
    biologic model)?

The next step in the Task Force process is to use the evidence from the
key questions to assess whether there would be net benefit if the
service were implemented. In 2001, the USPSTF published an article that
documented its systematic processes of evidence evaluation and
recommendation development. At that time, the Task Force\'s overall
assessment of evidence was described as good, fair, or poor. The Task
Force realized that this rating seemed to apply only to how well studies
were conducted and did not fully capture all of the issues that go into
an overall assessment of the evidence about net benefit. To avoid
confusion, the USPSTF has changed its terminology. Whereas individual
study quality will continue to be characterized as good, fair, or poor,
the term *certainty* will now be used to describe the Task Force\'s
assessment of the overall body of evidence about net benefit of a
preventive service and the likelihood that the assessment is correct.
Certainty will be determined by considering all 6 questions listed
above; the judgment about certainty will be described as high, moderate,
or low.

In making its assessment of certainty about net benefit, the evaluation
of the evidence from each key question plays a primary role. It is
important to note that the Task Force makes recommendations for
real-world medical practice in the United States and must determine to
what extent the evidence for each key question---even evidence from
screening RCTs or treatment RCTs---can be applied to the general primary
care population. Frequently, studies are conducted in highly selected
populations under special conditions. The Task Force must consider
differences between the general primary care population and the
populations studied in RCTs and make judgments about the likelihood of
observing the same effect in actual practice.

It is also important to note that 1 of the key questions in the analytic
framework refers to the potential harms of the preventive service. The
Task Force considers the evidence about the benefits and harms of
preventive services separately and equally. Data about harms are often
obtained from observational studies because harms observed in RCTs may
not be representative of those found in usual practice and because some
harms are not completely measured and reported in RCTs.

Putting the body of evidence for all key questions together as a chain,
the Task Force assesses the certainty of net benefit of a preventive
service by asking the 6 major questions listed above. The Task Force
would rate a body of convincing evidence about the benefits of a service
that, for example, derives from several RCTs of screening in which the
estimate of benefits can be generalized to the general primary care
population as \"high\" certainty (see the \"Rating Scheme for the
Strength of Recommendations\" field). The Task Force would rate a body
of evidence that was not clearly applicable to general practice or has
other defects in quality, research design, or consistency of studies as
\"moderate\" certainty. Certainty is \"low\" when, for example, there
are gaps in the evidence linking parts of the analytic framework, when
evidence to determine the harms of treatment is unavailable, or when
evidence about the benefits of treatment is insufficient. Table 4 in the
methodology document listed below (see \"Availability of Companion
Documents\" field) summarizes the current terminology used by the Task
Force to describe the critical assessment of evidence at all 3 levels:
individual studies, key questions, and overall certainty of net benefit
of the preventive service.

Some clinical preventive services have a strong, well-established
evidence base and are a routine part of clinical practice. Because it is
unlikely that new evidence will change USPSTF recommendations for such
services, the USPSTF reviews the evidence for them in an expedited
manner by conducting literature searches that address benefits and harms
and consulting experts. The reaffirmation recommendation statement on
Screening for Congenital Hypothyroidism was developed on the basis of
such an expedited literature review.

**Sources**

1.  Sawaya GF et al., Update on the methods of the U.S. Preventive
    Services Task Force: estimating certainty and magnitude of net
    benefit. Ann Intern Med. 2007;147:871-875. \[5 references\].

2.  Guirguis-Blake J, et al. Current processes of the U.S. Preventive
    Services Task Force: refining evidence-based recommendation
    development. Ann Intern Med. 2007;147:117-122. \[2 references\]

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**What the United States Preventive Services Task Force (USPSTF) Grades
Mean and Suggestions for Practice**

  ---------------------------------------------------------------------------
  **Grade**   **Grade Definitions**          **Suggestions for Practice**
  ----------- ------------------------------ --------------------------------
  A           The USPSTF recommends the      Offer or provide this service.
              service. There is high         
              certainty that the net benefit 
              is substantial.                

