22. Diagnosis and Treatment of Neonatal Hypothyroidism

2012 ◽  
pp. 323-338
Author(s):  
Stephen H. LaFranchi
Keyword(s):  
Diagnosis And Treatment ◽  
Neonatal Hypothyroidism

scholarly journals Approach to the Diagnosis and Treatment of Neonatal Hypothyroidism

2011 ◽  
Vol 96 (10) ◽  
pp. 2959-2967 ◽  
Author(s):  
Stephen H. LaFranchi
Keyword(s):  
Newborn Screening ◽  
Congenital Hypothyroidism ◽  
Neurodevelopmental Outcome ◽  
Diagnosis And Treatment ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Neonatal Hypothyroidism ◽  
Serum Free ◽  
Screening Programs ◽  
Diagnostic Studies

Abstract Congenital hypothyroidism, occurring in 1:3000 newborns, is one of the most common preventable causes of mental retardation. Neurodevelopmental outcome is inversely related to the age of diagnosis and treatment. Infants detected through newborn screening programs and started on l-T4 in the first few weeks of life have a normal or near-normal neurodevelopmental outcome. The recommended starting dose of l-T4 (10–15 μg/kg · d) is higher on a weight basis than the dose for children and adults. Tailoring the starting l-T4 dose to the severity of the hypothyroidism will normalize serum T4 and TSH as rapidly as possible. It is important to obtain confirmatory serum thyroid function tests before treatment is started. Further diagnostic studies, such as radionuclide uptake and scan and ultrasonography, may be performed to determine the underlying cause of hypothyroidism. Because results from these tests generally do not alter the initial treatment decision, however, these diagnostic studies are rarely indicated. The developing brain has a critical dependence on thyroid hormone for the first 2–3 yr of life; thus, monitoring occurs at more frequent intervals than in older children and adults. Serum free T4 and TSH should be checked at intervals frequent enough to ensure timely adjustment of l-T4 dosing and to keep serum free T4 and TSH levels in target ranges. Given the success of early detection and treatment of neonates with congenital hypothyroidism, a public health mandate should be to develop similar programs for the 75% of babies worldwide who are born in areas without newborn screening programs.

Pitfalls in Screening for Neonatal Hypothyroidism

PEDIATRICS ◽  
1982 ◽  
Vol 70 (1) ◽  
pp. 16-20
Author(s):  
◽  
Keyword(s):  
New England ◽  
Human Error ◽  
Screening Program ◽  
Delayed Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Diagnosis And Treatment ◽  
Clinical Judgement ◽  
Neonatal Hypothyroidism ◽  
Screening Programs ◽  
Blood Specimens

This report reviews problems encountered during the first five years of operation of the New England Regional Screening Program. Human error was responsible for either overlooked or delayed diagnosis and treatment in 14/159 infants with hypothyroidism. This group consisted of three infants who were never tested, six infants whose diagnosis was missed because of errors during the processing of the blood specimens, and five additional children in whom the diagnosis of hypothyroidism could not be made at birth because the concentrations of thyroid-stimulating hormone were not elevated. Many of the problems, most of which occurred during the first two years of the study, have been eliminated by improved communication and monitoring. This study emphasizes the potential vulnerability of all screening programs and underscores the need for physicians to continue to exercise their best clinical judgement regardless of the circumstances.

Infections of the urinary tract. Fundamental concepts of diagnosis and treatment

JAMA ◽  
1966 ◽  
Vol 195 (3) ◽  
pp. 193-194
Author(s):  
E. N. Cook
Keyword(s):  
Urinary Tract ◽  
Diagnosis And Treatment

Aortic root aneurysm. Diagnosis and treatment

JAMA ◽  
1966 ◽  
Vol 197 (2) ◽  
pp. 133-134 ◽  
Author(s):  
H. Najafi
Keyword(s):  
Aortic Root ◽  
Diagnosis And Treatment ◽  
Aortic Root Aneurysm

The Future Present

ASHA Leader ◽  
2013 ◽  
Vol 18 (1) ◽  
pp. 36-47
Author(s):  
Jennifer Stone ◽  
Edwin Rubel ◽  
Robert E. Hillman ◽  
Matthew Cutter ◽  
Shannon C. Mauszycki ◽  
...  
Keyword(s):  
Diagnosis And Treatment ◽  
Hearing Disorders ◽  
The Future

These 11 up-and-coming technologies could revolutionize diagnosis and treatment of speech, language and hearing disorders.

1763: Stage Migration of upper Tract Transitional Cell Carcinoma: An Argument for the Continued Role of Endourologic Diagnosis and Treatment

2004 ◽  
Vol 171 (4S) ◽  
pp. 466-466
Author(s):  
Stephen A. Boorjian ◽  
Casey K. Ng ◽  
Ravi Munver ◽  
R. Ernest Sosa ◽  
E. Darracott Vaughan ◽  
...  
Keyword(s):  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Transitional Cell ◽  
Diagnosis And Treatment ◽  
Stage Migration ◽  
Upper Tract

Subacute and Chronic Hepatitis: Diagnosis and Treatment

1952 ◽  
Vol 36 (5) ◽  
pp. 1341-1355 ◽  
Author(s):  
Thomas A. Wartiiin ◽  
Willard Dalrymple
Keyword(s):  
Chronic Hepatitis ◽  
Diagnosis And Treatment
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