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Fifth stage 

Pediatric 

Lec-10

 

د.ندى العلي

 

11/4/2016

 

 

Hypothyroidism

 

Few diseases affect multiple systems so severely as hypothyroidism yet are associated with 
so many nonspecific symptoms and signs. Hypothyroidism can occur at any age 

Its clinical manifestation during infancy differs markedly from that of childhood and 
adolescence; for this reason, we must distinguish between congenital and juvenile-acquired 
hypothyroidism. 

 

ETIOLOGY 

  In most instances the causes of hypothyroidism differ during infancy and childhood 
  children with congenital hypothyroidism usually have either familial goitrous 

hypothyroidism (dyshormonogenesis)9 or thyroid dysgenesis with an ectopic thyroid 
gland located somewhere between the foramen cecum of the tongue and the 
anterior mediastinum 

  In most cases of permanent congenital hypothyroidism, the cause is unknown. Several 

inborn errors of thyroid hormone synthesis are inherited as autosomal recessive traits 
and usually manifest with thyromegaly on physical examination 

  The most common cause of hypothyroidism in children beyond the perinatal period is 

goitrous or nongoitrous, autoimmune (chronic lymphocytic, Hashimoto's) thyroiditis 

 

HISTORY AND PHYSICAL EXAMINATION 

  Because hypothyroidism can affect most organ systems to varying degrees, it is very 

important that the clinician consider the diagnosis when the patient has many 
nonspecific or multisystemic complaints 

 

Congenital Hypothyroidism 

  Facial edema  

Large posterior fontanelle (>0.5 cm)  
Rectal temperature below 95° F (35° C)  
Decreased stooling (less than one stool per day)  
Prolonged hyperbilirubinemia (bilirubin above 10 mg/dl after 3 days of age)  

  Respiratory distress in a term infant  

Umbilical hernia  


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Birth weight above 4000 g  
Macroglossia  
Bradycardia (pulse below 100 beats/min)  
Feeding problems and lethargy  
Cutaneous mottling, vasomotor instability  
Hoarse cry  
Hirsute forehead 

  Increased skin pigmentation  

Physical and mental lazyness  
Pale, gray, cool, mottled, thickened, coarse skin  
Constipation  
Coarse, dry brittle hair  

 

Juvenile Hypothyroidism 

  Growth retardation (below 4 cm/yr)  

Delayed bone maturation  
Delayed dental development and tooth eruption  
Onset of puberty: usually delayed; rarely precocious  
Myopathy and muscular hypertrophy  
Menstrual disorders  
Galactorrhea  

 

LABORATORY DATA 

  An elevation of the serum TSH value is the single most sensitive test for primary 

hypothyroidism (thyroid gland failure) 

  combination of a low serum thyroxine (T

4

) value and an elevated TSH is diagnostic of 

primary hypothyroidism, either permanent or transient, at any age, including term 
and preterm infant 

  thyroid antibody determinations can be very helpful in finding the cause of infantile or 

juvenile-acquired hypothyroidism 

  A bone age determination consistent with that of a normal newborn would suggest 

recently acquired, mild congenital hypothyroidism,  

  The absence of ossification centers at the knee in addition to the presence of only the 

two ossification centers in the foot indicates that the fetus was affected by 
hypothyroidism during the third trimester of pregnancy.  

 

 


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THERAPY 

  The treatment of choice for hypothyroidism in infancy and childhood is the daily 

administration of oral L-thyroxine 

 

PROGNOSIS 

  Infants who were treated adequately for congenital hypothyroidism since the first 

month of age have an excellent prognosis for normal intellectual function and linear 
growth. However, delays in diagnosis and in the institution of adequate therapy after 
3 months of age usually are associated with an increased risk of mental retardation 

  no permanent intellectual impairment is found among patients who have juvenile 

hypothyroidism. Adolescents who have chronic hypothyroidism and severe growth 
retardation may never achieve their full growth potential. 

 




رفعت المحاضرة من قبل: Abdalmalik Abdullateef
المشاهدات: لقد قام 15 عضواً و 153 زائراً بقراءة هذه المحاضرة








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