Congenital hypothyroidism - An Indian perspective

Ambika G Unnikrishnan, Upal Vyas

Thyroid Research and Practice 2017 14(3):99-105

Congenital hypothyroidism (CH) is a preventable cause of mental retardation in neonates. In India, CH is compounded by a lack of efficient newborn screening (NBS) programs, nonavailability of infrastructure, and the rising cost of health care. This review focuses on NBS techniques for early detection of CH, along with management strategies in the Indian scenario. Guidelines recommend measuring thyroid-stimulating hormone (TSH) or thyroxine (T4) levels or combined TSH and T4 as an ideal approach for screening CH within 2–4 days after birth. In preterm and low birth weight neonates, additionally, after 2–4 weeks, a follow-up screening has been suggested. If laboratory test is positive, a noninvasive scintigraphy and/or ultrasound has also been suggested as additional test to identify underlying etiology. Levo-T4 (L-T4) has been recommended as the first-line treatment with an initial standard dose of 10–15 μg/kg/day, based on the disease severity; with regular follow-up, up to 3 years of age. Although L-T4 tablet form is the standard of care in many developing countries like India, liquid formulations of L-T4 have been found to possess some additional beneficial effects. In summary, the government or policymakers should encourage mandatory cost-effective NBS for the early detection and treatment of CH.

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