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新生児期の甲状腺機能低下症の診断と治療_Approach to the diagnosis and treatment of neonatal hypothyroidism

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2011年11月05日(Sat) 06:15 by drharasho

これは米国からの総説。
論文のPDFファイルをつけました。

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J Clin Endocrinol Metab. 2011 Oct;96(10):2959-67.

Approach to the diagnosis and treatment of neonatal hypothyroidism.
Lafranchi SH.

Department of Pediatrics (CDRCP), Oregon Health & Science University,
707 SW Gaines Street, Portland, Oregon 97239-3098. lafrancs@ohsu.edu.
Abstract

Congenital hypothyroidism, occurring in 1:3000 newborns, is one of
the most common preventable causes of mental retardation. Neurodevelopmental
outcome is inversely related to the age of diagnosis and treatment.
Infants detected through newborn screening programs and started on l-T(4)
 in the first few weeks of life have a normal or near-normal neurodevelopmental
 outcome. The recommended starting dose of l-T(4) (10-15 μg/kg · d) is higher
 on a weight basis than the dose for children and adults. Tailoring the starting
高用量の治療= l-T(4) (10-15 μg/kg · d)

 l-T(4) dose to the severity of the hypothyroidism will normalize serum T(4)
and TSH as rapidly as possible. It is important to obtain confirmatory serum
 thyroid function tests before treatment is started. Further diagnostic studies,
such as radionuclide uptake and scan and ultrasonography, may be performed
to determine the underlying cause of hypothyroidism. Because results from
these tests generally do not alter the initial treatment decision, however,
these diagnostic studies are rarely indicated. The developing brain has
a critical dependence on thyroid hormone for the first 2-3 yr of life; thus,
monitoring occurs at more frequent intervals than in older children and adults.
生後2~3歳までは成人より頻回の治療状況のモニタリングが必要。

Serum free T(4) and TSH should be checked at intervals frequent enough to
ensure timely adjustment of l-T(4) dosing and to keep serum free T(4) and TSH
levels in target ranges. Given the success of early detection and treatment
 of neonates with congenital hypothyroidism, a public health mandate should
be to develop similar programs for the 75% of babies worldwide who are born
in areas without newborn screening programs.

PMID:21976744   [PubMed - in process]

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