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    Hypothyroidism: By: Judhaimah Mardhiah BT Mat Tari 0810544

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    Jujue Mardhiah
    The document discusses hypothyroidism, including its causes, symptoms, diagnosis, and management. It describes congenital and acquired hypothyroidism, noting that congenital hypothyroidism can be caused by iodine deficiency or defects in thyroid development and function. The key aspects of diagnosis and treatment involve measuring thyroid hormones and administering thyroid hormone replacement therapy.

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    Hypothyroidism: By: Judhaimah Mardhiah BT Mat Tari 0810544

    Uploaded by

    Jujue Mardhiah
    131 views23 pages
    The document discusses hypothyroidism, including its causes, symptoms, diagnosis, and management. It describes congenital and acquired hypothyroidism, noting that congenital hypothyroidism can be caused by iodine deficiency or defects in thyroid development and function. The key aspects of diagnosis and treatment involve measuring thyroid hormones and administering thyroid hormone replacement therapy.

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    The document discusses hypothyroidism, including its causes, symptoms, diagnosis, and management. It describes congenital and acquired hypothyroidism, noting that congenital hypothyroidism can be caused by iodine deficiency or defects in thyroid development and function. The key aspects of diagnosis and treatment involve measuring thyroid hormones and administering thyroid hormone replacement therapy.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    131 views23 pages

    Hypothyroidism: By: Judhaimah Mardhiah BT Mat Tari 0810544

    Uploaded by

    Jujue Mardhiah
    The document discusses hypothyroidism, including its causes, symptoms, diagnosis, and management. It describes congenital and acquired hypothyroidism, noting that congenital hypothyroidism can be caused by iodine deficiency or defects in thyroid development and function. The key aspects of diagnosis and treatment involve measuring thyroid hormones and administering thyroid hormone replacement therapy.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23

    Hypothyroidism

    by:
    Judhaimah Mardhiah bt Mat Tari
    0810544
    case : A BABY WITH SLOW METABOLIC RATE

    A 3 month old baby, presented with failure to


    thrive. The facial features were rather coarse
    and the skin was dry. The tongue tended to
    protrude and there was an umbilical hernia.
    There was a tinge jaundice. The baby seemed
    apathethic and was not smilling or interacting
    with the parents. Blood testing showed a low
    thyroxine but very high TSH levels.
    Outline
    • Thyroid synthesis and function
    • Definition
    • Epidemiology
    • Classification
    • Clinical Manifestation
    • Diagnosis
    • Management :
    -Treatment
    -Follow-up
    Function of thyroid hormone
    Central nervous system -Brain maturation (esp.in
    the 1st 2-3 yrs of life)
    -Myelination and
    sympathetic development

    Musculoskeletal system -Bone growth and


    potentiate GH effect

    Cardiovascular system -Increase number and


    affinity of β2-
    adrenoceptor in the heart
    cont’..

    Gastrointestinal tract -Increase gastric


    motility

    Reproductive system -Normal menses


    Definition
    • A clinical condition that resulted from
    decreased production of thyroid hormone or
    defect in thyroid receptor activity

    Epidemiology
    • Incidence – 1/2500-4000 live births world
    wide
    • Lower in black Americans (1/32 000)
    • Higher in Hispanics and Native Americans
    (1/2000)
    • Twice as many girls as boys are affected
    • In Malaysia – 1/4000-5000
    Classification

    Divided into:
    Primary (disease of the thyroid gland)
    Secondary (abnormality of pituitary gland)
    Tertiary (abnormality of hypothalamus)

    It can be due to congenital or acquired


    CONGENITAL HYPOTHYROIDISM
    causes :CONGENITAL HYPOTHYROIDISM
    Iodine deficiency -commonest worldwide
    -prevented by iodination of
    salt in maternal diet

    Maldescent of thyroid and -can be either completely or


    athyrosis partially not develop
    -normally, thyroid migrates
    from a position at the base of
    the tongue (sublingual) to its
    normal site below larynx
    -if this is not occur
    (1) remains as lingual mass
    (2) thyroglossal cyst
    cont’..

    Dyshormonogenesis -inborn error of thyroid


    hormone synthesis
    -common in consanguineous
    marriage
    TSH deficiency -usually associated with
    panhypothyroidism
    *growth hormone
    * ACTH
    -isolated TSH deficiencydeficiency
    is rare
    (<1%)
    CLINICAL MANIFESTATION

    • Clinical manifestation in the immediate


    newborn period is usually subtle, it only
    becomes evident after weeks or months later.

