title: Clinical monitoring guidelines for congenital hypothyroidism: laboratory outcome data in the first year of life.
abstract: OBJECTIVE
  To examine whether current recommendations for thyroid status monitoring in children with congenital hypothyroidism (CH) (monthly in the first 6 months and every 3-4 months subsequently) are adequate, or whether monthly monitoring is necessary throughout the first year.
  
  
  METHODS
  We reviewed charts of 70 children with CH for initial thyroid-stimulating hormone (TSH), frequency of follow-up, dose changes, and thyroxine (T(4)) and TSH levels in the first year. Need for monthly monitoring was determined on the basis of guidelines to maintain T(4)/free T(4) in the upper half of the normal range and rapidly normalize TSH.
  
  
  RESULTS
  Monthly monitoring was justified in 75% in the first 6 months and 36% in the next 6 months. Children requiring monthly monitoring in the second 6 months had higher baseline TSH (P = .02) and lower T(4) (P = .01) than those not requiring monthly monitoring. Thyroid dysgenesis, starting levothyroxine dose, sex, and ethnicity did not predict requirement for monthly monitoring. Thirty percent of children in the first and second 6 months had ≥1 high TSH level, with a T(4)/free T(4) not in the upper half of the normal range.
  
  
  CONCLUSIONS
  More than a third of children with CH require monthly monitoring between 6 to 12 months on the basis of study criteria. Current monitoring guidelines may need to be reexamined.
authors.affiliation: Pediatric Endocrine Unit, Mass General Hospital for Children and Harvard Medical School, Boston, MA, USA.
authors.forename: Bharti
authors.initials: B
authors.lastname: Balhara
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Misra
authors.forename: Lynne L
authors.initials: LL
authors.lastname: Levitsky
mesh_terms: D003409:Congenital Hypothyroidism / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013960:Thyroid Function Tests / Q000592:standards; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use
chemical_list: D013972:Thyrotropin; D013974:Thyroxine