Congenital Hypothyroidism: Optimal Initial Dosage and Time of Initiation of Treatment: A Systematic Review

Overview

Journal Int J Endocrinol Metab

Publisher Brieflands

Specialty Endocrinology

Date 2016 Dec 13

PMID 27942261

Citations 6

Authors

Khaled Rahmani

Shahin Yarahmadi

Koorosh Etemad

Ahmad Koosha

Yadollah Mehrabi

Nasrin Aghang

Hamid Soori

Affiliations

Soon will be listed here.

Abstract

Context: Appropriate management of neonates, tested positive for congenital hypothyroidism (CH), in particular, the initial dosage of levothyroxine and the time of initiation of treatment is a critical issue. The aim of this study was to assess all current evidence available on the subject to ascertain the optimal initial dose and optimal initiation time of treatment for children with CH.

Evidence Acquisition: In this study, all published research related to the initiation treatment dose and the onset time of treatment in congenital hypothyroidism were reviewed. The searched electronic databases included Medline, Science direct, Scopus EMBASE, PsycINFO, Cochrane, BIOSIS and ISI Web of Knowledge. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major thyroid and pediatrics journals published within the past 35 years. Studies were included if they were written in English and investigated levothyroxine dose or timing of treatment or both, used for the treatment of children with congenital hypothyroidism.

Results: Two thousand three hundred and seventy-four articles (excluding duplicates) were retrieved from the primary search. After reviewing the titles, abstracts and full-texts of studies, eventually, 22 studies were found that met our inclusion criteria. Amongst these, 17 and 12 evaluated outcomes of different treatment doses and treatment timing, respectively. Overall, the majority of these studies emphasized the initial high dose of levothyroxine and early treatment of newborns with hypothyroidism. There were, however, some studies that disagreed with increasing levothyroxine dose at initiation of treatment.

Conclusions: Considering the results of this review, apparently there is no difference in opinion regarding the early initiation of treatment, whereas determining the optimal dose of levothyroxine for start of treatment in CH patients still remains a controversial issue, demonstrating the need for further studies, despite the fact that use of high doses can lead to rapid normalization of biochemical indices, although this may cause complications.

Citing Articles

Age of menarche and final height in patients with permanent congenital hypothyroidism.

Karimian P, Hovsepian S, Alinia T, Raispour H, Mirshahzadeh N, Hashemipour M Ann Pediatr Endocrinol Metab. 2025; 29(6):371-378.

PMID: 39778406 PMC: 11725635. DOI: 10.6065/apem.2448014.007.

Neuropsychological and physical development of patients diagnosed with congenital hypothyroidism at the San Ignacio University Hospital between 2001 and 2017.

Unigarro M, Forero C, Cespedes C Biomedica. 2022; 42(Sp. 1):144-153.

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Eslava-Schmalbach J, Eslava-Gonzalez L Rev Colomb Obstet Ginecol. 2021; 72(1):7-11.

PMID: 33878809 PMC: 8372766. DOI: 10.18597/rcog.3675.

Characterization of patients diagnosed with congenital hypothyroidism at the Hospital Universitario San Ignacio between 2001 and 2017.

Penaloza L, Forero C, Cespedes C Biomedica. 2020; 40(3):528-533.

PMID: 33030831 PMC: 7666848. DOI: 10.7705/biomedica.5334.

Evaluation and management of the child with hypothyroidism.

Leung A, Leung A World J Pediatr. 2019; 15(2):124-134.

PMID: 30734891 DOI: 10.1007/s12519-019-00230-w.

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