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19811 - THYROID DISORDERS Abdelaziz Elamin MD PhD FRCPCH...

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THYROID DISORDERS Abdelaziz Elamin. MD, PhD, FRCPCH Professor of Child Health Consultant Pediatric Endocrinologist Sultan Qaboos University, Oman
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HYPOTHYROIDISM-EPIDEMIOLOGY Neonatal screening reveals incidence that  varies between 1-5/1000 live births The most common cause of preventable  mental retardation in children Both acquired & congenital forms are  linked to iodine deficiency Diagnosis is easy & early treatment is  beneficial
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ETIOLOGY CONGENITAL Hypoplasia & mal-descent Familial enzyme defects Iodine deficiency (endemic cretinism) Intake of goitrogens during pregnancy Pituitary defects Idiopathic
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ETIOLOGY /2 ACQUIRED Iodine deficiency Auto-immune thyroiditis Thyroidectomy or RAI therapy TSH or TRH deficiency Medications (iodide & Cobalt) Idiopathic
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KILPATRIK GRADING OF GOITRE Grade 0: Not visible neck extended & Not palpable Grade 1: Not visible, but palpable Grade 2: Visible only when neck  is        extended & on swallowing, Grade 3: Visible in all positions Grade 4: Large goiter
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THYROID GLAND Derived from pharyngeal endoderm at  4/40 Migrate from base of the tongue to cover   the 2&3 tracheal rings. Blood supply from ext. carotid &  subclavian and blood flow is twice renal  blood flow/g tissue. Starts producing thyroxin at 14/40.
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OVERVIEW (2) Maternal & fetal glands are independent with  little transplacental transfer of T4. TSH doesn’t cross the placenta. Fetal brain converts T4 to T3 efficiently. Average intake of iodine is 500 mg/day. 70%  of this is trapped by the gland against a  concentration gradient up to 600:1
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THYROID HORMONES Iodine & tyrosine form both T3 & T4 under  TSH stimulation. However, 10% of T4  production is autonomous and is present in  patients with central hypothyroidism. When released into circulation T4 binds to: Globulin TBG             75% Prealbumin TBPA  20% Albumin TBA                  5%
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THYROID HORMONES (2) Less than 1% of T4 & T3 is free in plasma.
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