Hypothyroidism

Question 1

Newborn visit checklist

Answer 1

Prenatal history
Birth history
Feeding history
Development

Question 2

Weight gain in newborn period

Answer 2

can lose up to 10% of birth weight and then expected to regain by 2 weeks

Question 3

Breastfeeding

Answer 3

ideal nutrition for kids (HIV, herpes lesion, drugs only reasons not to)

• 8-12 feedings every 24 hrs
• getting enough? –> weight gain, UO, trend in feeding history
• Vit D supplement (400 units)

Question 4

Definition of lethargy

Answer 4

level of consciousness characterized by poor or absent eye movements
*DIFFICULT TO ASSESS IN NEWBORN

Question 5

DDx for lethargy in infant

Answer 5

infection (sepsis)
intracranial patholgy
metabolism error
chromosomal anomaly

Question 6

Abnormal movements in infants

Answer 6

seizures aren’t like regular ones -> weird jerky movements, fluttering eyelids or smacking lips
- myoclonic jerks - normal for infants when falling asleep

Question 7

Risks of out-of-hospital birhts

Answer 7

neonatal tetanus
Omphalitis - infection of umbilical stump
Hemorrhagic disease - no Vit K

Question 8

Congenital hypothyroidism

Answer 8

feeding problems, decreased activity, constipation, prolonged jaundice, umbilical hernia

Question 9

Shaken baby syndrome

Answer 9

young single parents, home stressors, low education level

Question 10

Down syndrome

Answer 10

hyptonia –> poor feeding

Question 11

Sepsis

Answer 11

fever, infection, poor feeding, vomiting, decreased activity

Question 12

Congenital adrenal hyperplasia

Answer 12

decreased feeding and activity

• salt-wasting –> decreased activity, dehydration –> shock
• most common is 21-OH –> no production of cortisol or aldosterone –> hyponatremia and hyperkalemia

Question 13

inborn error in metabolism

Answer 13

typically in first 1-2 days of life due to protein load in milk
- somnolence, lethargy, poor feeding –> vomiting

Question 14

Measuring fontanels

Answer 14

Mean = 2.1 cm

Question 15

Significance of abnormal fontanels

Answer 15

Large - skeletal disorders, chromosomal, hypothyroidism, malnutrition
Small - microcephaly, craniosynostosis, hyperthyroidism
Sunken - dehydration
Bulging - meningitis, hydrocephalus, subdural hematoma, lead poisoning

Question 16

Epicanthal fold

Answer 16

folds of skin between medial eye and nose

Question 17

Palpebral fissures

Answer 17

eye slits on lateral sides of eyes

Question 18

Hypoglycemia

Answer 18

decreased temp, irritability, tremors, jittery

- can be essentially asymptomatic

Question 19

Labwork for infant with hypotonia

Answer 19

Sodium, potassium –> congenital adrenal hyperplasia
Ammonia –> encephalopathy, inborn errors
TSH, T4 –> congenital hypothyroidism (T4 low, TSH high)
Glucose –> check all with hypotonia

Question 20

Etiology of congenital hypothyroidism

Answer 20

1:4000 births
aplasia, hypoplasia, ectopic gland
maternal autoimmune thyroiditis
iodine deficiency

Question 21

Primary vs Secondary Hypothyroidism

Answer 21

Primary - >95% of all cases (hypothalamic-pituitary axis function is elevated)
Secondary - 5% (abnormality at just hypothalamus or just pituitary) –> low TSH and low T4 respectively

Question 22

Presentation of congenital hypothyroidism

Answer 22

feeding problems
decreased activity
constipation
prolonged jaundice
skin mottling
umbilical hernia

Question 23

Newborn screeing of CH

Answer 23

performed in all 50 states

*early detection can completely reverse the disease and has great prognosis if caught and treated early

Question 24

Diagnosis and treatment of CH

Answer 24

low TSH and T4 is CH until proven otherwise in infant

• give levothyroxine (maintain level around 1)
• CLOSE FOLLOW UP

Question 25

PKU

Answer 25

if not caught and treated -> developmental delay, microcephaly, cognitive impairment, seizures, musty odor, albinism

Question 26

Benefits/Risks of screening tests

Answer 26

Benefits- detect serious fatal diseases and treat them appropriately
Risks - false negatives, anxiety, treatment not effective