Newborn Screening Guidelines for Congenital Hypothyroidism in India: Recommendations of the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) – Part II: Imaging, Treatment and Follow-up
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The Indian Society for Pediatric and Adolescent Endocrinology has formulated Clinical Practice Guidelines for newborn screening, diagnosis and management of congenital hypothyroidism (CH). This manuscript, part II addresses management and follow-up. Recommendations: Screening should be done for every newborn using cord blood, or postnatal blood ideally at 48 to 72 h of age. Neonates with screen TSH > 20 mIU/L serum units (or >34 mIU/L for samples taken between 24 and 48 h of age) should be recalled for confirmation. For screen TSH > 40 mIU/L, immediate confirmatory venous T4/FT4 and TSH, and for mildly elevated screen TSH, a second screening TSH at 7 to 10 d of age, should be taken. Preterm and low birth weight infants should undergo screening at 48–72 h age. Sick babies should be screened at least by 7 d of age. Venous confirmatory TSH >20 mIU/L before age 2 wk and >10 mIU/L after age 2 wk, with low T4 (<10 μg/dL) or FT4 (<1.17 ng/dL) indicate primary CH and treatment initiation. Imaging is recommended by radionuclide scintigraphy and ultrasonography after CH is biochemically confirmed but treatment should not be delayed till scans are performed. Levothyroxine is commenced at 10-15 μg/kg in the neonatal period. Serum T4/FT4 is measured at 2 wk and TSH and T4/FT4 at 1 mo, then 2 monthly till 6 mo, 3 monthly from 6 mo–3 y and every 3–6 mo thereafter. Babies with the possibility of transient CH should be re-evaluated at age 3 y, to assess the need for lifelong therapy.
KeywordsClinical practice guidelines Cord blood Dried blood spot Newborn thyroid screening
Dried blood spot
Indian Society for Pediatric and Adolescent Endocrinology
Thyroid stimulating hormone
MD, RS, SS, RP, RI, VB reviewed the literature, drafted the manuscript, obtained extensive inputs from the editorial team, and finalized the manuscript incorporating these inputs. VB will act as the guarantor of the study.
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- 1.Mathai S. Newborn screening for congenital hypothyroidism- experience from India. Abstract presented at 8th Asia Pacific Regional Meeting of the International Society for Neonatal Screening. New Delhi, Sep 2013.Google Scholar
- 2.Rama Devi AR. Newborn screening in India, experience from pilot initiative (ICMR Multicenter Project). Abstract presented at 8th Asia Pacific Regional Meeting of the International Society for Neonatal Screening. New Delhi, Sep 2013.Google Scholar
- 5.Léger J, Olivieri A, Donaldson M, et al; ESPE-PES-SLEP-JSPE-APEG-APPES-ISPAE; Congenital Hypothyroidism Consensus Conference Group. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab. 2014;99:363–84.Google Scholar
- 9.Swiglo BA, Murad MH, Schunemann HJ, et al. A case for clarity, consistency and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab. 2008;93:666–73.CrossRefPubMedGoogle Scholar
- 16.Olivieri A, Stazi MA, Mastroiacovo P, et al. A population-based study on the frequency of additional congenital malformations in infants with congenital hypothyroidism: data from the Italian Registry for congenital hypothyroidism (1991–1998). J Clin Endocrinol Metab. 2002;87:557–62.PubMedGoogle Scholar