ESPE Abstracts

Background: Most individuals with neonatal hypothyroidism present clinically asymptomatic or with few symptoms. Early treatment with oral levothyroxine prevents complications related to this disorder. We report a case of a male infant with Short Bowel syndrome (SBS) and congenital hypothyroidism (CH) treated with rectal levothyroxine.

Case and presentations: A male patient with previous gastroschisis underwent multiple surgical approaches for small bowel resection and developed SBS. We suspected of CH when he was 4 months old because of jaundice (direct bilirubin up to 59 mg/dl), the absence of evacuation, oral diet intolerance and intestinal dysmotility. The diagnosis was confirmed after a TSH=34.45 μIU/mL and a fT₄=0.64 ng/dl. As fasting was necessary because of SBS, we started rectal diluted levothyroxine. After 4 weeks, the patient had spontaneous bowell movements, improvement of jaundice, and direct bilirubin of 4.62 mg/dl, fT₄=1.34 ng/dl and TSH=0.75 mIU/l.

Conclusion: In the present case the patient was on fasting because of SBS. An alternative route for drug administration was warranted. We empirically prescribed rectal diluted levothyroxine because intravenous and suppository levothyroxine were not available. This method proved to be safe and effective on improving the patient clinical status besides normalizing fT₄ and TSH.