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.

Abstract

Screening should be done for every newborn using cord blood, or postnatal blood ideally at 48 to 72h of age. Neonates with screen TSH > 20mIU/L serum units (or >34mIU/L for samples taken between 24 and 48h of age) should be recalled for confirmation. For screen TSH > 40mIU/L, immediate confirmatory venous T4/FT4 and TSH, and for mildly elevated screen TSH, a second screening TSH at 7 to 10d of age, should be taken. Preterm and low birth weight infants should undergo screening at 48-72h age. Sick babies should be screened at least by 7d of age. Venous confirmatory TSH >20mIU/L before age 2wk and >10mIU/L after age 2wk, with low T4 (<10μg/dL) or FT4 (<1.17ng/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 2wk and TSH and T4/FT4 at 1mo, then 2 monthly till 6mo, 3 monthly from 6mo-3y and every 3-6mo thereafter. Babies with the possibility of transient CH should be re-evaluated at age 3y, to assess the need for lifelong therapy.