Inefficiency of levothyroxine suspension in a neonate with congenital hypothyroidism
Background: Congenital hypothyroidism is one of the major causes of preventable mental retardation. Diagnosis, hormonal replacement and normalization of thyroid function tests should happen before 2–3 weeks of life. Levothyroxine is the treatment of choice for congenital hypothyroidism. Case presentation: A patient born at 32 weeks for gestational age with a birthweight of 1.73 kg. The pregnancy and delivery were uncomplicated. The physical exam was unremarkable. The initial newborn screen noted a thyroid stimulating hormone (TSH) of 70.5 mIU/mL (n < 20 mIU/mL). Serum thyroid function test revealed a TSH of 215 mIU/mL and free thyroxine (FT4) of 0.08 ng/dL. The patient was started on levothyroxine 25 μg tablet daily at day of life (DOL) 7. Repeat TSH and FT4 after 1 week of treatment, revealed a TSH of 0.686 and FT4 of 4.12 ng/dL, levothyroxine was discontinued. Repeat tests after 1 week, showed a TSH of 47.5 mIU/mL and a FT4 of 0.84 ng/dL. Levothyroxine in a liquid form at 25 μg a day was started on DOL 21. On DOL 38, TSH was repeated and was noted to be 120 mIU/mL. Levothyroxine was switched to a tablet formulation and was increased to 37.5 μg daily. Repeat tests at DOL 50, showed a TSH that was trending down to 9.241 mIU/mL. Conclusion: Levothyroxine (T4) is a synthetic hormone considered to be the standard of care for the treatment of congenital hypothyroidism. Treatment is most effective if given orally in tablet form. To date, there are no liquid formulations and no compounding recipes that produce a stable concentration of levothyroxine in the USA. Efforts to create suspensions, especially for neonates, should be carefully considered as this is a critical time for brain development. The case presented shows how treatment of congenital hypothyroidism can be ineffective if using a liquid formulation of levothyroxine.
- Location
-
Deutsche Nationalbibliothek Frankfurt am Main
- Extent
-
Online-Ressource
- Language
-
Englisch
- Bibliographic citation
-
Inefficiency of levothyroxine suspension in a neonate with congenital hypothyroidism ; volume:8 ; number:2 ; year:2019 ; extent:3
Case reports in perinatal medicine ; 8, Heft 2 (2019) (gesamt 3)
- Creator
-
Chan, Jacqueline T.
D’Ambrosio, Fabiola
Minutti, Carla Z.
- DOI
-
10.1515/crpm-2018-0046
- URN
-
urn:nbn:de:101:1-2411121524285.636103324907
- Rights
-
Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
- Last update
-
15.08.2025, 7:29 AM CEST
Data provider
Deutsche Nationalbibliothek. If you have any questions about the object, please contact the data provider.
Associated
- Chan, Jacqueline T.
- D’Ambrosio, Fabiola
- Minutti, Carla Z.
Other Objects (12)
Congenital hypothyroidism
Congenital Analbuminemia Associated with Hypothyroidism in a Preterm Neonate: The First Case from a Highly Consanguineous Community
Factors associated with permanent hypothyroidism in infants with congenital hypothyroidism
Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”)
Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”)
Language disorders in children with congenital hypothyroidism
Congenital hypothyroidism: insights into pathogenesis and treatment
Congenital cerebral malaria: a masquerader in a neonate
The Italian National Register of infants with congenital hypothyroidism: twenty years of surveillance and study of congenital hypothyroidism
Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok)
Unusual Presentation of Congenital Ileal Stenosis in a Neonate
Rectal Atresia and Congenital Hypothyroidism: An Association or Coincidence?
Congenital hypothyroidism
Congenital Analbuminemia Associated with Hypothyroidism in a Preterm Neonate: The First Case from a Highly Consanguineous Community
Factors associated with permanent hypothyroidism in infants with congenital hypothyroidism
Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”)
Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”)
Language disorders in children with congenital hypothyroidism
Congenital hypothyroidism: insights into pathogenesis and treatment
Congenital cerebral malaria: a masquerader in a neonate
The Italian National Register of infants with congenital hypothyroidism: twenty years of surveillance and study of congenital hypothyroidism
Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok)
Unusual Presentation of Congenital Ileal Stenosis in a Neonate
Rectal Atresia and Congenital Hypothyroidism: An Association or Coincidence?
Congenital hypothyroidism
Congenital Analbuminemia Associated with Hypothyroidism in a Preterm Neonate: The First Case from a Highly Consanguineous Community
Factors associated with permanent hypothyroidism in infants with congenital hypothyroidism
Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”)
Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”)
Language disorders in children with congenital hypothyroidism
Congenital hypothyroidism: insights into pathogenesis and treatment
Congenital cerebral malaria: a masquerader in a neonate
The Italian National Register of infants with congenital hypothyroidism: twenty years of surveillance and study of congenital hypothyroidism
Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok)
Unusual Presentation of Congenital Ileal Stenosis in a Neonate