LEADING ARTICLE

Screening

Optimisation of thyroxine dose in congenital hypothyroidism

P C Hindmarsh

London Centre for Paediatric Endocrinology and Metabolism, Cobbold Laboratories, Middlesex Hospital, Mortimer Street, London W1T 3AA, UK

Correspondence to:
Correspondence to:
P C Hindmarsh
(p.hindmarsh@ucl.ac.uk)

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Optimum initial dosage remains unclear

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Keywords: thyroxine; congenital; hypothyroidism

The introduction of the screening programme for congenital hypothyroidism in the late 1970s and early 1980s has been rightly hailed as a major success in the prevention of neurological handicap. With a prevalence of between 1/3000 and 1/5000 live births, congenital hypothyroidism is by far the commonest metabolic disorder leading to neurological handicap; given the inexpensive nature of assays for thyroid stimulating hormone (TSH) and thyroxine treatment, its cost effectiveness must be beyond doubt. The improvement in outcome from intervention with thyroxine at an earlier stage than was hitherto possible, meant that for the majority of children treated with severe congenital hypothyroidism a near normal intelligence quotient (IQ) might be expected. Early reports tended to confirm this view, although a long term perspective suggests that there remain significant areas of cognitive deficit, particularly in visuospatial tasks, attention, and to a certain extent memory.^1–3

In addressing some of these issues . . . [Full text of this article]

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