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Flow chart for follow up of abnormal thyroid function test at birth
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Figure 1: Flow chart for follow up of abnormal thyroid function test at birth

Mentions: Whenever a decision cannot be made regarding the nature of congenital hypothyroidism it is always prudent to repeat the thyroid function tests at two weeks and one month of life. If the TSH remains persistently high and / or the FT4 is persistently low, treatment should be started with levothyroxine in a dose of 10 – 15 mcg / kg, similar to that for permanent hypothyroidism. However, the need to continue treatment should be reassessed at three years of age, when brain development is complete.[13] If the suspicion of TSHR antibody-induced transient congenital hypothyroidism is high, the treatment can be withdrawn at three-to-six months of age. A recommended flow chart for follow up of abnormal thyroid functions detected at birth is given in Figure 1.

Transient congenital hypothyroidism

Bhavani N - Indian J Endocrinol Metab (2011)

Bottom Line: Isolated hyperthyrotropinemia (normal Tetraiodothyronine (T4) and high Thyroid Stimulating hormone (TSH)) may persist as subclinical hypothyroidism in childhood.Transient hypothyroxinemia (low T4 and normal TSH) is very common in premature babies.The recognition of these conditions will obviate the risks associated with unnecessary thyroxine supplementation in childhood and parental concerns of a life long illness in their offspring.

Affiliation: Department of Endocrinology and Diabetes, Amrita Institute of Medical Sciences, Cochin, Kerala, India.

ABSTRACT
Transient thyroid function abnormalities in the new born which revert back to normal after varying periods of time are mostly identified in the neonatal screening tests for thyroid and are becoming more common because of the survival of many more premature infants. It can be due to factors primarily affecting the thyroid-like iodine deficiency or excess, maternal thyroid-stimulating hormone receptor (TSHR) antibodies, maternal use of antithyroid drugs, DUOX 2 (dual oxidase 2) mutations, and prematurity or those that affect the pituitary-like untreated maternal hyperthyroidism, prematurity, and drugs. Most of these require only observation, whereas some, such as those due to maternal TSHR antibodies may last for upto three-to-six months and may necessitate treatment. Isolated hyperthyrotropinemia (normal Tetraiodothyronine (T4) and high Thyroid Stimulating hormone (TSH)) may persist as subclinical hypothyroidism in childhood. Transient hypothyroxinemia (low T4 and normal TSH) is very common in premature babies. The recognition of these conditions will obviate the risks associated with unnecessary thyroxine supplementation in childhood and parental concerns of a life long illness in their offspring.

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