N/IICU Clinical Pathway for the Evaluation
of Thyroid Function in Newborns
Normal Newborn Screen for Thyroid (PA, NJ, DE)
Abnormal Newborn Screen for Thyroid (PA, NJ, DE)
> 34 0/7 wks
and
≥ 2000 g
and
≥ 2000 g
≤ 34 0/7 wks
or
< 2000 g
or
< 2000 g
< 32 wks: TSH ≥ 10 mIU/L
or
≥ 32 wks: TSH ≥ 40 mIU/L
or
≥ 32 wks: TSH ≥ 40 mIU/L
< 32 wks: TSH < 10 mIU/L
or
≥ 32 wks: TSH < 40 mIU/L
or
≥ 32 wks: TSH < 40 mIU/L
Send venous TSH and fT4 at Day of Life (DOL) 28
Send venous TSH and fT4
Consult EndocrineSend venous TSH and fT4
Normal TSH and fT4
Abnormal TSH or fT4
Normal TSH and fT4
Abnormal TSH or fT4
- No further testing
- Consider additional testing based on high-risk conditions
Consult Endocrine
- ≤ 34 0/7 wks or < 2000 g:
- Repeat TSH and fT4 on DOL 28
- >34 wks and ≥ 2000 g:
- No further testing
- Consider additional testing based on high-risk conditions
Consult Endocrine
High-Risk Conditions for Thyroid Dysfunction
- Trisomy 21
- Turner syndrome
- Williams syndrome
- Noonan syndrome
- Infantile Hemangioma
- Albright Hereditary osteodystrophy
- DiGeorge syndrome (22q11.2 deletion)
- Pendred syndrome
- Maternal Graves Disease
- Klinefelter syndrome
Evidence
- Congenital Hypothyroidism: Screening and Management
- Congenital Hypothyroidism: A 2020–2021 Consensus Guidelines Update—An ENDO–European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology
- Newborn Screening in the US May Miss Mild Persistent Hypothyroidism
- Screening Preterm Infants for Congenital Hypothyroidism: Better the Second Time Around