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The incidence of congenital hypothyroidism has been estimated to my baby. As a newborn infant he has been screened, and the doctor used filter paper spots. His serum sample was obtained and studied in details too. They found a low T4 and a normal TSH, they told me it could be a secondary hypothyroidism. I want to know which is the best way for treating his disorder.

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A low T4 and normal TSH may represent secondary or tertiary hypothyroidism or TBG deficiency. That is true, but low T4 levels also are found normally in premature infants and severely ill newborn infants and are not necessarily indicative of hypothyroidism. If the T4 is greater then 7 µg/dL, it is regarded as normal in premature or sick infants. First you have to found out if that was his diagnosis for sure. If it was, it is possible to treat some of the newborn errors of T4 synthesis with iodide, but T4 therapy is inexpensive and effective for all of the disorders causing congenital hypothyroidism. The dose of thyroid hormone prescribed should be sufficient to achieve high euthyroid levels of serum T4 within 2 weeks of starting therapy. This usually is achieved with a starting dose of L-thyroxine, during the newborn period. Once treated, the serum T4 returns to normal before the serum TSH. It is recommended that, to avoid overdosing with L-thyroxine during the first 4 weeks, the serum concentration of T4 should be used as the laboratory guide for adequate treatment. After 4-6 weeks of therapy, however, the TSH level is the best monitor of treatment. The prognosis for mental development has been correlated with time of onset of therapy. Patients treated before age of 3 months had significantly greater IQ then that of the children treated after 3 months of age.
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