DIAGNOSIS AND TREATMENT OF HASHIMOTO DISEASE

It is an autoinmune disease where the inmune system produces antithyroid antibodies that
attack the thyroid cells causing progressive fibrosis. Women are more often affected.

To diagnose this desease we may do a routine newborn screening, so we do it before the signs
are evident, early and adequate treatment with levothyroxine results in excellent
neurodevelopmental outcomes. If the screening is positive, we continue doing tests in order to
confirm the diagnosis.

These are the thyroid function tests, including measurement of free serum thyroxine (free T4)
and thyroid-stimulating hormone (TSH). If the level of TSH is high and the level of free T4 is low,
we can confirm the diagnosis of hypotiroidism.

Then we should do a radionuclide scanning (either technetium-99m pertechnetate or iodine-

123) or ultrasonography to evaluate the size and location of the thyroid gland.

In order to confirm the diagnosis of autoimmune thyroiditis we should measure thyroid antibody
titers (to thyroid peroxidase and thyroglobulin). Children confirmed to have central
hypothyroidism should have MRI of the brain and pituitary to rule out central nervous system
lesions.

TREATMENT

We should do a thyroid hormone replacement. In most treated infants, motor and intellectual
development is normal, we treat it with levothyroxine (syntetic thyroid hormone) 10 to 15
mcg/kg orally once a day mostly for the rest of his life. The dose is titrated to maintain serum T4
and TSH levels within the normal range for age.

Levothyroxine is typically given in tablet, that can be crushed, mixed with a small amount (1 to 2
mL) of water, breast milk, or non–soy-based formula, and given orally by syringe.