High versus low dose of initial thyroid hormone replacement for congenital hypothyroidism

Abstract

There is currently only one randomised controlled trial evaluating the effects of high versus low dose of initial thyroid hormone replacement for CHT. There is inadequate evidence to suggest that a high dose is more beneficial compared to a low dose initial thyroid hormone replacement in the treatment of CHT.

Journal Article Reviews

“…4,11,13,[14][15][16][17][18][19][20][21] However, the results are often difficult to compare with each other because screening method, guidelines for treatment (starting day of treatment and initial T4 dose, quality of treatment), sample size, and criteria for CH-T severity differ among these studies. The possible effects of the starting day of treatment, initial dose of thyroxine (T4) and CH-T severity on developmental outcome of patients detected by neonatal CH screening have been the object of many studies.…”

“…10,11,26,28 Furthermore, promising new guidelines from the European Society for Pediatric Endocrinology are underway, so it is important to take these in consideration in clinical practice and future research, when published. Consensus with respect to treatment (starting day of treatment, initial T4 dose, quality of treatment) and criteria for CH-T severity are of utmost importance to provide direction for helping children with CH and personalizing their medicine.…”

“…Because thyroid hormone is essential for brain development, these children are at risk for brain damage and subsequent cognitive and motor deficits. 10,11 Despite the progress made in terms of standardization of screening procedures and improvements in time and in dose at starting treatment, 10,12,13 controversy still exists worldwide as to the effect of these procedural changes on development. Several studies on the effect of these screening programs showed that early T4 supplementation resulted in intelligence quotients within the normal range.…”

“…[1][2][3] The early postnatal start of T4 supplementation, enabled by neonatal screening programs, aims to minimize this brain damage. 4,10,11,[14][15][16][17][18][19][20][21] Some researchers claim that early treatment with high T4 dose leads to normal brain development 14,22 ; others state that timing does not affect cognitive and motor development positively. However, subtle cognitive and motor deficits like attention and balance problems remain present in the majority of patients.…”

Hipotiroidismo congénito

“…1). 12 Las metas bioquímicas del tratamiento con levotiroxina son las siguientes: 1) Normalizar la concentración de T4 libre lo más pronto posible, es decir, en la primera semana de iniciada la sustitución 2) Mantener la T4 libre en la mitad superior de los rangos de referencia acordes con la edad (tabla 3) 13 3) Que la concentración de TSH se mantenga entre 0.5 y 2 mU/l a partir del primer mes de tratamiento 14 Para lograr estas metas, la dosis diaria de levotiroxina debe ser de 10 a 15 g/kg 13,15 . Generalmente se inicia con una dosis aproximada de 50 g diarios, aunque después sea necesario disminuirla.…”