eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Hypothyroidism: Follow-up

Author: Robert J Ferry Jr, MD, Chief, Division of Pediatric Endocrinology and Diabetes, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center at Memphis and St Jude Children's Research Hospital; Lieutenant Colonel (Medical Corps), 162nd Area Support Medical Company, Army National Guard
Coauthor(s): Andrew J Bauer, MD, Program Director, Department of Pediatrics, Division of Pediatric Endocrinology, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Jul 10, 2008

Follow-up

Further Outpatient Care

  • Once euthyroid, infants with congenital hypothyroidism should be observed every 3 months until they are aged 3 years. Thereafter, these children can be evaluated every 6 months.

Inpatient & Outpatient Medications

  • Levothyroxine is the appropriate replacement therapy for all clinically significant forms of hypothyroidism (see Medical Care).

Deterrence/Prevention

  • Screening of newborns for hypothyroidism is required by law in all 50 US states.
  • One preventable cause of congenital hypothyroidism is avoidance of administration of radioiodine to women who are pregnant.1 Thus, women should undergo pregnancy testing before receiving radioiodine.

Complications

  • The etiology of adverse clinical outcomes is multifactorial. Even with optimal therapy, some children with congenital hypothyroidism display intelligence quotient values lower than would be expected on the basis of genetic potential. Factors associated with this adverse outcome include a markedly low T4 value at birth, a markedly delayed bone age at diagnosis, delay in treatment, and low serum T4 levels during the first year of therapy.

Prognosis

  • The prognosis for patients with congenital hypothyroidism that is appropriately treated within 6 weeks of birth is excellent.
  • Children with acquired hypothyroidism who receive adequate treatment at least 5 years before the onset of puberty typically achieve a final adult height consistent with their genetic potential. Overtreating with thyroid hormone does not enhance catch-up growth and may compromise final adult height by advancing osseous maturation.

Miscellaneous

Medicolegal Pitfalls

  • Failure to make the diagnosis of hypothyroidism in infants remains a major medicolegal issue.
  • All physicians caring for infants must ascertain and document the results of newborn screening tests. Prompt follow-up of abnormal test results is essential.
  • In addition, communicating follow-up testing to the state screening program as soon as practical is important.
  • A normal screening test result in a newborn does not exclude the possibility of congenital hypothyroidism.
  • The clinician should consider this diagnosis in patients with growth failure, developmental delay, failure to thrive, and other symptoms and signs of hypothyroidism (see Clinical).
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Ann Marie Straight, MD to the development and writing of this article.



More on Hypothyroidism

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

  1. Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2007;92(8 Suppl):S1-47. [Medline].

  2. Ayala AR, Danese MD, Ladenson PW. When to treat mild hypothyroidism. Endocrinol Metab Clin North Am. Jun 2000;29(2):399-415. [Medline].

  3. Bongers-Schokking JJ, Koot HM, Wiersma D, et al. Influence of timing and dose of thyroid hormone replacement on development in infants with congenital hypothyroidism. J Pediatr. Mar 2000;136(3):292-7. [Medline].

  4. Brown RS, Bellisario RL, Botero D, et al. Incidence of transient congenital hypothyroidism due to maternal thyrotropin receptor-blocking antibodies in over one million babies. J Clin Endocrinol Metab. Mar 1996;81(3):1147-51. [Medline].

  5. Brown RS, Keating P, Mitchell E. Maternal thyroid-blocking immunoglobulins in congenital hypothyroidism. J Clin Endocrinol Metab. May 1990;70(5):1341-6. [Medline].

  6. Daliva AL, Linder B, DiMartino-Nardi J, Saenger P. Three-year follow-up of borderline congenital hypothyroidism. J Pediatr. Jan 2000;136(1):53-6. [Medline].

  7. DeBoer MD, Lafranchi SH. Pediatric thyroid testing issues. Pediatr Endocrinol Rev. 2007;5 Suppl 1:570-7. [Medline].

  8. Dubuis JM, Glorieux J, Richer F, et al. Outcome of severe congenital hypothyroidism: closing the developmental gap with early high dose levothyroxine treatment. J Clin Endocrinol Metab. Jan 1996;81(1):222-7. [Medline].

  9. Dussault JH. Childhood primary hypothyroidism and endemic cretinism. Curr Ther Endocrinol Metab. 1997;6:107-9. [Medline].

  10. Dussault JH. The anecdotal history of screening for congenital hypothyroidism. J Clin Endocrinol Metab. Dec 1999;84(12):4332-4. [Medline].

  11. Fisher DA. The importance of early management in optimizing IQ in infants with congenital hypothyroidism. J Pediatr. Mar 2000;136(3):273-4. [Medline].

  12. Fisher DA, Schoen EJ, La Franchi S, et al. The hypothalamic-pituitary-thyroid negative feedback control axis in children with treated congenital hypothyroidism. J Clin Endocrinol Metab. Aug 2000;85(8):2722-7. [Medline].

