Summary of guidelines
Identification of at risk babies
Based on maternal history and measurement of maternal TRAb (Thyroid receptor antibody) in the 2nd or 3rd trimester.
Investigations
Birth: Cord blood for TRAb level and fT4 + TSH if clinically indicated.
Day 1: TRAb if not done on cord blood.
Day 3-5: fT4 + TSH + T3 (TRAb if not done on cord blood).
Day 10-14: fT4 + TSH + T3 (TRAb if not done on cord blood).
Treatment
If thyroid function is abnormal at any point above:
- First line therapy:
- Carbimazole: 0.750mg/kg/day in single or divided doses until euthyroid,
then adjust dose as necessary (as per cBNF 2017).
- Carbimazole: 0.750mg/kg/day in single or divided doses until euthyroid,
- Adjunt therapy:
- Sympathetic overactivity – propranolol 2mg/kg/day in 3 or 4 divided doses.
- Haemodynamically unstable – Iodine solution 0.05ml TDS for 1 week.