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Pediatrics I - OSCE > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q
A
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2
Q

Stages of Thyroid Gland Development

A
  • Fetal thyroid gland
  • Neonatal thyroid gland
  • Childhood thyroid gland
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3
Q

Embryological Development of Thyroid Gland

A
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4
Q

Embryological Development of Thyroid Gland

  • Time
A

Thyroid gland develops in the ist month of life (5th - 7th week of gestation)

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5
Q

Embryological Development of Thyroid Gland

  • Origin
A

It develops by proliferation & invagination of the endoderm of the foregut and 4th, 5th pharyngeal pouch which forms a pouch in the floor of pharynx, migrates downward

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6
Q

Embryological Development of Thyroid Gland

  • Course
A
  • The thyroid becomes attached to the pharynx by the thyroglossal duct
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7
Q

Embryological Development of Thyroid Gland

  • Clinical Significance
A

Ectopic Thyroid Gland

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8
Q

Pathogenesis of Ectopic Thyroid Gland

A
  • Ectopic thyroid tissue results from a lack of caudal migration of the thyroid gland and is thus, usually located along the normal path of thyroid gland descent
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9
Q

Types of Ectopic Thyroid Gland

  • Lingual
A
  • The entire thyroid gland fails to descend to its normal adult orthotopic site.
  • The descent is completely arrested at the level of the base of the tongue
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10
Q

Do Patients with Ectopic Thyroid Gland have another thyroid?

A
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11
Q

Dx of Ectopic Thyroid Gland

A
  • Ectopic thyroid is mainly diagnosed with a thyroid scan, which can localize all ectopic foci that take up radioisotope outside the native thyroid location in the neck
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12
Q

Sequence of Intrauterine Thyroid Activity

A
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13
Q

Fetus depend on maternal thyroid hormones in ……

A

1st half of gestation

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14
Q
  • Maternal hypothyroidism has deleterious effects on …..
  • There should be biochemical screening of women who have a personal or family history of thyroid disease
A

offspring intellectual development (Cretinism)

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15
Q

Def of Cretinism

A
  • it’s a condition of severely physical, mental & sexual developmental disorder due to untreated congenital hypothyroidism usually with underlying maternal hypothyroidism
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16
Q

Changes in T4 & TSH

A
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17
Q

Changes in T4 & TSH

  • At Birth
A
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18
Q

Changes in T4 & TSH

  • Later
A
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19
Q

Steps of Thyroid Hormone Synthesis

VIP

A
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20
Q

Regulation of Thyroid Gland Function

A
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21
Q

Wolff-Chaikoff Effect

A
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22
Q

Physiologic effects of T3 & T4

A
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23
Q

Incidence of Congenital Hypothyroidism

A
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24
Q

Etiology of Congenital Hypothyroidism

A
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25
Q

Etiology of Congenital Hypothyroidism

  • 1ry
A
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26
Q

Etiology of Congenital Hypothyroidism

  • 2ry
A
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27
Q

Etiology of Congenital Hypothyroidism

  • 3ry
A
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28
Q

Etiology of Congenital Hypothyroidism

  • End-Organ Resistance
A
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29
Q

Etiology of 1ry Hypothyroidism

A

Conenital:

  • Thyroid Agenesis (90%)
  • Dyshormonogenesis
  • Antenatal Goitrogens

Acquired:
- Hashimotomo
- Iatrogenic
- etc …..

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30
Q

Etiology of 1ry Hypothyroidism

  • Thyroid Agenesis
A

Aplasia, hypoplasia or ectopic

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31
Q

Etiology of 1ry Hypothyroidism

  • Dyshormonogenesis
A
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32
Q

Etiology of 1ry Hypothyroidism

  • Antenatal Goitrogens
A
  • Maternal antithyroid drugs “lodide & carbimazole”.
  • Maternal radioactive iodine in the 1st trimester
  • Maternal diet (Endemic goiter / Cretinism)
  • Maternal disease (AIT.> (TRB-Ab, TG-Ab)
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33
Q

Etiology of 1ry Hypothyroidism

  • Acquired
A
  • Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis).
  • Surgical excision.
  • Irradiation to neck.
  • iodine in diet (Endemic goiter).
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34
Q

Etiology of 1ry Hypothyroidism may also be classified as …….

A

Transient & Permenant

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35
Q

Etiology of 1ry Hypothyroidism

  • Transient Causes
36
Q

Etiology of 1ry Hypothyroidism

  • Premnant Causes
A
  • Most common
  • Long term intellectual defect outcome
37
Q

CP of Congenital Hypothyroidism

A
  • During early weeks of life
  • With Growth
38
Q

CP of Congenital Hypothyroidism

  • Early Weeks of Life
39
Q

CP of Congenital Hypothyroidism

  • Hx
A
  • Maternal (Antenatal) history
  • Family history (Hereditary hypothyroidism)
40
Q

CP of Congenital Hypothyroidism

  • Ex
A
  • Apgar score for early suspicion of hypothyroidism
  • Thyroid gland examination
41
Q

CP of Congenital Hypothyroidism

  • Biochemical tests
A
  • Neonatal screening for congenital hypothyroidism
  • Confirmatory lab test
42
Q

