Congenital Hypothyroidism treatment:
Cord blood/ venous sample D3-D5
TSH (mU/L)
All newborns should be screened:
Cord blood/ venous sample D3-D5
TSH (mU/L)
<20
|
No further testing
|
>80
|
Immediate TSH & fT4 venous sample
|
Immediate Rx don't wait for report
| |
40-80
|
Immediate TSH & fT4 venous sample
|
Start Rx after report
| |
20-40
|
TSH & fT4 venous sample after 7-10days
|
Rx if TSH >20 in <2wk age
>10 in > 2wk age
| |
T4 & TSH for starting Rx:
T4
|
fT4
|
TSH
|
<8µg/dl
<100nmol/L
|
<1.1ng/dl
<12pmol/L
|
Any
|
<10µg/dl
<128nmol/L
|
<1.17ng/dl
<15pmol/L
|
>20mU/L in <2wk age
>10mU/L in >2wk age
|
N
|
N
|
>10mU/L in >3wk age
|
Rx dose:
L-thyroixine: 10-15 µg/kg/day
Monitoring schedule:
Age
|
Monitoring
| |
0-6m
|
1wk after start of Rx
every 2wks till TSH normal
every 2 months till 6m age
| |
6m-3yr
|
every 3months
| |
>3yrs
|
every 3-16months
| |
4-6wks after any change in dose/brand
| ||
After 3yrs of Rx
|
Stop for 1 month
|
Then TSH, T4
|
Target: maintain T4/fT4 in upper half of normal value
T4: 10-16µg/dl
fT4: 1.4-2.3ng/dl
(Sampling-atleast 4hrs after thyroxine intake)