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The Indian Journal of Pediatrics

, Volume 85, Issue 6, pp 448–453 | Cite as

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

  • S. Sudhanshu
  • I. Riaz
  • R. Sharma
  • M. P. Desai
  • R. Parikh
  • V. Bhatia
Review Article
  • 214 Downloads

Abstract

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.

Keywords

Clinical practice guidelines Cord blood Dried blood spot Newborn thyroid screening 

Abbreviations

CH

Congenital hypothyroidism

NBS

Newborn screening

LT4

Levothyroxine

DBS

Dried blood spot

ISPAE

Indian Society for Pediatric and Adolescent Endocrinology

TSH

Thyroid stimulating hormone

T4

Thyroxine

FT4

Free thyroxine

Notes

Contributions

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.

Compliance with Ethical Standards

Conflict of Interest

None.

Source of Funding

None.

Supplementary material

12098_2017_2576_MOESM1_ESM.pdf (174 kb)
ESM 1 (PDF 173 kb)

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Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  1. 1.Department of EndocrinologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of PediatricsSAT Hospital, Government Medical CollegeThiruvananthapuramIndia
  3. 3.Division of Pediatric Endocrinology, Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
  4. 4.Division of Pediatric EndocrinologyBai Jerbai Wadia Hospital for Children, Institute of Child Health & Research CentreMumbaiIndia

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