Diagnostic Considerations

Neonatal hypothyroxinemia

Premature and sick infants have lower levels of thyroid hormone than term infants but usually do not have elevated thyroid-stimulating hormone (TSH) levels.^{[47, 48]}Reference ranges appropriate to the infant's gestational age should be used to avoid confusing this with hypothyroidism. A meta-analysis suggests that treatment of these neonates with thyroxine is futile.^[49]

Transient neonatal hypothyroidism and hyperthyrotropinemia

Ingestion of excessive amounts of iodine,^[50]or of goitrogens such as lithium,^[51]thioamides,^{[33, 52]}or amiodarone,^{[53, 54]}can cause a temporary hypothyroid state. Maternal antibodies to the TSH receptor can also cause temporary hypothyroidism.^{[2, 3, 22]}This may require treatment with levothyroxine for a period of days to months. The etiology of transient hypothyroidism is often unclear.^{[5, 55, 56]}Preterm (< 35 wk gestation) infants may have profound abnormalities of thyroid function at birth, but they may not have permanent hypothyroidism, even infants with birth weights greater than 1500 g.^[57]

Differential Diagnoses

Workup

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Media Gallery

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

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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.

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

Sasigarn A Bowden, MD, FAAP Professor of Pediatrics, Section of Pediatric Endocrinology, Metabolism and Diabetes, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Division of Endocrinology, Nationwide Children’s Hospital; Affiliate Faculty/Principal Investigator, Center for Clinical Translational Research, Research Institute at Nationwide Children’s Hospital

Sasigarn A Bowden, MD, FAAP is a member of the following medical societies: American Society for Bone and Mineral Research, Central Ohio Pediatric Society, Endocrine Society, International Society for Pediatric and Adolescent Diabetes, Pediatric Endocrine Society, 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.