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Congenital Hypothyroidism Medication

  • Author: Maala S Daniel, MBBS; Chief Editor: Stephen Kemp, MD, PhD  more...
 
Updated: Dec 16, 2015
 

Medication Summary

Only levothyroxine is recommended for treatment.[10] It has been established as safe, effective, inexpensive, easily administered, and easily monitored. Some authors suggest that generic forms may be just as effective as branded medications,[65] but others diasagree.[66]

No liquid preparations are commercially available in the United States, but they are licensed elsewhere.[67] Pharmacies should be discouraged from dispensing suspensions prepared in-house by crushing tablets and mixing with various agents. The T4 in these preparations is very difficult to keep in suspension, and the delivery of drug is inconsistent.

Parents should be provided the hormone in pill form and taught proper administration. The pills can be crushed in a spoon; dissolved with a small amount of breast milk, water, or other liquid immediately before administration, and administered to the child with a syringe or dropper. The pills should not be mixed in a full bottle of formula. Toddlers readily chew the tablets without problems or complaints.

Optimum dosage regimens and follow-up laboratory monitoring have not yet been determined.[68, 69, 70] Initial dosages of 10-15 mcg/kg/d, equivalent to a starting dose of 50 mcg in many newborns, have been recommended.[11] Equally good developmental results, but with higher thyroid-stimulating hormone (TSH) levels, have been reported with half this starting dose (25 mcg/d).[12]

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Thyroid Hormones

Class Summary

These agents are administered to supplement thyroid hormone in patients with hypothyroidism. Levothyroxine is the preferred form of thyroid hormone replacement in all patients with hypothyroidism.[71] Desiccated thyroid is an obsolete medication made from pooled animal tissue. Desiccated thyroid should not be used.

Levothyroxine (Levothroid, Levoxyl, Synthroid)

 

Also known as L-thyroxine, T4, and thyroxine. A thyroid hormone with proven record of safety, efficacy, and ease of use. In active form, influences growth and maturation of tissues. Involved in normal growth, metabolism, and development.

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Contributor Information and Disclosures
Author

Maala S Daniel, MBBS Attending Physician, Division of Pediatric Endocrinology, Helen DeVos Children's Hospital

Maala S Daniel, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Medical Student Association/Foundation, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel C Postellon, MD Associate Professor or Pediatrics and Human Development, Michigan State University College of Human Medicine; Consulting Staff, Pediatric Endocrine Clinic, Helen DeVos Children's Hospital

Daniel C Postellon, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, Pediatric Endocrine Society, American Diabetes Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry B Bercu, MD Professor, Departments of Pediatrics, Molecular Pharmacology and Physiology, University of South Florida College of Medicine, All Children's Hospital

Barry B Bercu, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Medical Association, American Pediatric Society, Association of Clinical Scientists, Endocrine Society, Florida Medical Association, Pediatric Endocrine Society, Society for Pediatric Research, Southern Society for Pediatric Research, Society for the Study of Reproduction, American Federation for Clinical Research, Pituitary Society

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD Former Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Arlan L Rosenbloom, MD Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology

Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, International Society for Pediatric and Adolescent Diabetes

Disclosure: Nothing to disclose.

Acknowledgements

The author wishes to thank Thomas P Foley Jr, for his instruction and for his efforts in diagnosing and managing this disease.

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An infant with cretinism. Note the hypotonic posture, coarse facial features, and umbilical hernia.
Note the macroglossia.
An infant shown a few months after starting thyroid hormone replacement.
Infant a few months after starting thyroid hormone replacement.
 
 
 
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