PEDIATRIC ENDOCRINE DISORDERS 1.2 (TB)

Question 1

What is the most common preventable cause of intellectual disability?

Answer 1

Congenital hypothyroidism.

Question 2

According to December 2021 Philippines NBS data

Answer 2

how many newborns have CH?

Question 3

What is the female to male ratio in congenital hypothyroidism?

Answer 3

2:1.

Question 4

What is the most common cause of permanent congenital hypothyroidism?

Answer 4

Thyroid dysgenesis.

Question 5

What are the types of thyroid dysgenesis?

Answer 5

Agenesis. hypoplasia and ectopia.

Question 6

What are causes of primary hypothyroidism?

Answer 6

Defects in TSH responsiveness. hormone synthesis. iodine deficiency or excess. maternal medications.

Question 7

What are examples of maternal medications causing primary hypothyroidism?

Answer 7

Iodides. amiodarone. methimazole. propylthiouracil. radioactive iodine (131I).

Question 8

What causes central or secondary hypothyroidism?

Answer 8

Deficiency in TSH or TRH.

Question 9

What genes are involved in thyroid gland development?

Answer 9

TTF-2/FOXE-1 and PAX-8.

Question 10

Why is neonatal screening important in hypothyroidism?

Answer 10

Most infants are asymptomatic at birth.

Question 11

What are early signs of congenital hypothyroidism?

Answer 11

Wide fontanelles. increased head size. less crying. sleepy. hoarse cry. prolonged jaundice.

Question 12

What are other signs of congenital hypothyroidism?

Answer 12

Lethargy. constipation. hypothermia. macroglossia. bradycardia. umbilical hernia. anemia.

Question 13

What congenital anomalies are associated with hypothyroidism?

Answer 13

Cardiovascular anomalies and thyroglossal duct persistence.

Question 14

What is the most common cause of acquired hypothyroidism?

Answer 14

Chronic lymphocytic thyroiditis (Hashimoto thyroiditis).

Question 15

What drugs can cause hypothyroidism?

Answer 15

Antidepressants

Question 16

What systemic conditions can inactivate thyroid hormones?

Answer 16

Liver hemangiomas (type 3 deiodinase).

Question 17

What autoimmune diseases are associated with hypothyroidism?

Answer 17

Type 1 DM. celiac disease. polyglandular autoimmune syndromes.

Question 18

How is hypothyroidism diagnosed?

Answer 18

Elevated TSH and low FT4.

Question 19

What antibodies are detected in autoimmune hypothyroidism?

Answer 19

Thyroglobulin and TPO antibodies.

Question 20

What is the recommended treatment for hypothyroidism?

Answer 20

Daily lifetime levothyroxine.

Question 21

When should thyroid levels be monitored in treatment?

Answer 21

Every 4-6 months and 4-6 weeks after dose changes.

Question 22

What is thyroiditis?

Answer 22

Inflammation of the thyroid gland.

Question 23

What causes painful thyroiditis?

Answer 23

Infection or trauma.

Question 24

What causes painless thyroiditis?

Answer 24

Autoimmune diseases or drug exposure.

Question 25

What is the most common organism in acute infectious thyroiditis?

Answer 25

Alpha-hemolytic streptococci and Staphylococcus aureus.

Question 26

What are signs of acute infectious thyroiditis?

Answer 26

Neck pain. gland tenderness. erythema. dysphagia. fever. leukocytosis.

Question 27

How is acute thyroiditis diagnosed?

Answer 27

Ultrasound. FNAB. CT with contrast.

Question 28

What is the treatment for thyroid abscesses?

Answer 28

Incision. drainage and parenteral antibiotics.

Question 29

What causes subacute thyroiditis?

Answer 29

Viral or post-viral infection.

Question 30

What lab findings support subacute thyroiditis?

Answer 30

Suppressed TSH. elevated T3/T4. increased ESR. low radioiodine uptake.

Question 31

What are the four phases of subacute thyroiditis?

Answer 31

Thyrotoxic. euthyroid. hypothyroid. remission.

Question 32

Who gets radiation thyroiditis?

