Uw. Peds cases of thyroid 03-03 (1) Flashcards
A 16-year-old girl is brought to the clinic due to behavioral changes over the school year. The patient has had difficulty concentrating, and her academic performance has declined. She also has been uninterested in participating in her regular extracurricular activities or spending time with her boyfriend. She sleeps approximately 9 hours a night, has no difficulty falling or staying asleep, and naps after school. The patient typically eats 3 meals a day, but her appetite has recently decreased, which she attributes to intermittent constipation. Medications include oral contraceptive pills. Temp. 37 C BP 110/70, pulse 50/min, RR 16/min. BMI is at the 85th percentile. The patient appears well, and the physical examination is unremarkable. Which of the following is the best next step in management?
OBTAIN THYROID FUNCTION TESTS
Uw table. CP of hypothyroidism. MOOD SYMPTOMS? 3
depression
apathy
social withdrawal
Uw table. CP of hypothyroidism. Cognitive symptoms? 3
impaired concentration and memory
psychomotor slowing
executive dysfunction
Uw table. CP of hypothyroidism. severe symptoms?
delirium
psychosis (myxedema madness)
Uw table. CP of hypothyroidism. clinical symptoms?
brady
cold intolerance
fatigue
muscle weakness and myalgia
hyporeflexia
The most common cause of hypothyroidism in adolescents is ?
autoimmune thyroiditis (aka immune-mediated thyroid gland destruction impairs thyroxine synthesis)
hypothyroidism => Tx levothyroxine -> decr. depressive symptoms
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A 4-month-old girl is brought to the clinic for a well-child check. The mother is concerned that the girl is less active than other children at day care. The patient is exclusively formula-fed and must be awakened for most feeds; she has also been having less frequent bowel movements for the past month. She was born to a 30-year-old woman at term via spontaneous vaginal delivery at home. The mother is healthy but had limited prenatal care. Height and weight were at the 50th percentile at birth; weight is at the 25th percentile today. The patient is afebrile with mild bradycardia. The anterior and posterior fontanelles are enlarged, and the patient has a large, protruding tongue without fasciculations. The abdomen is protuberant with a large, reducible umbilical hernia. She is unable to lift her head when prone. Which of the following is the most likely cause of this patient’s presentation?
CONGENITAL HYPOTHYROIDISM
UW. congenital hypothyroidism. etiology?
most common - thyroid dysgenesis (eg agenesis, hypoplasia, ectopy)
UW. congenital hypothyroidism. CP at birth?
asymptomatic
UW. congenital hypothyroidism. onset of symptoms?
symptomatic weeks to months after birth (after maternal T4 wanes - it crosses placenta)
UW. congenital hypothyroidism. Hypometabolism CP?
decr. HR and temp., lethargy/poor feeding, hypotonia, constipation, jaundice
UW. congenital hypothyroidism. Mucopolysaccharide accumulation CP?
Macroglossia, unbilical hernia
UW. congenital hypothyroidism. MSK CP?
Delayed bone maturation -> enlarged fontanelles
UW. congenital hypothyroidism. Dx?2
screening at birth mehl. rase kad heel prick test - tiesiog is kulno paima krauja kad istirtu ligas 9
Incr. TSH, decr. T4
UW. congenital hypothyroidism. Tx?
levothyroixine
UW. congenital hypothyroidism. prognosis?
no deficits if Tx started in neonatal period
Untreated disease leads to intellectual disability, developmental delay and poor growth
T4 also regulates the degradation of mucopolysaccharides, which accumulate in subcutaneous tissue in hypothyroidism.
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1-month-old boy + born at home to a 24-year-old primigravid woman who consumed a well-balanced diet and took prenatal vitamins throughout the pregnancy. Family history is unremarkable. The patient is exclusively formula-fed but has a weak suck and rarely finishes the bottle. The patient has scleral icterus; jaundice of the face and chest; a large, protruding tongue; and a hoarse cry. His tone is normal, but his activity level has decreased. Laboratory results are as follows:
Total bilirubin 8 mg/dL
Direct bilirubin 0.7 mg/dL
TSH 110 µU/mL
T4, serum 0.6 µg/dL
Which of the following is the most likely cause of this patient’s condition?
THYROID DYSGENESIS
Maternal iodine deficiency can cause congenital hypothyroidism; however, this patient’s mother consumed a well-balanced diet and took prenatal vitamins throughout the pregnancy. Furthermore, this patient is exclusively formula-fed, and all infant formulas contain iodine
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