  B           The USPSTF recommends the      Offer or provide this service.
              service. There is high         
              certainty that the net benefit 
              is moderate or there is        
              moderate certainty that the    
              net benefit is moderate to     
              substantial.                   

  C           The USPSTF recommends against  Offer/provide this service only
              routinely providing the        if there are other
              service. There may be          considerations in support of the
              considerations that support    offering/providing the service
              providing the service in an    in an individual patient.
              individual patient. There is   
              moderate or high certainty     
              that the net benefit is small. 

  D           The USPSTF recommends against  Discourage the use of this
              the service. There is moderate service.
              or high certainty that the     
              service has no net benefit or  
              that the harms outweigh the    
              benefits.                      

  I\          The USPSTF concludes that the  Read \"Clinical Considerations\"
  Statement   current evidence is            section of USPSTF Recommendation
              insufficient to assess the     Statement (see \"Major
              balance of benefits and harms  Recommendations\" field). If
              of the service. Evidence is    offered, patients should
              lacking, of poor quality or    understand the uncertainty about
              conflicting, and the balance   the balance of benefits and
              of benefits and harms cannot   harms.
              be determined.                 
  ---------------------------------------------------------------------------

**USPSTF Levels of Certainty Regarding Net Benefit**

**Definition**: The U.S. Preventive Services Task Force defines
certainty as \"likelihood that the USPSTF assessment of the net benefit
of a preventive service is correct.\" The net benefit is defined as
benefit minus harm of the preventive service as implemented in a
general, primary care population. The USPSTF assigns a certainty level
based on the nature of the overall evidence available to assess the net
benefit of a preventive service.

+---------+------------------------------------------------------------+
| **Level | **Description**                                            |
| of      |                                                            |
| Cert    |                                                            |
| ainty** |                                                            |
+=========+============================================================+
| High    | The available evidence usually includes consistent results |
|         | from well-designed, well-conducted studies in              |
|         | representative primary care populations. These studies     |
|         | assess the effects of the preventive service on health     |
|         | outcomes. This conclusion is therefore unlikely to be      |
|         | strongly affected by the results of future studies.        |
+---------+------------------------------------------------------------+
| M       | The available evidence is sufficient to determine the      |
| oderate | effects of the preventive service on health outcomes, but  |
|         | confidence in the estimate is constrained by factors such  |
|         | as:                                                        |
|         |                                                            |
|         | -   The number, size, or quality of individual studies     |
|         |                                                            |
|         | -   Inconsistency of findings across individual studies    |
|         |                                                            |
|         | -   Limited generalizability of findings to routine        |
|         |     primary care practice                                  |
|         |                                                            |
|         | -   Lack of coherence in the chain of evidence             |
|         |                                                            |
|         | As more information becomes available, the magnitude or    |
|         | direction of the observed effect could change, and this    |
|         | change may be large enough to alter the conclusion.        |
+---------+------------------------------------------------------------+
| Low     | The available evidence is insufficient to assess effects   |
|         | on health outcomes. Evidence is insufficient because of:   |
|         |                                                            |
|         | -   The limited number or size of studies                  |
|         |                                                            |
|         | -   Important flaws in study design or methods             |
|         |                                                            |
|         | -   Inconsistency of findings across individual studies    |
|         |                                                            |
|         | -   Gaps in the chain of evidence                          |
|         |                                                            |
|         | -   Findings not generalizable to routine primary care     |
|         |     practice                                               |
|         |                                                            |
|         | -   A lack of information on important health outcomes     |
|         |                                                            |
|         | More information may allow an estimation of effects on     |
|         | health outcomes.                                           |
+---------+------------------------------------------------------------+

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Comparison with Guidelines from Other Groups\
External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

[Peer Review]{.underline}. Before the U.S. Preventive Services Task
Force makes its final determinations about recommendations on a given
preventive service, the Evidence-Based Practice Center and the Agency
for Healthcare Research and Quality send a draft evidence review to 4 to
6 external experts and to federal agencies and professional and
disease-based health organizations with interests in the topic. They ask
the experts to examine the review critically for accuracy and
completeness and to respond to a series of specific questions about the
document. After assembling these external review comments and
documenting the proposed response to key comments, the topic team
presents this information to the Task Force in memo form. In this way,
the Task Force can consider these external comments before it votes on
its recommendations about the service. Draft recommendation statements
are then circulated for comment from reviewers representing professional
societies, voluntary organizations and Federal agencies. These comments
are discussed before the final recommendations are confirmed.

