Delayed Presentation of Neonatal Withdrawal Symptoms in Neonates with Congenital Hypothyroidism

Patient selection: neonate with congenital hypothyroidism

Significance:

(1) The presence of a positive drug test (meconium, urine, hair, etc) and absence of typical symptoms of withdrawal may indicate the presence of an underlying metabolic disorder.

(2) In a neonate with congenital hypothyroidism the testing for symptoms of drug withdrawal should be prolonged to detect late onset or deterioration.

(3) If congenital hypothyroidism is present, then symptoms of drug withdrawal may be misinterpreted.

(4) In a neonate with congenital hypothyroidism a deterioration after starting levothyroxine replacement may indicate underlying drug withdrawal.

(5) If a clinician only does drug testing on "high risk" patients then one source of valuable information may be lacking.

where:

• The presence of other conditions may also mask withdrawal.