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Congenital Hypothyroidism


Step 1: View clinicals

A 3 day old boy presents with jaundice from the 2nd day of life. He was born via cesarian section at 38 weeks of gestation, following an uncomplicated pregnancy. His mother is 24 years old, and is in good health.

Step 2: Order all relevant investigations

FBC & Blood Film

Hb: 14.2 g/dl PCV (Hct): 41.4% Reticulocyte count: 3% Blood film (picture) : The blood film appears normal, with no evidence of hemolysis.

Serum Bilirubin

Total bilirubin: 19.2 mg/dl Direct (conjugated) bilirubin: 1.9 mg/dl

Liver transaminases

AST: 24 IU/L (0-40) ALT: 33 IU/L (0-40)

Thyroid Function tests

TSH: 49.90 mIU/ml (0.9-7.7) Free T4: 9.65 pg/ml (9-26)

Step 3: Select appropriate management

Phototherapy stat
Levothyroxine stat
Radioiodine therapy
IV Immunoglobulin

Score: ★★☆