Hypothyroidism 2020
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Hypothyroidism is caused by insufficient production of thyroid hormones. It can be congenital or acquired later in life. The thyroid gland normally produces T4 and T3 hormones which regulate growth, metabolism and development. Hypothyroidism is diagnosed by high TSH levels and low T4 levels in blood tests. Treatment involves lifelong thyroid hormone replacement therapy with oral thyroxine medication. Early diagnosis and treatment is important to prevent intellectual disability, especially in congenital hypothyroidism. Iodine deficiency is a major preventable cause of hypothyroidism.
Hypothyroidism 2020
- 1. Hypothyroidism Prof. Imran Iqbal Prof of Paediatrics (2003-2018) Prof of Pediatrics Emeritus, CHICH Multan, Pakistan
- 2. In the name of Our Creator Allah, the most Gracious, the most Merciful
- 4. Development of Thyroid Gland 3RD week of gestation From Buccopharyngeal cavity During Fetal life TSH secreted by 6 weeks Thyroxine secreted by 12 weeks
- 5. Physiology
- 7. Thyroid Hormones • Two forms of circulating thyroid hormone– T3 - Tri iodo thyronine T4 - Thyroxine • Thyroid produces daily T4 – (100 ug) and T3 – (20 ug) • Most thyroid hormone in the blood is T4. • Enzymes in Liver kidney and other tissues in the body convert T4 to T3. • T3 is the physiologically more active
- 8. Physiologic Effects of Thyroid Hormones • Growth: Thyroid hormones are necessary for normal growth of child • Development: Thyroid hormones are important for Brain maturation and development • Metabolism: Thyroid hormones stimulate diverse metabolic activities and increase the BMR (basal metabolic rate)
- 9. Metabolic Effects of Thyroid Hormones • Carbohydrate metabolism: Increased glycogenolysis, gluconeogenesis and entry of glucose into cells • Lipid metabolism: fat mobilization and oxidation of fatty acids • Protein metabolism: increased catabolism
- 10. Effects of Thyroid Hormones on Body Systems • CVS: increases heart rate and cardiac output • CNS: promotes mental activity • GIT: increases motility
- 11. Role of Iodine • Iodine is essential for the synthesis of Thyroid Hormones • Daily Requirement of Iodine - RDA 100 ug/ day
- 12. Iodine deficiency is common worldwide Iodine deficiency can result in: Goitre Hypothyroidism Iodine deficiency is common worldwide: • 130 countries affected • 740 million people affected • 13 % population affected • 30 % population at risk • 50 million brain damaged
- 13. Iodine deficiency disorders Maternal Iodine Deficiency:- • Abortion or Stillbirth • Deaf-mutism with severe neurological damage • Cretinism (Congenital Hypothyroidism) Childhood Iodine Deficiency:- • Simple Goitre (common in hilly areas) • Low intellectual function – loss of 15 IQ points • Hypothyroidim
- 14. Causes of Goitre (enlarged Thyroid gland) in children • Iodine deficiency - child may have Hypothyroidism • Dyshormonogenesis - absence of an enzyme for producing thyroxine in the gland - will develop Hypothyroidism • Thyroiditis - autoimmune disease - may develop Hypothyroidism
- 15. Hypothyroidism
- 16. Types of Hypothyroidism • Congenital Hypothyroidism (Cretinism) – from Birth - may present in infancy or childhood (depending upon severity of disease) - May be seen in 1: 2000 births • Acquired Hypothyroidism – seen in older children
- 17. Case scenario An 2 months old baby presents to the OPD with the complaints of poor feeding and noisy breathing. Baby was born by SVD and was normal at birth. He remains constipated and passes stool only when a suppository is given. On examination, weight of the child is 4 kg. His mouth is open and tongue is visible. His abdomen is distended with gases and umbilical hernia is seen. He has dry skin.
- 18. Causes of Congenital Hypothyroidism • Thyroid Dysgenesis - absence or abnormal development of thyroid gland - most common cause • Thyroid dyshormonogenesis - absence of an enzyme for producing thyroxine in the gland - autosomal recessive inheritance (both parents carriers) - goiter may be present in the newborn • Iodine deficiency - seen in mountainous regions - mother is having iodine deficiency and goitre • TSH deficieny (very rare)
- 19. Case scenario An 6 years old boy presents to the OPD with the complaints of delayed mental development. Child started walking at 3 years of age and speaks only few words. He keeps sitting and is not active. He remains constipated since birth. On examination, weight of the child is 15 kg and his height is 95 cm. His face is puffy with depressed bridge of nose and a large visible tongue. He has dry skin and cold hands. He has a hoarse voice
- 20. Causes of Childhood Hypothyroidism • Congenital Hypothyroidism (diagnosed late) - Thyroid hypoplasia - Ectopic development of thyroid gland (less severe disease) - Thyroid dyshormonogenesis (partial hormone produced) • Iodine deficiency (goiter) • Thyroiditis - autoimmune - seen in older children, mainly girls • Rare causes (surgery, radiations)
- 21. How to recognize Hypothyroidism ? Clinical Features
- 22. Newborns and Infants • Lethargy, sleepiness and poor activity • Delay in milestones of development • Poor feeding • Constipation • Large tongue and noisy breathing • Open mouth, thick lips and puffy face • Hoarse voice • Dry skin • Distended abdomen and Umbilical hernia • Neonatal goitre
- 23. Older Children • Delayed development • Short stature • Poor activity and school failure • Large tongue, thick lips and puffy face • Hoarse voice • Dry skin • Distended abdomen and Constipation • Anemia • Goitre
- 26. How to confirm Hypothyroidism ? Lab Diagnosis
- 27. Lab Diagnosis • Bone age – delayed - X-ray Knee in newborns - X-ray Wrist in children • Thyroid hormone profile in blood (specific investigation) - TSH - often very high - T 4 - - T 3 -
- 28. How to treat Hypothyroidism ? Thyroxine replacement therapy
- 29. Hypothyroidism • Treatment must be started in first 2 weeks of life to prevent brain damage • Thyroxine tablets are given orally • Treatment with Thyroxine is life-long • Drug is given empty stomach usually in the morning • Daily dose should not be missed
- 30. Thyroxine • Neonate: 10-15mcg/kg • 6-12mo : 6-8mcg/kg • 1-6 yrs : 5-6 mcg/kg • 6-12 yrs : 4-5 mcg/kg • Adults : 100-150 mcg
- 31. Monitoring of Treatment • Clinical Examination: • Linear growth • Weight gain • Developmental progression • Investigations: • serum TSH, T3, T4 levels every 3-6 months
- 32. How to prevent Hypothyroidism ? Prevention saves from mental handicap
- 33. Prevention of Hypothyroidism • Iodine deficiency - Community education - Iodine supplementation (Iodised salt) • Congenital Hypothyroidism - Early diagnosis and treatment - Newborn TSH screening programs • Acquired Hypothyroidism - High index of suspicion for diagnosis and treatment
- 34. Hypothyroidism – Take Home Message • Hypothyroidism is most important preventable cause of mental and intellectual handicap • Iodine deficiency is most important preventable cause of Hypothyroidism • Early diagnosis and treatment after birth is important for normal mental development