Scribd Logo
Upload

Welcome to Scribd!

  • 47 views

    THyroid Disorder

    Uploaded by

    T.A.B
    This document discusses thyroid disorders including hypothyroidism, its epidemiology, etiology, clinical features, diagnosis, treatment, and prognosis. Some key points: - Neonatal screening reveals hypothyroidism incidence varies between 1-5/1000 live births and is the most common preventable cause of mental retardation in children. - Both congenital and acquired hypothyroidism can be caused by iodine deficiency. Clinical features include constipation, feeding problems, and growth failure. - Diagnosis involves laboratory tests showing low T4 and high TSH levels. Treatment is lifelong thyroid hormone replacement therapy, usually with levothyroxine. - Prognosis depends on early diagnosis

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    THyroid Disorder

    Uploaded by

    T.A.B
    47 views39 pages
    This document discusses thyroid disorders including hypothyroidism, its epidemiology, etiology, clinical features, diagnosis, treatment, and prognosis. Some key points: - Neonatal screening reveals hypothyroidism incidence varies between 1-5/1000 live births and is the most common preventable cause of mental retardation in children. - Both congenital and acquired hypothyroidism can be caused by iodine deficiency. Clinical features include constipation, feeding problems, and growth failure. - Diagnosis involves laboratory tests showing low T4 and high TSH levels. Treatment is lifelong thyroid hormone replacement therapy, usually with levothyroxine. - Prognosis depends on early diagnosis

    Original Description:

    THyroid disorder

    Original Title

    THyroid disorder

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses thyroid disorders including hypothyroidism, its epidemiology, etiology, clinical features, diagnosis, treatment, and prognosis. Some key points: - Neonatal screening reveals hypothyroidism incidence varies between 1-5/1000 live births and is the most common preventable cause of mental retardation in children. - Both congenital and acquired hypothyroidism can be caused by iodine deficiency. Clinical features include constipation, feeding problems, and growth failure. - Diagnosis involves laboratory tests showing low T4 and high TSH levels. Treatment is lifelong thyroid hormone replacement therapy, usually with levothyroxine. - Prognosis depends on early diagnosis

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    47 views39 pages

    THyroid Disorder

    Uploaded by

    T.A.B
    This document discusses thyroid disorders including hypothyroidism, its epidemiology, etiology, clinical features, diagnosis, treatment, and prognosis. Some key points: - Neonatal screening reveals hypothyroidism incidence varies between 1-5/1000 live births and is the most common preventable cause of mental retardation in children. - Both congenital and acquired hypothyroidism can be caused by iodine deficiency. Clinical features include constipation, feeding problems, and growth failure. - Diagnosis involves laboratory tests showing low T4 and high TSH levels. Treatment is lifelong thyroid hormone replacement therapy, usually with levothyroxine. - Prognosis depends on early diagnosis

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 39

    THYROID DISORDERS

    Abdelaziz Elamin. MD, PhD,


    FRCPCH
    Professor of Child Health
    Consultant Pediatric
    Endocrinologist
    Sultan Qaboos University, Oman

    HYPOTHYROIDISM-EPIDEMIOLOGY
    Neonatal screening reveals incidence
    that varies between 1-5/1000 live
    births
    The most common cause of preventable
    mental retardation in children
    Both acquired & congenital forms are
    linked to iodine deficiency
    Diagnosis is easy & early treatment is
    beneficial

    ETIOLOGY
    CONGENITAL
    Hypoplasia & mal-descent
    Familial enzyme defects
    Iodine deficiency (endemic cretinism)
    Intake of goitrogens during pregnancy
    Pituitary defects
    Idiopathic

    ETIOLOGY /2
    ACQUIRED
    Iodine deficiency
    Auto-immune thyroiditis
    Thyroidectomy or RAI therapy
    TSH or TRH deficiency
    Medications (iodide & Cobalt)
    Idiopathic

    KILPATRIK GRADING OF GOITRE


    Grade 0: Not visible neck extended &
    Not palpable
    Grade 1: Not visible, but palpable
    Grade 2: Visible only when neck is
    extended & on swallowing,
    Grade 3: Visible in all positions
    Grade 4: Large goiter

    THYROID GLAND
    Derived from pharyngeal endoderm
    at 4/40
    Migrate from base of the tongue to
    cover the 2&3 tracheal rings.
    Blood supply from ext. carotid &
    subclavian and blood flow is twice
    renal blood flow/g tissue.
    Starts producing thyroxin at 14/40.

