Thyroid Disorders -Clark Flashcards
What are the most common causes of congenital hypothyroidism?
- failure of development (thyroid aplasia or hypoplasia)
- failure of descent (ectopic thyroid gland)
75%=thyroid dysgenesis
What are the most common causes of congenital hypothyroidism?
- failure of development (thyroid aplasia or hypoplasia)
- failure of descent (ectopic thyroid gland)
What are the common symptoms of congenital hypothyroidism?
-normal=asymptomatic
-prolonged jaundice
-lethargy
-poor feeding
-Cretinism (puffy face, depressed nasal bridge, hoarse cry, large fontanels, hyotonia, delayed reflexes, large protruding tongue
)
What are the common symptoms of congenital hypothyroidism?
- normal=asymptomatic
- prolonged jaundice
- lethargy
- poor feeding
- Cretinism (puffy face, depressed nasal bridge, hoarse cry, large fontanels, hyotonia, delayed reflexes, large protruding tongue)
Until what age does the brain need thyroid hormone to develop properly?
up to 3 yo
How is congenital hypothyroidism diagnosed?
- TSH – increased
- T4, FT4 – decreased
- T3 – normal or low
- Skeletal maturation – delayed
- Thyroid scan (I-123 or pertechnetate) – decreased uptake or ectopic tissue
What is the treatment for congenital hypothyroidism?
tx: thyroxine
- Initial treatment - 0-3 months -10-15 ug/kg/day
- Maintain normal thyroid function - individualize dosage in the upper half of the normal range for age
What is the risk with a longer delay in diagnosis of congenital hypothyroidism?
increased risk of mental retardation*
Diagnose ASAP**
Who do we screen for congenital hypothyroidism? What is an abnormal TSH level in a primary screen of a newborn?
EVERYONE
> 25 TSH is abnormal
What is the most common cause of acquired hypothyroidism? What is the most common initial symptom in kids?
Hashimoto’s
most common symptom=dec growth rate
can also show delayed bone age
Will there be intellectual impairment in acquired hypothyroidism after 2-3 years old?
NO!
What causes neonatal Graves disease? What is the treatment?
- transplacental passage of TSH receptor-stimulating antibody from a mother with active or inactive Graves disease
- Clinical course lasts from 3-12 weeks and resolves spontaneously
What causes neonatal Graves disease? What is the treatment?
- transplacental passage of TSH receptor-stimulating antibody from a mother with active or inactive Graves disease
- Clinical course lasts from 3-12 weeks and resolves spontaneously (or potentially the same as adults–> that was confusing)
What auto antigens can be measured in Grave’s Disease in children? What are the signs and symptoms? Treatment?
TSH receptor autoantibody
TSI – thyroid stimulating immunoglobulin
Signs/symptoms: tachy, emotionally labile, tremor, exhaustion, increased appetite, goiter, low TSH
- Treatment:
- prevent new hormone synthesis with PTU and MMI (can cause agranulocytosis)
- block release of synthesized hormone
- block peripheral conversion of T4–> T3
When would you treat Graves disease in children with radioactive iodine?
if no remission for > 2 years of non compliant or experiencing SE of medications