  13. Franceschi R, Camilot M, Teofoli F. Thyrotropin receptor gene mutations and TSH resistance: variable expressivity in the heterozygotes. Clin Endocrinol (Oxf). 2005;63:146-151. [Medline].

  14. Garcia-Filion P, Epport K, Nelson M, et al. Neuroradiographic, endocrinologic, and ophthalmic correlates of adverse developmental outcomes in children with optic nerve hypoplasia: a prospective study. Pediatrics. 2008;121:e653-9. [Medline].

  15. Glinoer D, Delange F. The potential repercussions of maternal, fetal, and neonatal hypothyroxinemia on the progeny. Thyroid. Oct 2000;10(10):871-87. [Medline].

  16. Gruneiro-Papendieck L, Chiesa A, Mendez V. Efficacy of congenital hypothyroidism neonatal screening in preterms less than 32 weeks of gestational age: more evidence. J Pediatr Endocrinol Metab. 2005;18:373-377. [Medline].

  17. Guarnieri GF, Laforgia N, Mautone A, Balducci G. Delayed closure of ductus arteriosus in term newborns with congenital hypothyroidism: effect of L-thyroxine therapy. Pediatr Cardiol. 2008;29:455-6. [Medline].

  18. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. New England Journal of Medicine. 1999;341(8):549-555. [Medline].

  19. Hanukoglu A, Perlman K, Shamis I, et al. Relationship of etiology to treatment in congenital hypothyroidism. J Clin Endocrinol Metab. Jan 2001;86(1):186-91. [Medline].

  20. Hardy O, Worley G, Lee MM, et al. Hypothyroidism in Down syndrome: screening guidelines and testing methodology. Am J Med Genet A. 2004;124:436-7. [Medline].

  21. Hashimoto K, Curty FH, Borges PP, et al. An unliganded thyroid hormone receptor causes severe neurological dysfunction. Proc Natl Acad Sci U S A. Mar 27 2001;98(7):3998-4003. [Medline].

  22. Hopwood NJ, Kelch RP. Thyroid masses: approach to diagnosis and management in childhood and adolescence. Pediatr Rev. Dec 1993;14(12):481-7. [Medline].

  23. Hsiao PH, Chiu YN, Tsai WY, et al. Intellectual outcome of patients with congenital hypothyroidism detected by neonatal screening. J Formos Med Assoc. Jan 2001;100(1):40-4. [Medline].

  24. Hsiao PH, Chiu YN, Tsai WY, et al. Intellectual outcomes of patients with congenital hypothyroidism not detected by neonatal screening. J Formos Med Assoc. Jul 1999;98(7):512-5. [Medline].

  25. Ishikawa N, Eguchi K, Ohmori T, et al. Defective organification of iodide causing congenital goitrous hypothyroidism. J Clin Endocrinol Metab. Jan 1996;81(1):376-83. [Medline].

  26. Kempers MJ, van Trotsenburg AS, van Rijn RR, et al. Loss of integrity of thyroid morphology and function in children born to mothers with inadequately treated Graves' disease. J Clin Endocrinol Metab. 2007;92:2984-91. [Medline].

  27. Kordonouri O, Hartmann R, Riebel T, Liesenkoetter KP. Early treatment with L-thyroxine in children and adolescents with type 1 diabetes, positive thyroid antibodies, and thyroid gland enlargement. Pediatr Diabetes. 2007;8:180-4. [Medline].

  28. LaFranchi S. Congenital hypothyroidism: etiologies, diagnosis, and management. Thyroid. Jul 1999;9(7):735-40. [Medline].

  29. LaFranchi S. Thyroid function in the preterm infant. Thyroid. Jan 1999;9(1):71-8. [Medline].

  30. Lomenick JP, El-Sayyid M, Smith WJ. Effect of levo-thyroxine treatment on weight and body mass index in children with acquired hypothyroidism. J Pediatr. 2008;152:96-100. [Medline].

  31. McElduff A, McElduff P, Wiley V. Neonatal TSH as measured in a congenital hypothyroidism screening program: influence of the mode of delivery. J Clin Endocrinol Metab. 2005;[Medline].

  32. Morreale de Escobar G, Obregon MJ, Escobar del Rey F. Is neuropsychological development related to maternal hypothyroidism or to maternal hypothyroxinemia?. J Clin Endocrinol Metab. Nov 2000;85(11):3975-87. [Medline].

  33. Muller AF, Berghout A, Wiersinga WM, Kooy A, Smits JW, Hermus AR. Thyroid function disorders - Guidelines of the Netherlands Association of Internal Medicine. Neth J Med. 2008;66:134-42. [Medline].

  34. Park SM, Chatterjee VK. Genetics of congenital hypothyroidism. J Med Genet. 2005;42:379-389. [Medline].

  35. Rovet JF. Congenital hypothyroidism: long-term outcome. Thyroid. Jul 1999;9(7):741-8. [Medline].

  36. Ruiz M, Rajatanavin R, Young RA, et al. Familial dysalbuminemic hyperthyroxinemia: a syndrome that can be confused with thyrotoxicosis. N Engl J Med. 1982;306:635-9. [Medline].

