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 language | English (US) |
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Pages (from-to) | 658-659 |
Number of pages | 2 |
Journal | Nature Clinical Practice Endocrinology and Metabolism |
Volume | 4 |
Issue number | 12 |
DOIs | |
State | Published - Dec 2008 |
Externally published | Yes |
Keywords
- Congenital hypothyroidism
- Free T
- Newborn screening
- TSH
- Thyroid scintigraphy scan
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Endocrinology