    OVERVIEW (2)
    Maternal & fetal glands are independent
    with little transplacental transfer of T4.
    TSH doesnt cross the placenta.
    Fetal brain converts T4 to T3 efficiently.
    Average intake of iodine is 500 mg/day.
    70% of this is trapped by the gland
    against a concentration gradient up to
    600:1

    THYROID HORMONES
    Iodine & tyrosine form both T3 & T4 under
    TSH stimulation. However, 10% of T4
    production is autonomous and is present in
    patients with central hypothyroidism.
    When released into circulation T4 binds to:
    Globulin TBG
    75%
    Prealbumin TBPA
    20%
    Albumin TBA
    5%

    THYROID HORMONES (2)


    Less than 1% of T4 & T3 is free in
    plasma.
    T4 is deiodinated in the tissues to either
    T3 (active) or reverse T3 (inactive).
    At birth T4 level approximates maternal
    level but increases rapidly during the
    first week of life.
    High TSH in the first 5 days of life can
    give false positive neonatal screening

    TSH
    Is a Glico-protein with Molecular Wt
    of 28000
    Secreted by the anterior pituitary
    under influence of TRH
    It stimulates iodine trapping,
    oxidation, organification, coupling
    and proteolysis of T4 & T3
    It also has trophic effect on thyroid
    gland

    TSH (2)
    T4 & T3 are feed-back regulators of TSH
    TSH is stimulated by a-adrenergic
    agonists
    TSH secretion is inhibited by:
    Dopamine
    Bromocreptine
    Somatostatin
    Corticosteroids

    THYROID HORMONES (3)


    Conversion of T4 to T3 is decreased by:
    Acute & chronic illnesses
    b-adrenergic receptor blockers
    Starvation & severe PEM
    Corticosteroids
    Propylthiouracil
    High iodine intake (Wolff-Chaikoff effect)

    THYROXINE (T4)
    Total T4 level is decreased in:
    Premature infants
    Hypopituitarism
    Nephrotic syndrome
    Liver cirrhosis
    PEM
    Protein losing entropathy

    THYROXINE (2)
    Total T4 is decreased when the

    following drugs are used:


    Steroids
    Phenytoin
    Salicylates
    Sulfonamides
    Testosterone
    Maternal TBII

    THYROXINE (3)
    Total T4 is increased with:
    Acute thyroiditis
    Acute hepatitis
    Estrogen therapy
    Clofibrate
    iodides
    Pregnancy
    Maternal TSI

    FUNCTIONS OF THYROXINE
    Thyroid hormones are essential for:

    Linear growth & pubertal development


    Normal brain development & function
    Energy production
    Calcium mobilization from bone
    Increasing sensitivity of b-adrenergic
    receptors to catecholeamines

    CLINICAL FEATURES
    Gestational age > 42 weeks
    Birth weight > 4 kg
    Open posterior fontanel
    Nasal stuffiness & discharge
    Macroglossia
    Constipation & abdominal distension
    Feeding problems & vomiting

    CLINICAL FEATURES (2)


    Non pitting edema of lower limbs &
    feet
    Coarse features
    Umbilical hernia
    Hoarseness of voice
    Anemia
    Decreased physical activity
    Prolonged (>2/52) neonatal jaundice

    CLINICAL FEATURES (3)


    Dry, pale & mottled skin
    Low hair line & dry, scanty hair
    Hypothermia & peripheral cyanosis
    Hypercarotenemia
    Growth failure
    Retarded bone age
    Stumpy fingers & broad hands

    CLINICAL FEATURES (5)


    Skeletal abnormalities:
    Infantile proportions
    Hip & knee flexion
    Exaggerated lumbar lordosis
    Delayed teeth eruption
    Under developed mandible
    Delayed closure of anterior fontanel

    OCCASIONAL FEATURES
    Overt obesity
    Myopathy & rheumatic pains
    Speech disorder
    Impaired night vision
    Sleep apnea (central & obstructive)
    Anasarca
    Achlorhydria & low intrinsic factor

    OCCASIONAL FEATURES (2)


    Decreased bone turnover
    Decreased VIII, IX & platelets
    adhesion
    Decreased GFR & hyponatremia
    Hypertension
    Increased levels of CK, LDH & AST
    Abnormal EEG & high CSF protein
    Psychiatric manifestations