  37. Sakata S, Matsuda M, Ogawa T, et al. Prevalence of thyroid hormone autoantibodies in healthy subjects. Clin Endocrinol (Oxf). Sep 1994;41(3):365-70. [Medline].

  38. Sbrocchi AM, Chédeville G, Scuccimarri R, Duffy CM, Krishnamoorthy P. Pediatric hypothyroidism presenting with a polymyositis-like syndrome and increased creatinine: report of three cases. J Pediatr Endocrinol Metab. 2008;21:89-92. [Medline].

  39. Screening for congenital hypothyroidism: US Preventive Services Task Force reaffirmation recommendation. Ann Fam Med. 2008;6:166. [Medline].

  40. Topaloglu AK. Athyreosis, dysgenesis, and dyshormonogenesis in congenital hypothyroidism. Pediatr Endocrinol Rev. 2006;3 Suppl 3:498-502. [Medline].

  41. van der Sluijs Veer L, Kempers MJ, Last BF, Vulsma T, Grootenhuis MA. Quality of life, developmental milestones, and self-esteem of young adults with congenital hypothyroidism diagnosed by neonatal screening. J Clin Endocrinol Metab. May 6 2008;[Medline].

  42. van Tijn DA, de Vijlder JJ, Verbeeten B Jr. Neonatal detection of congenital hypothyroidism of central origin. J Clin Endocrinol Metab. 2005;90:3350-3359. [Medline].

  43. Van Vliet G. Neonatal hypothyroidism: treatment and outcome. Thyroid. Jan 1999;9(1):79-84. [Medline].

  44. Veasey SC, Guilleminault C, Strohl KP, Sanders MH, Ballard RD, Magalang UJ. Medical therapy for obstructive sleep apnea: a review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 2006;29:1036-44. [Medline].

  45. Vela M, Gamboa S, Loera-Luna A, et al. Neonatal screening for congenital hypothyroidism in Mexico: experience, obstacles, and strategies. J Med Screen. 1999;6(2):77-9. [Medline].

  46. Vigone MC, Fugazzola L, Zamproni I. Persistent mild hypothyroidism associated with novel sequence variants of the DUOX2 gene in two siblings. Hum Mutat. 2005;26:395. [Medline].

  47. Woeber KA. Subclinical thyroid dysfunction. Arch Intern Med. May 26 1997;157(10):1065-8. [Medline].

  48. Working Group on Neonatal Screening of the European Society for Paediatric Endo. Revised guidelines for neonatal screening programmes for primary congenital hypothyroidism. Horm Res. 1999;52(1):49-52. [Medline].

  49. Zamproni I, Grasberger H, Cortinovis F, et al. Biallelic inactivation of the dual oxidase maturation factor 2 (DUOXA2) gene as a novel cause of congenital hypothyroidism. J Clin Endocrinol Metab. 2008;93:605-10. [Medline].

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Further Reading

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Keywords

hypothyroidism, congenital hypothyroidism, acquired hypothyroidism, chronic lymphocytic thyroiditis, CLT, autoimmune thyroiditis, Hashimoto thyroiditis, Hashimoto's thyroiditis, Hashimoto disease, Hashimoto's disease, lymphadenoid goiter, infantile hypothyroidism, cretinism, secondary hypothyroidism, transient hypothyroidism, tertiary hypothyroidism, dietary iodine deficiency, goiter, obstructive sleep apnea, constipation, heat intolerance, hyperthyroidism, toxic thyroiditis, Graves disease, Graves' disease, short stature, sexual pseudoprecocity, precocious puberty, galactorrhea, bradycardia, umbilical hernia, thyroid carcinoma, 21 syndrome, Ulrich-Turner syndrome, Klinefelter syndrome, type 1 diabetes mellitus, histiocytosis X, cystinosis

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Contributor Information and Disclosures

Author

Robert J Ferry Jr, MD, Chief, Division of Pediatric Endocrinology and Diabetes, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center at Memphis and St Jude Children's Research Hospital; Lieutenant Colonel (Medical Corps), 162nd Area Support Medical Company, Army National Guard
Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society
Disclosure: Nutropin Speakers Bureau Honoraria Speaking and teaching

Coauthor(s)

Andrew J Bauer, MD, Program Director, Department of Pediatrics, Division of Pediatric Endocrinology, Uniformed Services University of the Health Sciences
Andrew J Bauer, MD is a member of the following medical societies: American Academy of Pediatrics, American Thyroid Association, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Thomas A Wilson, MD, Professor of Clinical Pediatrics, Department of Pediatrics; Director of Pediatric Endocrinology, Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York at Stony Brook
Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Phi Beta Kappa
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

George P Chrousos, MD, FAAP, MACP, MACE, Professor and Chair, Department of Pediatrics, Athens University Medical School
George P Chrousos, MD, FAAP, MACP, MACE is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and 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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