CP of Congenital Hypothyroidism

  • APGAR Score for hypothyroidism

(VIP)

43
Q

CP of Congenital Hypothyroidism

  • Others
A
  • Little horse cry
  • Always sleep
  • Pulse & Respiratory rate
  • Feed Feeding difficulties & Chocking
44
Q

CP of Congenital Hypothyroidism

  • X-ray findings
A
  • Absence of ossification centers on lower end of femur
45
Q

CP of Congenital Hypothyroidism

  • Later with Growth
46
Q

CP of Congenital Hypothyroidism

  • Coarse Features
47
Q

Most children with congenital hypothyroidism do not have symptoms at the time of birth because ……

A

because the placenta supplies the fetus with maternal thyroid hormone.

48
Q

For this reason, neonatal screening is vital even if children are asymptomatic.

49
Q

Irreversible intellectual disabilities can be avoided through early initiation of adequate therapy

50
Q

Investigations for Congenital Hypothyroidism

A

Lab:

  • TFT
  • Abs
  • Cholesterol

Rad:

  • US
  • Thyroid Scan
  • X-Ray
51
Q

Investigations for Congenital Hypothyroidism

  • Labs
A

Lab:

  • TFT
  • Abs
  • Cholesterol
52
Q

Investigations for Congenital Hypothyroidism

  • Thyroid Function Tests
53
Q

Investigations for Congenital Hypothyroidism

  • Radioactive T3 resin uptake (RU)
A

Normally 26 - 35 % (depend on the unbound protein binding globulin)

54
Q

Investigations for Congenital Hypothyroidism

  • T4 Index
A

Total T4 x T3 RU (Normally 1.3 - 4.3)

55
Q

Investigations for Congenital Hypothyroidism

  • Additional Labs
A
  • Anti-thyroglobulin and anti-microsomal antibodies
  • T Serum cholesterol
56
Q

Investigations for Congenital Hypothyroidism

  • Rad
A

Rad:

  • US
  • Thyroid Scan
  • X-Ray
57
Q

Investigations for Congenital Hypothyroidism

  • US
58
Q

Investigations for Congenital Hypothyroidism

  • Thyroid Scan
59
Q

Investigations for Congenital Hypothyroidism

  • X-ray
60
Q

Neonatal Screening for Congenital Hypothyroidism

61
Q

Neonatal Screening for Congenital Hypothyroidism

  • Def
A
  • A national program for early diagnosis of congenital hypothyroidism to prevent mental retardation
62
Q

Neonatal Screening for Congenital Hypothyroidism

  • Technique
A

It’s done by blood sample (heal pin prick) en filter paper which is collected and examined for TSH or T4

63
Q

Neonatal Screening for Congenital Hypothyroidism

  • Timing
A
  • Sample is taken 3-7 days after birth (to avoid TSH surge during the 1st 3 days after birth).
64
Q

Neonatal Screening for Congenital Hypothyroidism

  • Appraoches
65
Q

Neonatal Screening for Congenital Hypothyroidism

  • Screening by TSH
66
Q

Neonatal Screening for Congenital Hypothyroidism

  • Screening by T4
A

T4 < 6.6 mg/dl is diagnostic

67
Q

If screening is positive, ……..

68
Q

Start treatment at once till the results of investigation.

69
Q

If the reinvestigation is:
* Positive → …….
* If not → …….

A
  • Continue TTT
  • Stop TTT
70
Q

Interpretation of Thyroid Screening

71
Q

Interpretation of Thyroid Screening

72
Q

Interpretation of Thyroid Screening

73
Q

Interpretation of Thyroid Screening

74
Q
  • Persistent elevated TSH despite of normal size thyroid gland should be treated as congenital hypothyroidism.
75
Q
  • Treatment should continue until 2 years of age “At which myelination of CNS is complete” & then repeat the investigations.
76
Q
  • Occasionally, an infant with congenital hypothyroidism may escape detection in newborn screening programs. These infants must be diagnosed on clinical basis
77
Q

TTT of Congenital Hypothyroidism

78
Q

TTT of Congenital Hypothyroidism

  • Principles
A
  • Start treatment within 2-3 weeks after birth.
  • Start treatment after withdrawal of blood for investigation & I123 thyroid scan.
79
Q

TTT of Congenital Hypothyroidism

  • The level of cord T4 & the degree of delay of bone age at birth is highly correlated with the neurodevelopmental delay in congenital hypothyroidism
80
Q

TTT of Congenital Hypothyroidism

  • Dose of L-Thyroxine
81
Q

TTT of Congenital Hypothyroidism

  • Monitoring of L-Thyroxine
82
Q

TTT of Congenital Hypothyroidism

  • Early Signs of Improvement
83
Q

TTT of Congenital Hypothyroidism

  • Goals of Therapy
84
Q

TTT of Congenital Hypothyroidism

  • Follow up
85
Q

TTT of Congenital Hypothyroidism

  • SE of L-Thyroxine
86
Q

Prognosis of Congenital Hypothyroidism

Pediatrics I - OSCE (20 decks)

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