An infant is diagnosed with congenital hypothyroidism after newborn screening shows elevated TSH levels. What is the first-line treatment?
- A) Levothyroxine ✓
- B) Methimazole
- C) Iodine supplementation
- D) Surgery
Congenital hypothyroidism is a condition present at birth where the thyroid gland does not produce enough thyroid hormones. This can lead to various developmental issues if not treated promptly. Newborn screening programs typically measure levels of Thyroid Stimulating Hormone (TSH) and thyroxine (T4) to identify this condition early.
- Diagnosis Confirmation: In cases where elevated TSH levels are detected, it indicates that the pituitary gland is signaling the thyroid to produce more hormones, but the thyroid is unable to respond adequately due to its underdevelopment or absence.
- Understanding Treatment Options:
- Levothyroxine (A): This is a synthetic form of the thyroid hormone thyroxine (T4). It is used as a replacement therapy in individuals with hypothyroidism, including congenital hypothyroidism.
- Methimazole (B): This medication is an antithyroid drug used primarily for hyperthyroidism, particularly in conditions like Graves’ disease. It would not be appropriate for treating congenital hypothyroidism.
- Iodine Supplementation (C): While iodine is essential for thyroid hormone production, congenital hypothyroidism typically arises from structural or functional abnormalities of the thyroid gland itself rather than iodine deficiency.
- Surgery (D): Surgical intervention may be necessary in certain cases of acquired hypothyroidism or specific thyroid disorders but is not a first-line treatment for congenital hypothyroidism.
- Clinical Guidelines: According to clinical guidelines and consensus statements from pediatric endocrinology associations, immediate treatment with levothyroxine should begin as soon as congenital hypothyroidism is diagnosed to prevent developmental delays and other complications associated with low thyroid hormone levels.
Based on this analysis, the first-line treatment for an infant diagnosed with congenital hypothyroidism after newborn screening showing elevated TSH levels is:
Levothyroxine
