1. Calculate the optimal dose and adjust dosage pre-emptively, using Thyroid Function Tests to confirm adherence.
  2. Assess growth:
    • Weight measurement.
    • Supine length measurement until 2 years, then height measurement.
    • Head circumference measurement until 3 years.
  3. Development assessment:
    1. Consider pre-school formal audiology (for subtle hearing impairment due to congenital hypothyroidism.1

      if aged <4-5 years, developmental progress

      aged over 4-5 years, school progress

    2. Consider neurodevelopmental assessment.
  4. Education:
    • From secondary school onwards ensure the patient has reasonable knowledge of CH.
  5. Adult transfer:
    • Boys to GP.
    • Girls to GP, give pre-pregnancy counselling.

Transfer to primary care for 6-12 monthly monitoring of TFT’s.

Aim for: fT4 in the upper quartile of reference range and TSH <5.0 mU/I (but avoid undetectable TSH).