[Comparison with Guidelines from Other Groups]{.underline}.
Recommendations for screening from the following groups were discussed:
the European Society of Paediatric Endocrinology, the American Academy
of Pediatrics, the American Academy of Family Physicians, the American
Thyroid Association, and the Lawson Wilkins Pediatric Endocrine Society.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

The US Preventive Services Task Force (USPSTF) grades its
recommendations (A, B, C, D, or I) and identifies the Levels of
Certainty regarding Net Benefit (High, Moderate, and Low). The
definitions of these grades can be found at the end of the \"Major
Recommendations\" field.

**[Summary of Recommendation and Evidence]{.underline}**

The U. S. Preventive Services Task Force (USPSTF) recommends screening
for congenital hypothyroidism (CH) in newborns. **This is a grade A
recommendation.**

**[Clinical Considerations]{.underline}**

**Patient Population under Consideration**

This recommendation applies all infants born in the U.S. Premature, very
low birth weight and ill infants may benefit from additional screening
because these conditions are associated with decreased sensitivity and
specificity of screening tests.

**Screening Tests**

Screening for CH is mandated in all 50 states and the District of
Columbia, though methods of screening vary. There are two main methods
used in the U.S.: Primary thyroid-stimulating hormone (TSH) with backup
serum thyroxine (T~4~); and primary T~4~ with backup TSH. A few states
use both tests in initial screening. Clinicians should become familiar
with the tests used in their area and the limitations of the employed
screening strategy. For example, a primary TSH method may be falsely
negative in low and very low birth weight infants with CH because of
delayed elevation in TSH. Additionally, few states currently screen for
centrally-mediated congenital hypothyroidism. Families should be
provided with appropriate information about newborn screening tests,
including the benefits and harms of screening. They should be aware of
the potential of a false positive test, and the process required for
definitive testing. Nationally, only 1 in 25 positive screening tests
are confirmed to be CH. Normal newborn screening results for CH should
not preclude appropriate evaluation of infants presenting with clinical
signs and symptoms suggestive of hypothyroidism.

**Timing of Screening**

Infants should be tested between 2 and 4 days of age. Infants discharged
from hospitals before 48 hours of life should be tested immediately
before discharge. Specimens obtained in the first 24-48 hours of age may
be falsely elevated for TSH regardless of the screening method used.

**Treatment**

Primary care clinicians should ensure that infants with abnormal screens
receive confirmatory testing and begin appropriate treatment with
thyroid hormone replacement within 2 weeks after birth. Children with
positive confirmatory testing in whom no permanent cause of CH is found
(such as lack of thyroid tissue on thyroid ultrasound or thyroid scan),
should, at some time point after the age of 3 years, undergo a 30-day
trial of reduced or discontinued thyroid hormone replacement therapy to
determine if the hypothyroidism is permanent or transient.

**[Definitions]{.underline}**:

**What the United States Preventive Services Task Force (USPSTF) Grades
Mean and Suggestions for Practice**

  ---------------------------------------------------------------------------
  **Grade**   **Grade Definitions**          **Suggestions for Practice**
  ----------- ------------------------------ --------------------------------
  A           The USPSTF recommends the      Offer or provide this service.
              service. There is high         
              certainty that the net benefit 
              is substantial.                

  B           The USPSTF recommends the      Offer or provide this service.
              service. There is high         
              certainty that the net benefit 
              is moderate or there is        
              moderate certainty that the    
              net benefit is moderate to     
              substantial.                   

  C           The USPSTF recommends against  Offer/provide this service only
              routinely providing the        if there are other
              service. There may be          considerations in support of the
              considerations that support    offering/providing the service
              providing the service in an    in an individual patient.
              individual patient. There is   
              moderate or high certainty     
              that the net benefit is small. 

