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HYPOTHYROIDISM

HYPOTHYROIDISM. Dr Rona. H ypothyroidism. Common endocrine disorder of childhood Congenital/acquired. Hypothyroidism. Primary congenital &acquired Secondary

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HYPOTHYROIDISM

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  1. HYPOTHYROIDISM Dr Rona

  2. Hypothyroidism Common endocrine disorder of childhood Congenital/acquired

  3. Hypothyroidism • Primary congenital &acquired • Secondary - due to deficiency of TSH/TRH - Hypopituitarism

  4. Congenital hypothyroidism • Familial/sporadic • 85%cases-dysgenesis(manifests at birth) • 10-15%cases-inborn errors of thyroid hormone synthesis(often present later in infancy)

  5. Congenital hypothyroidism • Etiology 1.dysgenesis:aplasia, hypoplasia, ectopic thyroid 2.inborn errors of thy: hormone synthesis 3.insensitivity/resistance to thy:hormone 4.maternal medication-radioiodine,PTU, Carbimazole

  6. Clinical features(when to suspect?) • Prolonged physiological jaundice • Constipation • Lethargy • Feeding problems • Large tongue • Open posterior fontenel&wide open cranial sutures • Skin-dry,thick&coarse,cool&mottled

  7. abdomen is large • sleep most of the time • Cry little, feed poorly &often get choking spells during feeding • Resp difficulties-noisy breathing, nasal obstruction&apnea • Hypothermia • Umbilical hernia

  8. By the age of 8-10 wks characteristic coarse facial features become evident • Puffy face, swollen eyelids • Widely separated eyes, narrow palpebral fissures • Broad nose ,depressed nasal bridge • Open mouth, broad thick protuberant tongue

  9. Neck is short and thick • Supraclavicular pad of fat may be present • Voice is hoarse • Skin-pale yellow, dry scaly&thick • Hair-sparse,coarse&brittle • Muscles are flaccid&markedly hypotonic

  10. Marked physical and mental retardation • Social smile is delayed • Dentition &skeletal maturation is also significantly delayed • Pulse is slow, cardiomegaly &heart murmurs may be present • Refractory anemia is common

  11. Acquired hypothyroidism • Etiology • Iodine deficiency • Hashimoto thyroiditis • Irradiation • Surgical ablation • Ingestion of goiterogens • Drug induced-iodides,PTU,Carbimazole.Li

  12. Acquired hypothyroidism • Symptoms depend upon the severity and duration of thyroid dysfunction • Onset is insidious • Growth velocity is low;child appears short and stocky with disproportionately large head&trunk as compared to limbs

  13. Expression is dull. • face appears puffy, skin and s/c tissue are thick and pigmented-myxedematous appearance • Child is lethargic with cold intolerence • Pulse rate & BP is low • Muscles flabby & hypotonic, rarely pseudo hypertrophy

  14. Puberty is usually delayed. Galactorrhoea(increased prolactin secretion),sexual precocity may be seen • Goiter is frequently encountered

  15. Investigations • Radiologicalretarded osseous devpmt. X-ray knee: absence of distal femoral epiphysis at birth, punctate epiphyseal dysgenesis • TFT T4, T3 low and TSH high in secondary hypo: TSH normal • Normal T3-60to80ng/dl,T4-5to12.5microgm/dl, TSH-2to4 IU

  16. ECG- low voltage waves • Serum cholesterol-high • Imaging studies-USS and radio isotope scan : to identify anatomical and functional status of gland • Thyroid antibody studies-to identify auto immune thyroiditis

  17. Neonatal screening • Measurement of TSH and T4 values using cord blood samples on filter paper • Infants with low T4 levels with elevated TSH are identified and recalled for repeat T4 and TSH measurements • Low T4 and elevated TSH- primary hypo: • Low T4 and TSH-Ix for TBG deficiency/sec hypothyroidism

  18. Management • Sodium levothyroxin[100 microgm tab] is the treatment of choice • 0-3months of age10-15microgm/kg/day • 3-6months of age8-12microgm/kg/day • 7-12months of age6-8microgm/kg/day

  19. 1-5years4-6microgm/kg/day • 6-12years3-5microgm/kg/day • >12years2-4microgm/kg/day • Roughly 5-10microgm/kg/day decreases with advancing age

  20. Better administered as a single dose early morning in empty stomach for maximum absorption • Start with smaller dose and gradually increase to optimal requirement • Neonates and children <1 year should receive therapy immediately

  21. In children with secondary hypothyroidism cortisol replacement should be initiated before thyroid replacement thyroxine induces increased metabolism of steroid hormones

  22. Therapy should be monitored by assessment of • Clinical symptoms • Gain in weight • Improvement in mental performance • Periodic thyroid function tests

  23. TFT is done 4wks after initiation of treatment in newborn • If normal once a year monitoring with adjustment of dose for age/wt . • Skeletal maturation should be monitored

  24. THANK YOU

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