Hypothyroidism - symptoms and signs
Symptoms and signs of hypothyroidism.
Hypothyroidism is a deficiency of thyroid hormones. Symptoms in young children include malnutrition and physical retardation. Signs in older children and adolescents are similar to those in adults, but also include low physical development, late puberty, or a combination thereof. Diagnosis is carried out on the basis of a study of the function of the thyroid gland. Treatment includes thyroid hormone replacement therapy.
Hypothyroidism in infants and small children can be congenital or neonatal. Congenital hypothyroidism occurs in approximately 1 child per 4000 live births. Most congenital cases are sporadic, but approximately 10–20% are hereditary. The most common cause of congenital hypothyroidism is dysgenesis or the absence or underdevelopment of the thyroid gland. Approximately 10% of congenital hypothyroidism is the result of dyshormonogenesis, which can be of 4 types.Rarely in the US, but often in some developing countries, hypothyroidism is the result of iodine deficiency in the mother. Rarely, transient hypothyroidism can be caused by transplacental intake of antibodies, goitrogenic substances or thyrostatic drugs.
Symptoms and signs differ from those in adults. If iodine deficiency occurs in early pregnancy, the child may develop endemic cretinism, mental retardation and muscle spasticity. In most cases, babies with hypothyroidism have few manifestations, or they are completely absent, because the mother’s thyroid hormones enter the placenta. However, after maternal hormones are metabolized, while the main cause of hypothyroidism is preserved, and if hypothyroidism is not diagnosed and no treatment is given, there is a moderate or pronounced slowdown in the development of the CNS, which may be accompanied by muscle hypotension, prolonged hyperbi-lyrubinemia, umbilical hernias, respiratory failure, macroglossia, large size springs, hypotrophy and hoarse voice.Rarely, late diagnosis and treatment of severe hypothyroidism lead to mental retardation and short stature.
Routine screening of newborns reveals hypothyroidism before clinical manifestations become apparent. When a positive screening test is obtained, a study of thyroid function, including thyroxin, free T and serum thyroid stimulating hormone, is shown.
In most cases, life-long thyroid hormone replacement therapy is required. Treatment with L-thyroxine at 10-15 µg / kg orally once a day should be started immediately and regularly monitored at short intervals. This dose is designed to quickly normalize the level of T in serum, after which it should be corrected to maintain the serum T level in the range of 10-15 μg / dl during the first years of life. In the second year of life, the usual dose is 5-6 µg / kg orally once a day, which should maintain the level of T and TSH in the blood serum in the normal age limits. In the majority of children receiving treatment, motor and mental development is normal.Severe congenital hypothyroidism, even with adequate treatment, can still lead to minor developmental problems, as well as neurosensory hearing loss. Hearing impairment may be so minor that initial screening may not reveal it. It is recommended to re-examine in 1-2 years to identify hidden hearing defects that may affect the development of speech. A deficiency of tirok-synsobing globulin, which is detected during screening tests, which is primarily based on the definition of T, does not require treatment, since this causes euthyroidism in children.
The cause is usually autoimmune thyroiditis. Some symptoms and signs are similar to those in adults. Signs specific to children include delayed physical development, late maturation of the skeleton, and usually delayed puberty. Treatment is carried out with L-thyroxine at a dose of 5-6 µg / kg orally once a day; in adolescents, the dose is reduced to 2–3 μg / kg orally once a day and is titrated to maintain serum T and TSH levels within normal age limits.
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