  D           The USPSTF recommends against  Discourage the use of this
              the service. There is moderate service.
              or high certainty that the     
              service has no net benefit or  
              that the harms outweigh the    
              benefits.                      

  I\          The USPSTF concludes that the  Read \"Clinical Considerations\"
  Statement   current evidence is            section of USPSTF Recommendation
              insufficient to assess the     Statement (see \"Major
              balance of benefits and harms  Recommendations\" field). If
              of the service. Evidence is    offered, patients should
              lacking, of poor quality or    understand the uncertainty about
              conflicting, and the balance   the balance of benefits and
              of benefits and harms cannot   harms.
              be determined.                 
  ---------------------------------------------------------------------------

**USPSTF Levels of Certainty Regarding Net Benefit**

**Definition**: The U.S. Preventive Services Task Force defines
certainty as \"likelihood that the USPSTF assessment of the net benefit
of a preventive service is correct.\" The net benefit is defined as
benefit minus harm of the preventive service as implemented in a
general, primary care population. The USPSTF assigns a certainty level
based on the nature of the overall evidence available to assess the net
benefit of a preventive service.

+---------+------------------------------------------------------------+
| **Level | **Description**                                            |
| of      |                                                            |
| Cert    |                                                            |
| ainty** |                                                            |
+=========+============================================================+
| High    | The available evidence usually includes consistent results |
|         | from well-designed, well-conducted studies in              |
|         | representative primary care populations. These studies     |
|         | assess the effects of the preventive service on health     |
|         | outcomes. This conclusion is therefore unlikely to be      |
|         | strongly affected by the results of future studies.        |
+---------+------------------------------------------------------------+
| M       | The available evidence is sufficient to determine the      |
| oderate | effects of the preventive service on health outcomes, but  |
|         | confidence in the estimate is constrained by factors such  |
|         | as:                                                        |
|         |                                                            |
|         | -   The number, size, or quality of individual studies     |
|         |                                                            |
|         | -   Inconsistency of findings across individual studies    |
|         |                                                            |
|         | -   Limited generalizability of findings to routine        |
|         |     primary care practice                                  |
|         |                                                            |
|         | -   Lack of coherence in the chain of evidence             |
|         |                                                            |
|         | As more information becomes available, the magnitude or    |
|         | direction of the observed effect could change, and this    |
|         | change may be large enough to alter the conclusion.        |
+---------+------------------------------------------------------------+
| Low     | The available evidence is insufficient to assess effects   |
|         | on health outcomes. Evidence is insufficient because of:   |
|         |                                                            |
|         | -   The limited number or size of studies                  |
|         |                                                            |
|         | -   Important flaws in study design or methods             |
|         |                                                            |
|         | -   Inconsistency of findings across individual studies    |
|         |                                                            |
|         | -   Gaps in the chain of evidence                          |
|         |                                                            |
|         | -   Findings not generalizable to routine primary care     |
|         |     practice                                               |
|         |                                                            |
|         | -   A lack of information on important health outcomes     |
|         |                                                            |
|         | More information may allow an estimation of effects on     |
|         | health outcomes.                                           |
+---------+------------------------------------------------------------+

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

**Benefits of Detection and Early Intervention**

Early detection of congenital hypothyroidism (CH) by neonatal screening
and appropriate treatment substantially improves neurodevelopmental
outcomes for affected persons.

#### POTENTIAL HARMS

**Harms of Detection and Early Treatment**

Positive test results, whether true positive or false positive, cause
anxiety in parents. For some parents, this anxiety may be considerable.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   The U.S. Preventive Services Task Force (USPSTF) makes
    recommendations about preventive care services for patients without
    recognized signs or symptoms of the target condition.

-   Recommendations are based on a systematic review of the evidence of
    the benefits and harms and an assessment of the net benefit of the
    service.

