Clinical Monitoring Guidelines for Congenital Hypothyroidism: Laboratory Outcome Data in the First Year of Life

• Published in: The Journal of pediatrics 2011-04, Vol.158 (4), p.532-537
• Main Authors: Balhara, Bharti, MD, Misra, Madhusmita, MD, MPH, Levitsky, Lynne L., MD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; children; Congenital Hypothyroidism - blood; Congenital Hypothyroidism - diagnosis; Congenital Hypothyroidism - therapy; Endocrinopathies; Female; General aspects; Guideline Adherence - standards; guidelines; Humans; hypothyroidism; Infant; Infant, Newborn; L-thyroxine; Male; Medical sciences; monitoring; Monitoring, Physiologic - standards; nationalities and ethnic groups; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pediatrics; Practice Guidelines as Topic; Retrospective Studies; Thyroid Function Tests - standards; Thyroid. Thyroid axis (diseases); thyrotropin; Thyrotropin - blood; Thyroxine - blood; Thyroxine - therapeutic use
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2010.10.006

Objective To examine whether current recommendations for thyroid status monitoring in children with congenital hypothyroidism (CH) (monthly in the first 6 months and every 3-4 months subsequently) are adequate, or whether monthly monitoring is necessary throughout the first year. Study design We reviewed charts of 70 children with CH for initial thyroid-stimulating hormone (TSH), frequency of follow-up, dose changes, and thyroxine (T4 ) and TSH levels in the first year. Need for monthly monitoring was determined on the basis of guidelines to maintain T4 /free T4 in the upper half of the normal range and rapidly normalize TSH. Results Monthly monitoring was justified in 75% in the first 6 months and 36% in the next 6 months. Children requiring monthly monitoring in the second 6 months had higher baseline TSH ( P = .02) and lower T4 ( P = .01) than those not requiring monthly monitoring. Thyroid dysgenesis, starting levothyroxine dose, sex, and ethnicity did not predict requirement for monthly monitoring. Thirty percent of children in the first and second 6 months had ≥1 high TSH level, with a T4 /free T4 not in the upper half of the normal range. Conclusion More than a third of children with CH require monthly monitoring between 6 to 12 months on the basis of study criteria. Current monitoring guidelines may need to be reexamined.