Hypothyroidism pedi

Question 1

Hypothyroidism pedi
most children present____ and sx such as ____

TSH=
T4=

Answer 1

asymptomatic,

• declining growth velocity***/short stature/decreased bone age
• abnormal pubertal development
• functioning in school (good or bad)

tsh high
t4 low

Question 2

Hypothyroidism pedi
tsh comes from ___
works on____

Answer 2

pituitary gland

feedback loop

Question 3

causes of acquired hypothyroidism

more common in:

most common cause worldwide:

Answer 3

lymphocytic thyroiditis, hashimoto thyroiditis

girls

iodine deficiency

Question 4

Hypothyroidism pedi

growth delay occurs insidiously and sx develop ____

Answer 4

years later, if ever

Question 5

Hypothyroidism pedi

if symptomatic present with:

Answer 5

malaise, cold intolerance, constipation, dry skin, brittle hair

facial puffiness, edema around eyes, muscle aches/pains

decreased appetite

Question 6

PE for Hypothyroidism pedi

Answer 6

short, overweight 
puffy face
bradycardia 
delayed DTR 
thyroid- normal or enlarged
delayed puberty

Question 7

most common preventable cause of intellectual disability

Answer 7

Congenital hypothyroid

Question 8

clinical manifestations congenital hypothyroid

dx/screening/when is it done

cause

Answer 8

few or none

radioimmunoassay for thyroxine (t4) close to time of discharge from hospital (1-2d after birth)- heel stick

iodine deficiency- required for thyroid hormone synthesis

Question 9

Congenital hypothyroid

if abnormal radioimmunoassay for t4 on newborn screen, do

Answer 9

venipuncture measuring TSH and free thyroxine (t4)

Question 10

possible PE findings on Congenital hypothyroid

Answer 10

large posterior fontanel
umbilical hernia 
constipation
prolonged jaundice
hypothermia
hypotonia

Question 11

Dosing considerations for pedi hypothyroid

dosing age:

Goal for tsh/t3/t4

Answer 11

children clear t4 more rapidly, higher doses needed

1-3: 4-6 mcg/kg
3-10: 3-5 mcg/kg
10-16: 2-4 mcg/kg

TSH: keep in lower normal range
T4: keep in upper normal range (Bc clear quickly)

Question 12

tx hypothyroid and how to take

Answer 12

levothyroxine in am on empty on stomach

Question 13

short stature after first year or two=

Answer 13

familial (genetic) short stature

Question 14

constitutional short stature

normal/abnormal?

Answer 14

normal nonpathological variant of grwoth

Question 15

short stature definition

test to order:

Answer 15

2 SD or more below mean height of same sex/age

bone age to determine relative maturity and growth potential

Question 16

Stature phases and patterns

Answer 16

nonlinear:
(IU- size determined by nutrition)
-infantile- begins rapid linear, gradual decel
-childhood
-puberty- 8-14 cm per year (girls- starts at 10, boys-12)

Question 17

stature height calculation

Answer 17

girls: subtract five from father and avg with mother
boys: add five to mother and avg with father

Question 18

definition delayed bone age

Answer 18

2 sd or more below mean (20%)

Question 19

child 6 and healthy, bone age 3 years…what is outcome?

what is this called?

Answer 19

predict normal adult height, but may have delayed puberty

constitutional growth delay, growing at normal rate but delayed bone age

Question 20

bone age determined by

Answer 20

epiphyseal ossification centers (left hand)