Hypothyroidism_Sherman

Hypothyroidism_Sherman - Hypothyroidism Eric Sherman...

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Unformatted text preview: Hypothyroidism Eric Sherman Pediatric Endo Fellow Captain, USAF, MC Who has ordered thyroid function tests (TFT)? Who has made decisions based on the results? Who has been confused by the results? Who has referred someone to peds endo for abnormal TFTs? Who follows patients with hypothyroidism without endocrine assistance? Causes of hypothyroidism Congenital 1 in 4000 live births Acquired Most common cause world wide?? Causes of congenital hypothyroidism (CH) Thyroid dysgenesis 1:4000 Thyroid dyshormonogenesis 1:40,000 Central hypothyroidism 1:100,000 Transient hypothyroidism 1:40,000 Sperling Signs/symptoms of CH Signs/symptoms of CH Newborn Screen Mandatory in all 50 states If performed before 24 hours, must be repeated at least one more time Screening TSH: DC Screening FT4: VA, MD, overseas samples Figure 15-4. Postnatal TSH, T4, T3, and rT3 secretion in the full-term and premature infant in the first week of life (modified from Fisher DA: Disorders of the thyroid in the newborn and infant. In: Sperling M (ed) Pediatric Endocrinology, WB Saunders Co., Philadelphia, 51, 1996). Positive newborn screen Confirmatory serum TSH and FT4 ASAP Call pediatric endocrinology Start Synthroid at 10-15 micrograms/kg/day (50 micrograms once daily in term infants) Example of MD newborn screen T4 10.8 (>7.0) T4 result is less than the 10 th percentile for this run. A TSH has been performed on this specimen to complete the thyroid testing. TSH result is 74.9 uIU/mL (<28.5 uIU/mL). Consultation with a pediatric endocrinologist and further serum thyroid studies are recommended. How do you give Synthroid? Pill crushed Give with water or formula on a spoon, not in bottle or syringe Avoid soy formula (absorption issues) May double dose if previous days dose is missed Follow up TSH and FT4 ever 1-2 months during year 1 Every 3-6 months from ages 1-3 Every 6-12 months from 3 until patient stops growing Goal: bring FT4 into high normal range as rapidly as possible (TSH may remain elevated in 10% of patients) Why treat CH? Average IQ 76 in pre newborn screen era Untreated patients lose an average of 1-2 IQ points per month until age 2 40% of untreated patients require special education in school Data suggests that treatment should be initiated within 2 weeks (PREP says 3 months) Long term consequences w/ treatment Sensorineural hearing loss Decline in verbal IQ Head circumference 1 SD above the mean Normal height and weight Goitrogens...
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Hypothyroidism_Sherman - Hypothyroidism Eric Sherman...

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