-   The USPSTF recognizes that clinical or policy decisions involve more
    considerations than this body of evidence alone. Clinicians and
    policy-makers should understand the evidence but individualize
    decision making to the specific patient or situation.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

The experiences of the first and second U.S. Preventive Services Task
Force (USPSTF), as well as that of other evidence-based guideline
efforts, have highlighted the importance of identifying effective ways
to implement clinical recommendations. Practice guidelines are
relatively weak tools for changing clinical practice when used in
isolation. To effect change, guidelines must be coupled with strategies
to improve their acceptance and feasibility. Such strategies include
enlisting the support of local opinion leaders, using reminder systems
for clinicians and patients, adopting standing orders, and audit and
feedback of information to clinicians about their compliance with
recommended practice.

In the case of preventive services guidelines, implementation needs to
go beyond traditional dissemination and promotion efforts to recognize
the added patient and clinician barriers that affect preventive care.
These include clinicians\' ambivalence about whether preventive medicine
is part of their job, the psychological and practical challenges that
patients face in changing behaviors, lack of access to health care or of
insurance coverage for preventive services for some patients, competing
pressures within the context of shorter office visits, and the lack of
organized systems in most practices to ensure the delivery of
recommended preventive care.

Dissemination strategies have changed dramatically in this age of
electronic information. While recognizing the continuing value of
journals and other print formats for dissemination, the Agency for
Healthcare Research and Quality will make all U.S. Preventive Services
Task Force (USPSTF) products available through its [Web
site](http://www.preventiveservices.ahrq.gov/). The combination of
electronic access and extensive material in the public domain should
make it easier for a broad audience of users to access U.S. Preventive
Services Task Force materials and adapt them for their local needs.
Online access to U.S. Preventive Services Task Force products also opens
up new possibilities for the appearance of the annual, pocket-size
*Guide to Clinical Preventive Services*.

To be successful, approaches for implementing prevention have to be
tailored to the local level and deal with the specific barriers at a
given site, typically requiring the redesign of systems of care. Such a
systems approach to prevention has had notable success in established
staff-model health maintenance organizations, by addressing organization
of care, emphasizing a philosophy of prevention, and altering the
training and incentives for clinicians. Staff-model plans also benefit
from integrated information systems that can track the use of needed
services and generate automatic reminders aimed at patients and
clinicians, some of the most consistently successful interventions.
Information systems remain a major challenge for individual clinicians\'
offices, however, as well as for looser affiliations of practices in
network-model managed care and independent practice associations, where
data on patient visits, referrals, and test results are not always
centralized.

#### IMPLEMENTATION TOOLS

Foreign Language Translations\
Patient Resources\
Personal Digital Assistant (PDA) Downloads\
Pocket Guide/Reference Cards\
Tool Kits

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Preventive Services Task Force (USPSTF). Screening for congenital
hypothyroidism: U.S. Preventive Services Task Force reaffirmation
recommendation statement. Rockville (MD): Agency for Healthcare Research
and Quality (AHRQ); 2008 Mar. 6 p. \[5 references\]

US Preventive Services Task Force. Screening for congenital
hypothyroidism: US Preventive Services Task Force reaffirmation
recommendation. Ann Fam Med 2008 Mar-Apr;6(2):166.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18332410)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1996 (revised 2008 Mar)

#### GUIDELINE DEVELOPER(S)

United States Preventive Services Task Force - Independent Expert Panel

#### GUIDELINE DEVELOPER COMMENT

The U.S. Preventive Services Task Force (USPSTF) is a
federally-appointed panel of independent experts. Conclusions of the
U.S. Preventive Services Task Force do not necessarily reflect policy of
the U.S. Department of Health and Human Services (DHHS) or its agencies.

