Thyroid disease in child

Question 1

What is congenital hypothyroidism in a child

Answer 1

Usually refers to congenital hypothyroidism - lack from birth -associated with neuro issues, poor growth and jaundice if untreated

causes - Thyroid defects (75%) -not inherited
disorder of thryroid hormone metabolism (inherited )-
Hypo/pit dysf -tumour, ischemia, congenital
Transient -maternal medication (carbimazole), maternal AB (hashimoto)

Sx -always be susp of Jaundice
Feeding difficulties, lethargy, constipation, JAUNDICE
Large fontanelles, myxeodema (swelling, nasal obstruction, low temp, hypotonia, pleural effusion, short stature, odedema
depending on cause - goitre, congenital dfects
Child unique - Coarse features, macroglossia, umbilical hernia

Question 2

Ix and mx of congenital hypothyroidism in children

Answer 2

Ix - TSH high and T4 low
Thyroid antibodies- can be high depending on cause
US/radionucleotide scan

Mx-
early detect and replace
levothyroxine, titrate with TFT and monitor
monitor growth milestones, development

Question 3

What is aquired hypothyroidism in children? (full)

Answer 3

Primary hypothyroidism -
most common cause =hashimotos thryroiditis (own AB, not mothers)
Very associated with - Downs, turners

Sx - Growth failure, weight gain, short stature, cold, constipation etc (normal adult signs)

mx - levothyroxine -if caught early catch up growth occurs

Question 4

What is congenital/neonate hyperthyrodisim in chidren (full)

Answer 4

if mother has graves disease -1-2% of new borns with have circulating TSHR AB (cross placenta) and stimulate T4 prod -hyperthyroidism

Sx -
in foetus -high CTG trace and Foetal goitre on USS
Neonate (<2w) - irritable, Weight loss, ttachycardia, heart failure, diarrhoea, exophtalmos)

Ix -TSH low, T4 high

Mx -
Medical <2y
Carbimazole or propylthiouracil 
CARE --Both are associated with neutropenia -SAFETY NET IF SORE THROAT/FEVER
Bblocker for sx relief

other - radioiodine and repalce
surgery and replace

like adults