    ASSOCIATIONS
    Autoimmune diseases (Diabetes
    Mellitus)
    Cardiomyopathy & CHD
    Galactorrhoea
    Muscular dystrophy +
    pseudohypertrophy (Kocher-DebreSemelaigne)

    GOITROGENS
    DRUGS
    Anti-thyroid
    Cough medicines
    Sulfonamides
    Lithium
    Phenylbutazone
    PAS
    Oral hypoglycemic agents

    GOITROGENS
    FOOD
    Soybeans
    Millet
    Cassava
    Cabbage

    CLINICAL FEATURES (4)


    Neurological manifestations
    Hypotonia & later spasticity
    Lethargy
    Ataxia
    Deafness + Mutism
    Mental retardation
    Slow relaxation of deep tendon jerks

    CONGENITAL HYPOTHYRODISM
    Primary thyroid defect: usually
    associated with goiter.
    Secondary to hypothalamic or pituitary
    lesions: not associated with goiter.
    2 distinct types of presentation:
    Neurological with MR-deafness & ataxia
    Myxodematous with dwarfism &
    dysmorphism

    DIAGNOSIS
    Early detection by neonatal screening
    High index of suspicion in all infants
    with increased risk
    Overt clinical presentation
    Confirm diagnosis by appropriate lab
    and radiological tests

    LABROTARY FINDINGS
    Low (T4, RI uptake & T3 resin uptake)
    High TSH in primary hypothyroidism
    High serum cholesterol & carotene levels
    Anaemia (normo, micro or macrocytic)
    High urinary creatinine/hydroxyproline
    ratio
    CXR: cardiomegaly
    ECG: low voltage & bradycardia

    IMAGING TESTS
    X-ray films can show:
    Delayed bone age or epiphyseal
    dysgenesis
    Anterior peaking of vertebrae
    Coxavara & coxa plana

    Thyroid radio-isotope scan


    Thyroid ultrasound
    CT or MRI

    TREATMENT (2)
    L-Thyroxin is the drug of choice. Start with
    small dose to avoid cardiac strain.
    Dose is 10 g/kg/day in infancy. In older
    children start with 25 g/day and increase
    by 25 g every 2 weeks till required dose.
    Monitor clinical progress & hormones level

    TREATMENT
    Life-long replacement therapy
    5 types of preparations are available:
    L-thyroxin (T4)
    Triiodothyronine (T3)
    Synthetic mixture T4/T3 in 4:1 ratio
    Desiccated thyroid (38mg T4 & 9mg
    T3/grain)
    Thyroglobulin (36mg T4 & 12mg T3/grain)

    THYROID FUNCTION TESTS


    1. Peripheral effects:
    BMR
    Deep Tendon Reflex
    Cardiovascular indices (pulse, BP, LV
    function tests)
    Serum parameters (high cholesterol, CK,
    AST, LDH & carcino-embryonic antigen)

    THYROID FUNCTION TESTS (2)


    2. Thyroid gland economy:
    Radio iodine uptake
    Perchlorate discharge test (+ve in Pendred
    syndrome & autoimmune thyroiditis)
    TSH level
    TRH stimulation tests
    Thyroid scan

    THYROID FUNCTION TESTS (3)


    3. Tests for thyroid hormone:
    Total & free T4 & T3
    Reverse T3 level
    T3 Resin Uptake
    T3RU x total T4= Thyroid Hormone
    Binding Index (formerly Free Thyroxin
    Index)

    THYROID FUNCTION TESTS (4)


    Special Tests:
    Thyroglobulin level
    Thyroid Stimulating Immunoglobulin
    Thyroid antibodies
    Thyroid radio-isotope scan
    Thyroid ultrasound
    CT & MRI
    Thyroid biopsy

    PROGNOSIS
    Depends on:
    Early diagnosis
    Proper diabetes education
    Strict diabetic control
    Careful monitoring
    Compliance

    MYXOEDMATOUS COMA
    Impaired sensorium, hypoventilation
    bradycardia, hypotension &
    hypothermia
    Precipitated by:
    Infections
    Trauma (including surgery)
    Exposure to cold
    Cardio-vascular problems
    Drugs

    PROGNOSIS
    Is good for linear growth & physical
    features even if treatment is delayed,
    but for mental and intellectual
    development early treatment is crucial.
    Sometimes early treatment may fail to
    prevent mental subnormality due to
    severe intra-uterine deficiency of
    thyroid hormones

    You might also like