Down Syndrome Health Screening — MRCPsych Paper B MCQ

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ModerateIntellectual DisabilityDown Syndrome Health ScreeningMRCPsych Paper B

A 30-year-old man with Down syndrome and moderate intellectual disability is clinically well and has no known thyroid disease. He is included on his GP's learning disability register. According to the relevant NICE indicator, how frequently should routine thyroid-stimulating hormone screening be performed?

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Correct answer: C — Annually

The correct answer is C: annually. NICE indicator IND79 applies to adults aged 18 years or over with Down syndrome who are on the learning disability register and are not already on the thyroid disease register. It specifies a record of blood TSH within the previous 15 months, operationalising annual screening. This reflects the increased risk of thyroid dysfunction, particularly hypothyroidism, in people with Down syndrome and the possibility that clinical manifestations may be non-specific or difficult to recognise. Symptom-triggered testing alone is therefore insufficient. Screening every 2 or 5 years, or only once on entering adult services, would not meet the indicator. Once thyroid disease has been diagnosed, subsequent testing is monitoring rather than screening and should follow disease-specific recommendations.

Reference: National Institute for Health and Care Excellence. IND79: Learning disabilities—annual TSH test. Published 2010; last reviewed 2020. https://www.nice.org.uk/indicators/ind79-learning-disabilities-annual-tsh-test