Answer 32

Children treated with radioiodine for Graves disease.

Question 33

What causes palpation-induced thyroiditis?

Answer 33

Surgery. trauma. biopsy. vigorous palpation.

Question 34

What is Hashimoto thyroiditis?

Answer 34

Chronic lymphocytic thyroiditis caused by autoimmune destruction.

Question 35

What antibodies are found in Hashimoto thyroiditis?

Answer 35

TPO-Abs and Tg-Abs.

Question 36

What are symptoms of Hashimoto thyroiditis?

Answer 36

Goiter. growth deceleration. may be euthyroid or hypothyroid.

Question 37

What syndromes are associated with Hashimoto thyroiditis?

Answer 37

APS-1. APS-2. IPEX. celiac. Turner. Down. Klinefelter.

Question 38

What is the definitive diagnosis of Hashimoto thyroiditis?

Answer 38

Biopsy.

Question 39

How is overt hypothyroidism treated?

Answer 39

With levothyroxine.

Question 40

What is painless thyroiditis?

Answer 40

Transient thyrotoxicosis. sometimes followed by hypothyroidism. then recovery.

Question 41

What drugs can cause drug-induced thyroiditis?

Answer 41

Lithium and amiodarone.

Question 42

What is Riedel thyroiditis?

Answer 42

A rare fibrous thyroiditis with extensive fibrosis.

Question 43

What is goiter?

Answer 43

Enlargement of the thyroid gland.

Question 44

What is the normal thyroid volume at birth?

Answer 44

Approximately 1 mL.

Question 45

What rule is used to evaluate thyroid size in children?

Answer 45

Each lobe equals size of the child's distal thumb phalanx.

Question 46

What are common causes of pediatric goiter?

Answer 46

Chronic lymphocytic thyroiditis. iodine deficiency. dyshormonogenesis.

Question 47

What is Pendred syndrome?

Answer 47

Familial goiter and sensorineural hearing loss due to SLC26A4 mutation.

Question 48

What is intratracheal goiter?

Answer 48

Ectopic thyroid tissue in the trachea.

Question 49

What is endemic goiter caused by?

Answer 49

Iodine deficiency.

Question 50

What are the two syndromes of endemic cretinism?

Answer 50

Neurologic type and myxedematous type.

Question 51

What is the treatment for endemic goiter?

Answer 51

Iodinated poppy seed oil or T4 replacement.

Question 52

What is the Wolff-Chaikoff effect?

Answer 52

Acute iodine excess inhibits thyroid hormone synthesis.

Question 53

What is a simple goiter?

Answer 53

Colloid goiter of unknown cause. more common in girls.

Question 54

What is multinodular goiter?

Answer 54

Lobulated goiter with nodules; may become toxic or malignant.

Question 55

What are goitrogens?

Answer 55

Substances that can cause goiter. especially when iodine intake is low.

Question 56

What are examples of goitrogens?

Answer 56

Lithium carbonate and amiodarone.

Question 57

What is thyrotoxicosis?

Answer 57

State of excess circulating thyroid hormone.

Question 58

What is the most common cause of hyperthyroidism in children?

Answer 58

Graves disease.

Question 59

What antibodies are involved in Graves disease?

Answer 59

TRSAbs that stimulate the TSH receptor.

Question 60

What lab values confirm Graves disease?

Answer 60

Suppressed TSH. elevated T4 and T3.

Question 61

What are cardiac signs of hyperthyroidism?

Answer 61

Tachycardia. palpitations. widened pulse pressure. cardiac enlargement.

Question 62

What are ocular signs of Graves disease?

Answer 62

Exophthalmos. lid lag. stare. eye pain. decreased vision.

Question 63

What is thyroid storm?

Answer 63

Severe hyperthyroidism with hyperthermia. tachycardia. delirium and possible death.

Question 64

What drugs are used to treat Graves disease?

Answer 64

Methimazole. beta-blockers. radioactive iodine and sometimes thyroidectomy.

Question 65

Why is propylthiouracil avoided in children?

Answer 65

Risk of liver failure.