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470561
Hypothyroidism
Descripción
(Endocrine & metabolic) Paediatrics Mapa Mental sobre Hypothyroidism, creado por v.djabatey el 08/01/2014.
Sin etiquetas
endocrine & metabolic
paediatrics
paediatrics
endocrine & metabolic
Mapa Mental por
v.djabatey
, actualizado hace más de 1 año
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Creado por
v.djabatey
hace más de 10 años
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Resumen del Recurso
Hypothyroidism
Congenital hypothyroidism
detection is important
CH relatively common
incidence- 1 in 4000 births
a preventable cause of severe learning difficulties
Causes
maldescent of thyroid & athyrosis
commonest cause of sporadic congenital hypothyroidsim
thyroid migrates from sublingual position to normal site below larynx in early fetal life
partial or complete failure of thyroid to develop may occur
maldescent- thyroid remains as lingual mass or unilobular small gland
reason for failure of formation or migration not understood
dyshormonogenesis
inborn error of thyroid hormone synthesis
commoner in some ethnic groups w/ consanguineous marriage
about 5-10% of congenital hypo cases
iodine def
commonest cause of congenital hypothyroidism worldwide
but rare in UK
preventable
by iodination of salt in diet
hypothyroidism due to TSH def
isolated TSH def is rare
about 1% of cases
usually assoc w/ panhypopituitarism
which manifests as
growth hormone def, gonadotrophin def & ACTH def
this -> hypoglycaemia & micropenis & undescended testes in affected boys
the above appear before hypothyroidism becomes evident
clinical features
hard to differentiate from normal in 1st month of life
but become more prominent w/ age
usually asymptomatic & picked up on Guthrie test (neonatal biochemical screening)
otherwise
failure to thrive
feeding probs
prolonged jaundice
constipation
pale, cold, mottled skin
coarse facies
large tongue
hoarse cry
goitre (sometimes)
umbilical hernia
delayed development
slight excess of other congenital abnormalities
esp heart defects
Ix
Guthrie test
raised TSH in blood
NB: thyroid dysfun secondary to pituitary abnormalities won't be detected on Guthrie as they'll have low TSH
T4
in some countries
Rx
thyroxine
start at 2-3 weeks old
early Rx to prevent learning difficulties
intelligence will be in normal range
life-long oral replacement
titrate to maintain normal growth, TSH & T4 levels
Juvenile hypothyroidism
usually caused by autoimmune thyroiditis
increased risk in children w/ Down or Turner syndrome
increased risk of developing other autoimmune disease
vitiligo
rheumatoid arthritis
diabetes mellitus
Addison's disease in some families
Rx
thyroxine
clinical features
goitre
goitre can also be physiological in pubertal girls
short stature/growth failure
females> males
cold intolerance
cold peripheries
bradycardia
thin, dry hair
pale, puffy eyes, w/ loss of eyebrows
slow-relaxing reflexes
constipation
delayed puberty
obesity
slipped upper femoral epiphysis
deterioration in school work
learning difficulties
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