Management of CH

Initial workup
    Detailed history and physical examination
    Referral to pediatric endocrinologist
    Recheck serum TSH and FT4
    Thyroid ultrasonography and/or thyroid scan (see text for recommendations)
    L-T4: 10–15 μg/kg by mouth once daily
    Recheck T4, TSH
    2–4 wk after initial treatment is begun
    Every 1–2 mo in the first 6 mo
    Every 3–4 mo between 6 mo and 3 y of age
    Every 6–12 mo from 3 y of age to end of growth
Goal of therapy
    Normalize TSH and maintain T4 and FT4 in upper half of reference range
Assess permanence of CH
    If initial thyroid scan shows ectopic/absent gland, CH is permanent
    If initial TSH is <50 mU/L and there is no increase in TSH after newborn period, then trial off therapy at 3 y of age
    If TSH increases off therapy, consider permanent CH