Congenital Hypothyroidism Differential Diagnoses

Updated: Oct 14, 2017
  • Author: Maala S Daniel, MBBS; Chief Editor: Sasigarn A Bowden, MD  more...
  • Print
DDx

Diagnostic ConsiderationsNeonatal hypothyroxinemiaTransient neonatal hypothyroidism and hyperthyrotropinemia

Premature and sick infants have lower levels of thyroid hormone than term infants but usually do not have elevated thyroid-stimulating hormone (TSH) levels. [45, 46] 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. [47]

Ingestion of excessive amounts of iodine, [48] or of goitrogens such as lithium, [49] thioamides, [50, 30] or amiodarone, [51, 52] can cause a temporary hypothyroid state. Maternal antibodies to the TSH receptor can also cause temporary hypothyroidism. [12, 13, 24] This may require treatment with levothyroxine for a period of days to months. The etiology of transient hypothyroidism is often unclear. [4, 53, 54] 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. [55]

Differential Diagnoses