eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Congenital Hypothyroidism: Treatment & Medication

Author: Daniel C Postellon, MD, Clinical Associate Professor, College of Human Medicine, Pediatrics and Human Development, Michigan State University; Consulting Staff, Pediatric Endocrine Clinic, DeVos Children's Hospital
Coauthor(s): Michael J Bourgeois, MD, Director of Pediatric Undergraduate Medical Education, Associate Professor, Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Texas Tech University School of Medicine; Surendra Varma, MD, Vice-Chairman and Program Director, University Distinguished Professor, Department of Pediatrics, Texas Tech University School of Medicine
Contributor Information and Disclosures

Updated: May 28, 2008

Treatment

Medical Care

The mainstay in the treatment of congenital hypothyroidism is early diagnosis and thyroid hormone replacement. One study suggested that optimal care includes diagnosis before age 13 days and normalization of thyroid hormone blood levels by age 3 weeks.8

Endemic cretinism can be prevented by appropriate iodine supplementation. Iodization of salt is the usual method, but cooking oil, flour, and drinking water have also been iodinated for this purpose. Long-acting intramuscular injections of iodized oil (Lipiodol) have been used in some areas.

Consultations

The treatment of hypothyroidism is straightforward. However, because of the potential for serious morbidity with inadequate treatment or overtreatment, physicians without experience in treating congenital hypothyroidism should consult a pediatric endocrinologist. Appropriate assistance for psychological, developmental, and educational evaluations should also be solicited.

Diet

Dietary iodide supplementation, especially in endemic areas, can prevent endemic cretinism.

Soy-based formulas may decrease the absorption of levothyroxine.9 This is not a contraindication to their use, even in infants with congenital hypothyroidism. Switching an infant from a milk-based formula to a soy-based formula may increase the dose of thyroid hormone needed to maintain a euthyroid status.

Activity

Activity should be encouraged in children with congenital hypothyroidism, because activity should be encouraged in all children.

Medication

Only levothyroxine is recommended for treatment and has been established as safe, effective, inexpensive, easily administered, and easily monitored. No liquid preparations are commercially available in the United States. 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 very inconsistent. Children have been harmed by this approach.

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. Toddlers readily chew the tablets without problems or complaints.

Thyroid hormones

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. Desiccated thyroid is an obsolete medication made from pooled animal tissue. Desiccated thyroid should not be used because of unknown risks from potential viral or prion contamination.


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.

Adult

Varies, typically 100 to 150 mcg daily, PO.

Pediatric

PO:
<6 months: 8-10 mcg/kg/d PO or 25-50 mcg/d PO; some studies indicate that minimum starting dose of 37.5-50 mcg optimized normalization of T4 and TSH levels with no significant adverse affects
6-12 months: 6-8 mcg/kg/d PO or 50-75 mcg/d PO
1-5 years: 5-6 mcg/kg/d PO or 75-100 mcg/d PO
6-12 years: 4-5 mcg/kg/d PO or 100-150 mcg/d PO
>12 years: 2-3 mcg/kg/d PO or 150 mcg/d PO
IV/IM: 50-75% of PO dose

Absorption is decreased by soy-based formulas, cholestyramine resin, iron salts, sodium polystyrene sulfonate, aluminum hydroxide, and sucralfate; increases antidiabetic drug requirements; thyroid requirements increased by estrogen; increases effects of PO anticoagulants; levels may be decreased by phenytoin

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

In appropriate doses and with appropriate monitoring, no adverse affects; monitor infants for indications of overtreatment (eg, nervousness, hyperactivity, anxiety, tachycardia, palpitations, tremors, fever, diaphoresis, abdominal symptoms, weight loss); in children who have been on inadequate doses for prolonged periods, hyperactivity is common after their dosage has been increased to physiologic replacement; this improves with time as child adjusts to being euthyroid

More on Congenital Hypothyroidism

Overview: Congenital Hypothyroidism
Differential Diagnoses & Workup: Congenital Hypothyroidism
Treatment & Medication: Congenital Hypothyroidism
Follow-up: Congenital Hypothyroidism
Multimedia: Congenital Hypothyroidism
References
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References

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Further Reading

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Keywords

congenital hypothyroidism, thyroid dysfunction, congenital myxedema, endemic cretinism, hypothyroidism, sporadic cretinism, thyroid, inadequate thyroid hormone production, inborn error of thyroid metabolism, iodine deficiency, goiter, thyroid aplasia, thyroid dysplasia, thyroid ectopy, ectopic thyroid, hyperthyroidism, dyshormonogenesis, hypothalamic-pituitary dysfunction, jaundice, hypotonia, macroglossia, umbilical hernia, developmental delay, myxedema, Pendred syndrome, thyroglobulin defect, deiodinase defect, hypopituitarism

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Contributor Information and Disclosures

Author

Daniel C Postellon, MD, Clinical Associate Professor, College of Human Medicine, Pediatrics and Human Development, Michigan State University; Consulting Staff, Pediatric Endocrine Clinic, DeVos Children's Hospital
Daniel C Postellon, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Bourgeois, MD, Director of Pediatric Undergraduate Medical Education, Associate Professor, Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Texas Tech University School of Medicine
Michael J Bourgeois, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Surendra Varma, MD, Vice-Chairman and Program Director, University Distinguished Professor, Department of Pediatrics, Texas Tech University School of Medicine
Surendra Varma, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Medical Association, American Thyroid Association, Endocrine Society, Medical Group Management Association, New York Academy of Sciences, Sigma Xi, Society for Pediatric Radiology, Southern Society for Pediatric Research, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Arlan L Rosenbloom, MD, Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida; 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, Florida Pediatric Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

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 Federation for Clinical Research, American Medical Association, American Pediatric Society, Association of Clinical Scientists, Endocrine Society, Florida Medical Association, Lawson-Wilkins Pediatric Endocrine Society, Pituitary Society, Society for Pediatric Research, Society for the Study of Reproduction, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and 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, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfiser, Inc. Honoraria Consulting

 
 
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