Counsel parents given a new diagnosis of congenital hypothyroidism — OSCE

Communication framework

Establish what the parents already understand and fear. Ask them to recount what they have been told and what they have read, and acknowledge their fear directly. Do not correct them before you have heard them; the fear of intellectual disability is the one you will spend the most time addressing, and you address it with the evidence that early treatment protects the developing brain. ^[1]

Explain the thyroid in plain language. The thyroid is a small gland in the neck that makes a hormone the body needs for energy, growth, and brain development. Your baby's gland did not form fully or does not work as it should, so the hormone is low. The screening test we do on every newborn — a drop of blood from the heel — measures a signal called TSH that rises when the thyroid is underworking, and your baby's was raised. We confirmed it with a blood test and the result is congenital hypothyroidism. ^[3]

Reassure on cause and guilt. This is not caused by anything you did or did not do in pregnancy. In most cases the gland simply did not develop correctly, and it is one of the commonest conditions newborn screening finds. You did not cause it, and you could not have prevented it — but you have done exactly the right thing by having the screening, because that is how we found it in time. ^[3]

The treatment and the monitoring plan