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CH Treatment Timing — RACP Paediatrics MCQ

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HardEndocrinologyCH Treatment TimingRACP Paediatrics

A 10-day-old has confirmatory serum free T4 below the age-specific range and TSH 38 mU/L after an abnormal newborn screen. The baby is clinically well. Thyroid ultrasound and scintigraphy cannot be arranged for five days. What should be done?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Begin levothyroxine now; arrange imaging without postponing therapy

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E

C is correct because low free T4 with clearly raised TSH confirms primary congenital hypothyroidism and levothyroxine should begin immediately; imaging can follow if it does not delay treatment. A prolongs cerebral thyroid-hormone deficiency. B makes useful aetiological testing an unsafe prerequisite; scintigraphy can often still be interpreted with specialist planning. D waits for features that may be subtle while neurodevelopmental harm accrues. E uses short-acting T3 rather than standard levothyroxine replacement. This international endocrine consensus is directly applicable to Australian newborn-screen follow-up and conflicts with no Australian neonatal practice.

Reference: Queensland Health, neonatal levothyroxine monograph: https://www.health.qld.gov.au/__data/assets/pdf_file/0018/1211094/nmq-levothyroxine.pdf; ENDO-ERN/ESPE consensus guideline update, congenital hypothyroidism: https://pmc.ncbi.nlm.nih.gov/articles/PMC8001676/