    • Therefore, newborn screening is crucial for


    early diagnosis and initiate therapy by younger
    than 1month of age in the absence of
    definitive signs.
    CONGENITAL HYPOTHYROIDISM
    Symptoms Signs
    General General
    -failure to thrive -pale, cold and mottled dry skin
    -feeding problems -hypothermia
    -delayed development
    GIT
    -prolonged jaundice Head and Neck
    -constipation -large anterior frontanelle
    -coarse facies
    -large tongue
    -goiter (occasionally)

    Abdomen
    -umbilical hernia
    DIAGNOSIS

    • Thyroid Function Test


    1.TSH measurement
    =can differentiate between hyper-or hypo
    thyrodism
    2. Serum free T4 test
    3. TRH test
    =to check for hypothalamus dysfunction
    ACQUIRED HYPOTHYROIDISM

    • Common condition – prevalence of 0.1-0.2%


    in population.
    • Incidence in girls is 5 to 10 times greater than
    boys.
    ACQUIRED HYPOTHYROIDISM
    Primary hypothyroidism -Autoimmune
    -Iodine deficiency
    -Subacute thyroiditis
    -Drugs
    -Post-irradiation thyroid
    -Post-ablative

    Central hypothyroidism -Intracranial tumors/masses


    -Post cranial
    radiotherapy/surgery
    -Development pituitary defect,
    isolated TSH deficiency,
    multiple pituitary hormone
    deficiency
    ACQUIRED HYPOTHYROIDISM
    Symptoms Signs
    General General
    -weight gain -short stature/growth failure
    -cold intolerance -dry skin
    -tiredness and lethargy -obesity (BMI>30)
    -delayed puberty
    -learning difficulties Hands
    -deterioration in school work -cold peripheries
    -changes in voices (husky and coarse) -bradycardia
    GIT Head and Neck
    -constipation -thin dry hair
    -pale, puffy eyes with loss of eyebrows
    Reproductive system -goiter (usually present)
    -menorrhagia
    -oligomenorrhagia/amenorrhoea Musculoskeletal
    -infertility -slipped femoral epiphysis
    -slow-relaxing reflex
    DIAGNOSIS

    • Diagnosis may be confirmed by serum anti-


    thyroid peroxidase and anti-thyroglobulin
    antibodies.
    • Neither biopsy, nor thyroid scan is indicated in
    hashimoto’s thyroiditis
    MANAGEMENT
    • Treatment should begin immediately after
    diagnosis is established.
    • If features of hypothyroidism are present,
    treatment is started urgently pending
    T4/TSH results.
    • It is lifelong except in children suspected of
    having transient hypothyroidism where re-
    evaluation is done at 2-3 years of age.
    • ONLY T4 tablet should be used.(crushed and
    mixed with breast milk, formula or water
    and fed the baby)
    • General doses of L-tyroxine by age :
    Age mg/kg/dose, daily

    0-3 months 10-15

    3-6 months 8-10

    6-12 months 6-8

    1-5 years 5-6

    6-12 years 4-5

    >12 years 2-3


    • Follow-up :
    (1)Monitor T4/TSH at regular interval :
    recommendation by The American Academy of
    Paediatrics
    •At 2 and 4 weeks after initiation of T4 treatment.
    •Every 1 to 2 months during 1st year of life.
    •Every 2 to 3 months between 1 to 3 years of age.
    •Every 3-12 months threafter until growth is
    complete.
    •Two weeks after any change in dosage
    •At more frequent intervals when compliance is
    questioned
    (2)Monitor or abnormal
    growth results are obtained.
    (weight/height/OFC)
    (3)Development assesment
    REFERENCES

    • Pocket Essential of Paediatrics, Saunders Elsevier


    • Paediatric Protocols For Malaysian Hospitals 2nd
    edition
    • Nelson Essentials of Pediatrics 5th edition
    • Illustrated Textbook of Paediatric 3rd Edition
    • Nelson Textbook, 12th Edition
    • Oxford Handbook of Paediatric
    • http://www.buzzle.com/articles/congenital-hyp
    othyroidism-symptoms-causes-and-treatment.ht
    ml

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