Should the levothyroxine starting dose be tailored to disease severity in neonates with congenital hypothyroidism?

Stephen Lafranchi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Early levothyroxine treatment is crucial to minimize neurocognitive impairment associated with congenital hypothyroidism. In this Practice Point commentary, I discuss the findings, implications, and limitations of the study of Mathai et al. in which neonates with congenital hypothyroidism were treated with variable initial doses of levothyroxine. A high initial levothyroxine dose was used for newborn babies with athyreosis, an intermediate dose for those with ectopic glands, and a low dose for those with dyshormonogenesis. Serum free T4 levels normalized within 2 weeks, but serum TSH levels within up to 4 weeks. A dose adjustment (mostly a dose reduction) was required in about half of the neonates in the first 2 weeks of life. As Mathai et al. carried out no neuropsychological tests, we do not know if their approach has a more beneficial effect on neurocognitive outcomes than other treatment strategies. Nevertheless, as tailoring the levothyroxine dose to severity rapidly normalized serum free T4 levels, one would predict a beneficial effect of this approach on neurocognitive outcome.

Original languageEnglish (US)
Pages (from-to)658-659
Number of pages2
JournalNature Clinical Practice Endocrinology and Metabolism
Volume4
Issue number12
DOIs
StatePublished - Dec 2008

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Congenital Hypothyroidism
Thyroxine
Serum
Social Adjustment
Neuropsychological Tests

Keywords

  • Congenital hypothyroidism
  • Free T
  • Newborn screening
  • Thyroid scintigraphy scan
  • TSH

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Should the levothyroxine starting dose be tailored to disease severity in neonates with congenital hypothyroidism? / Lafranchi, Stephen.

In: Nature Clinical Practice Endocrinology and Metabolism, Vol. 4, No. 12, 12.2008, p. 658-659.

Research output: Contribution to journalArticle

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