#### SOURCE(S) OF FUNDING

United States Government

#### GUIDELINE COMMITTEE

U.S. Preventive Services Task Force

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Task Force Members\**: Ned Calonge, MD, MPH, Chair, USPSTF (Chief
Medical Officer and State Epidemiologist, Colorado Department of Public
Health and Environment, Denver, CO); Diana B. Petitti, MD, MPH ,
Vice-chair, USPSTF (Department of Preventive Medicine, Keck School of
Medicine, University of Southern California, Sierra Madre, CA); Thomas
G. DeWitt, MD (Carl Weihl Professor of Pediatrics and Director of the
Division of General and Community Pediatrics, Department of Pediatrics,
Children\'s Hospital Medical Center, Cincinnati, OH); Leon Gordis, MD,
MPH, DrPH (Professor, Epidemiology Department, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD); Kimberly D. Gregory, MD, MPH
(Director, Women\'s Health Services Research and Maternal-Fetal
Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical
Center, Los Angeles, CA); Russell Harris, MD, MPH (Professor of
Medicine, Sheps Center for Health Services Research, University of North
Carolina School of Medicine, Chapel Hill, NC); George Isham, MD, MS
(Medical Director and Chief Health Officer, HealthPartners, Minneapolis,
MN); Michael L. LeFevre, MD, MSPH (Professor, Department of Family and
Community Medicine, University of Missouri School of Medicine, Columbia,
MO); Carol Loveland-Cherry, PhD, RN (Executive Associate Dean, Office of
Academic Affairs, University of Michigan School of Nursing, Ann Arbor,
MI); Lucy N. Marion, PhD, RN (Dean and Professor, School of Nursing,
Medical College of Georgia, Augusta, GA); Virginia A. Moyer, MD, MPH
(Professor, Department of Pediatrics, University of Texas Health Science
Center, Houston, TX); Judith K. Ockene, PhD (Professor of Medicine and
Chief of Division of Preventive and Behavioral Medicine, University of
Massachusetts Medical School, Worcester, MA); George F. Sawaya, MD
(Associate Professor, Department of Obstetrics, Gynecology, and
Reproductive Sciences and Department of Epidemiology and Biostatistics,
University of California, San Francisco, CA); Albert L. Siu, MD, MSPH
(Professor and Chairman, Brookdale Department of Geriatrics and Adult
Development, Mount Sinai Medical Center, New York, NY); Steven M.
Teutsch, MD, MPH (Executive Director, Outcomes Research and Management,
Merck & Company, Inc., West Point, PA); and Barbara P. Yawn, MD, MSPH,
MSc (Director of Research, Olmstead Medical Center, Rochester, MN)

*\*Members of the Task Force at the time this recommendation was
finalized. For a list of current Task Force members, go to
[www.ahrq.gov/clinic/uspstfab.htm](http://www.ahrq.gov/clinic/uspstfab.htm)*.

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The U.S. Preventive Services Task Force has an explicit policy
concerning conflict of interest. All members disclose at each meeting if
they have a significant financial, professional/business, or
intellectual conflict for each topic being discussed. Task Force members
with conflicts may be recused from discussing or voting on
recommendations about the topic in question.

#### GUIDELINE STATUS

This is the current release of the guideline.

This release updates a previously published guideline: U.S. Preventive
Services Task Force. Guide to clinical preventive services. 2nd ed.
Baltimore (MD): Williams & Wilkins; 1996. Chapter 45, Screening for
congenital hypothyroidism. p. 503-507. \[39 references\]

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [U.S. Preventive Services Task
Force (USPSTF) Web site](http://www.ahrq.gov/clinic/uspstfix.htm).

Print copies: Available from the Agency for Healthcare Research and
Quality (AHRQ) Publications Clearinghouse. For more information, go to
<http://www.ahrq.gov/news/pubsix.htm> or call 1-800-358-9295 (U.S.
only).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

Evidence Reviews:

-   Meyers D, Haering S. Screening for congenital hypothyroidism in
    newborns: a literature update for the U.S. Preventive Services Task
    Force. AHRQ Publication No. 08-05109-EF-1. Rockville, Maryland:
    Agency for Healthcare Research and Quality, March 2008. Electronic
    copies: Available from the [U.S. Preventive Services Task Force
    (USPSTF) Web site](http://www.ahrq.gov/clinic/uspstfix.htm).

-   Screening for congenital hypothyroidism: clinical summary of U.S.
    Preventive Services Task Force recommendations. 2008. Electronic
    copies: Available in Portable Document Format (PDF) from the U.S.
    Preventive Services Task Force (USPSTF) Web site. Electronic copies:
    Available from the [U.S. Preventive Services Task Force (USPSTF) Web
    site](http://www.ahrq.gov/clinic/uspstfix.htm).

