Table 2.

Management of Congenital hypothyroidism (CH)

Medications

L-T4: 10-15 microgram/kg by mouth once daily

Monitoring

Recheck T4, TSH

2-4 weeks after initial treatment is begun

Every 1-2 months in the first 6 months

Every 3-4 months between 6 months and 3 years of age

Every 6-12 months from 3 years of age to end of growth

Goal of therapy

Normalize TSH and maintain T4 and FT4 in upper half of reference range

Assess permanence of CH

If initial thyroid scan shows ectopic/absent gland, CH is permanent

If initial TSH is 50 mU/L and there is no increase in TSH after newborn period, then trial off therapy at 3 years of age

If TSH increases off therapy, consider permanent CH

CH - congenital hypothyroidism, T4 - thyroxin, FT4 - free thyroxin, L-T4 - levothyroxine, TSH - thyroid stimulating antibodies.