congenital hypothyroidism guideline.pdfVIP

Guidelines for Management of Congenital Hypothyroidism Summary Please refer to the full Guidelines below for details. 1. Diagnosis TSH assay is used as the primary newborn screening test for congenital hypothyroidism (CH). 2. Evaluation [Section 4] All babies notified by the central laboratory need immediate evaluation (within 48 hours). History and Examination • Maternal: diet, history of drugs, auto-immune disease • Baby: symptoms and signs of CH, jaundice, goitre, growth parameters, other congenital problems Investigations • Thyroid function tests (TFTs), consisting of thyroid stimulating hormone (TSH) and free thyroxine (FT4) • Plasma bilirubin if indicated • Thyroid scan using technetium99 or I123 • Xray of the knee for bone age (optional) • Maternal and baby TSH receptor antibodies (or antithyroglobulin and antimicrosomal antibodies if former not available) where there is a positive maternal history of auto- immune thyroid disease 3. Treatment [Section 5] • This should be started as soon as congenital hypothyroidism is confirmed on TFTs (preferably same day). • Thyroxine is given at a dose of approximately 10 ug/kg/day. • Thyroxine tablet is crushed and mixed with a little milk or water (prepared suspensions are not sufficiently stable). • Dosage is adjusted according to TFTs aiming to keep the free T4 concentration at the upper end of the normal range and TSH suppressed into the normal range. 4. Follow-up [Section 7] • Follow-up should occur at two weeks, six weeks, three months and then two to three monthly during the first year. Thereafter at three monthly intervals until two to three years, then four monthly. • TFTs are repeated at each visit and dosage adjusted as above. TFTs may need to be performed more frequently if