Background Articles:

-   Barton M et al. How to read the new recommendation statement:
    methods update from the U.S. Preventive Services Task Force. Ann
    Intern Med. 2007;147:123-127.

-   Guirguis-Blake J et al. Current processes of the U.S. Preventive
    Services Task Force: refining evidence-based recommendation
    development. Ann Intern Med. 2007;147:117-122. \[2 references\]

-   Sawaya GF et al., Update on the methods of the U.S. Preventive
    Services Task Force: estimating certainty and magnitude of net
    benefit. Ann Intern Med. 2007;147:871-875. \[5 references\].

Electronic copies: Available from [U.S. Preventive Services Task Force
(USPSTF) Web site](http://www.ahrq.gov/clinic/uspstmeth.htm).

The following is also available:

-   The guide to clinical preventive services, 2007. Recommendations of
    the U.S. Preventive Services Task Force. Rockville (MD): Agency for
    Healthcare Research and Quality (AHRQ), 2007. 228 p. Electronic
    copies available from the [AHRQ Web
    site](http://www.ahrq.gov/clinic/pocketgd.htm).

-   A step-by-step guide to delivering clinical preventive services: a
    systems approach. Rockville (MD): Agency for Healthcare Research and
    Quality (AHRQ), 2002 May. 189 p. Electronic copies available from
    the [AHRQ Web site](http://www.ahrq.gov/ppip/manual/). See the
    related QualityTool summary on the [Health Care Innovations Exchange
    Web site](http://innovations.ahrq.gov/content.aspx?id=542).

Print copies: Available from the Agency for Healthcare Research and
Quality Publications Clearinghouse. For more information, go to
<http://www.ahrq.gov/news/pubsix.htm> or call 1-800-358-9295 (U.S.
only).

The [Electronic Preventive Services Selector
(ePSS)](http://epss.ahrq.gov/PDA/index.jsp), available as a PDA
application and a web-based tool, is a quick hands-on tool designed to
help primary care clinicians identify the screening, counseling, and
preventive medication services that are appropriate for their patients.
It is based on current recommendations of the USPSTF and can be searched
by specific patient characteristics such as age, sex, and selected
behavioral risk factors.

#### PATIENT RESOURCES

The following are available:

-   Men: Stay Healthy at Any Age -- Checklist for Your Next Checkup.
    Rockville (MD): Agency for Healthcare Research and Quality. AHRQ
    Pub. No. 07-IP006-A. February 2007. Electronic copies: Available
    from the [USPSTF Web site](http://www.ahrq.gov/ppip/healthymen.htm).

-   Women: Stay Healthy at Any Age -- Checklist for Your Next Checkup.
    Rockville (MD): Agency for Healthcare Research and Quality. AHRQ
    Pub. No. 07-IP005-A. February 2007. Electronic copies: Available
    from the [USPSTF Web site](http://www.ahrq.gov/ppip/healthywom.htm).

Print copies: Available from the Agency for Healthcare Research and
Quality (AHRQ) Publications Clearinghouse. For more information, go to
<http://www.ahrq.gov/news/pubsix.htm> or call 1-800-358-9295 (U.S.
only).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This summary was completed by ECRI on June 30, 1998. The information was
verified by the guideline developer on December 1, 1998. This NGC
summary was updated by ECRI Institute on March 5, 2008. The updated
information was verified by the guideline developer on March 11, 2008.

#### COPYRIGHT STATEMENT

Requests regarding copyright should be sent to: Randie A. Siegel,
Electronic Dissemination Advisor, Division of Print and Electronic
Publishing, Agency for Healthcare Research and Quality (formerly the
Agency for Health Care Policy and Research), 540 Gaither Road,
Rockville, MD 20850. Facsimile: 301-427-1873. E-mail:
<Randie.siegel@ahrq.hhs.gov>.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
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All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
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Guidelines represented on the NGC Web site are submitted by guideline
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Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008