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Factors involved in the rate of fall of thyroid stimulating hormone in treated hypothyroidism
  1. PETER G F SWIFT,
  2. NASSOS THOMAS,
  3. VIPAN DATTA,
  4. CHRIS CUTTS
  1. Endocrine and Pharmacy Departments
  2. Children’s Hospital
  3. Leicester Royal Infirmary, Leicester LE1 5WW, UK

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    Editor,—We would like to comment on the recommendations on the management of congenital hypothyroidism by Razaet al. 1 Although thyroxine dosage recommendations have been available for the treatment of congenital hypothyroidism for many years2 it has not been possible to answer the crucial question as to what concentrations of circulating thyroid hormones and degree of thyroid stimulating hormone (TSH) suppression are required to provide the optimal environment for maximising neurobehavioural and intellectual development. The working group on congenital hypothyroidism of the European Society for Paediatric Endocrinology has emphasised that it has not been possible to measure a dose–response relation, and it is coordinating a prospective study to assess the adequacy of treatment and outcome using two different dosage schedules for the first 24 months after birth.

    In the absence of randomised, prospective outcome studies, previous authors have recommended …

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