Congenital Hypothyroidism Guidelines

Updated: May 02, 2023
  • Author: Maala S Daniel, MBBS; Chief Editor: Sasigarn A Bowden, MD, FAAP  more...
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Guidelines Summary

Screening of Newborns

Congenital hypothyroidism is included in the RUSP (Recommended Uniform Screening Panel) list of disorders to be screened at birth recommended by the Department of Health and Human Services. [83] The American Academy of Pediatrics (AAP) guidelines include an algorithm for screening and interpreting results. [58]

The European Society for Paediatric Endocrinology (ESPE) guidelines recommend performing a second screening for the following infants [59] :

  • Preterm, low-birth weight (LBW) and very low-birth weight (VLBW) neonates

  • Infants admitted to neonatal intensive care units (NICU)

  • Infants originally tested within the first 24 hours of life

  • Multiple births (particularly same-sex twins)


The AAP, ESPE, and American Thyroid Association (ATA) guidelines all agree that levothyroxine replacement at a dose of 10–15 μg/kg/day should be initiated once newborn screening is positive. Additional key recommendations from ESPE include the following [59] :

  • Levothyroxine treatment should be initiated as soon as possible and no later than 2 weeks after birth or immediately after confirmatory serum test results in infants with congenital hypothyroidism detected by a second screening test.
  • Infants with severe disease, as defined by a very low pretreatment TT4 or FT4 concentration, should be treated with the highest initial dose
  • L-T4 should be administered orally; if intravenous treatment is necessary, the dose should be no more than 80% of the oral dose, The dose should then be adjusted according to TSH and FT4 determinations.