علاج نقص اليود الخلقي في قصور الغدة الدرقية الأولي المؤكد

References

DOI: 10.1089/thy.2020.0333

• If the serum fT4 concentration is below and TSH clearly above the age-specific reference interval, then levothyroxine (LT4) treatment should be started immediately.
• If the serum TSH concentration is >20 mU/L at confirmatory testing (approximately in the second week of life), treatment should be started, even if fT4 is normal (arbitrary threshold, expert opinion).
• In countries or regions where thyroid function tests are not readily available, LT4 treatment should be started if filter paper TSH concentration is >40 mU/L (at the moment of neonatal screening; arbitrary threshold, expert opinion).
• LT4 alone is recommended as the medication of choice for the treatment of CH.
• LT4 treatment should be started as soon as possible, not later than 2 weeks after birth or immediately after confirmatory (serum) thyroid function testing in neonates in whom CH is detected by a second routine screening test.
• The first treatment goal in neonates with primary CH is to rapidly increase the circulating amount of thyroid hormone, reflected by normalization of serum TSH; thereafter, TSH should be kept within the reference interval.
• Rapid normalization of TSH and keeping fT4 in the upper half of the age-specific reference interval have been shown to optimize the neurodevelopmental outcome.