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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Feihong / Mericq, Veronica / Roth, Christian / Toppari, Jorma

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Volume 25, Issue 9-10 (Oct 2012)


In congenital hypothyroidism, an initial L-thyroxine dose of 10–12 μg/kg/day is sufficient and sometimes excessive based on thyroid tests 1 month later

Priya Vaidyanathan
  • Corresponding author
  • Pediatric Endocrinology, Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA
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/ Meenal Pathak / Paul B. Kaplowitz
Published Online: 2012-09-06 | DOI: https://doi.org/10.1515/jpem-2012-0025


Background: Current guidelines recommend an initial L-thyroxine (L-T4) dose of 10–15 μg/kg/day for the treatment of congenital hypothyroidism (CH). We analyzed our data for the treatment outcome at 1 month after we noted a frequent overtreatment even at the lower end of this dose range.

Methods: A 3-year chart review of 55 patients with confirmed CH was performed. The patients were divided to three groups based on L-T4 dose: Group 1 (6–9.9 μg/kg), Group 2 (10–11.9 μg/kg), and Group 3 (12–15 μg/kg). Overtreatment was defined as T4>16 μg/dL/free T4>2.3 ng/dL±thyroid-stimulating hormone (TSH) <0.5 μIU/L and undertreatment was defined as TSH>6 μIU/L at 1 month.

Results: At 1 month, 45.8%, 37.5%, and 16.6% in Group 1, 30%, 55%, and 15% in Group 2, and 0%, 75%, and 25% in Group 3 had target labs, overtreatment, and undertreatment, respectively.

Conclusions: An initial L-T4 dose of 10–11.9 μg/kg for TSH>100 μIU/L and 8–10 μg/kg for TSH<100 μIU/L at diagnosis met and often exceeded the target thyroid levels at 1 month. More frequent overtreatment was seen when >12 μg/kg was given.

Keywords: congenital; hypothyroidism; L-thyroxine dose

About the article

Corresponding author: Priya Vaidyanathan, Pediatric Endocrinology, Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA

Received: 2012-01-31

Accepted: 2012-08-04

Published Online: 2012-09-06

Published in Print: 2012-10-01

Citation Information: Journal of Pediatric Endocrinology and Metabolism, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2012-0025.

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©2012 by Walter de Gruyter Berlin Boston. Copyright Clearance Center

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