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Infant with congenital hypothyroidism a 3 month old

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Infant with congenital hypothyroidism. A3 month old infant withuntreated CH; picture demonstrates hypotonic posture, myxedamatousfacies, macroglossia, and umbilical hernia. BSame infant, close up offace, showing myxedematous facies, macroglossia, and skin mottling. Csame infant, close up showing abdominal distension and umbilicalhernia. (Rastogi and LaFranchi, 2010)Findings for Congenital Hypothyroidism: The 6 P’s(ASMPH 2021)Pot belliedPalePuffy-faced childProtruding umbilicusProtuberant tonguePoor brain developmentTable 1.Signs and symptoms of the physiologic effects of congenitalhypothyroidism (Mendoza-Aragon, 2019)EffectSigns and SymptomsHypoplasia of cortical neurons,retarded myelinationMental retardationPsychomotor delay, speech delayDecreased peristalsis of thealimentary systemConstipation, abdominal distensionLoss of inotropic and chronotropiceffects of thyroid hormoneBradycardiaImpaired protein synthesis anddecreased IGF-1Decreased bone maturationGrowth failureWide anterior fontanellesDelayed dentition, bone ageDecreased lipid degradationIncreases cholesterol, LDL
Endocrine Pathologies09.03: PEDIATRIC THYROID DISEASE3 of 9Decreased energy metabolismLow basal metabolic rateDecreased appetiteCold intoleranceLow basal body temperatureAccumulation of hyaluronic acid-mucinous edemaPuffy appearanceMacroglossiaThickening of laryngeal andpharyngeal mucous membranesPoor feedingHoarse cryDecreased secretions of sweat andsebaceous glandsDry and coarse skinDiminished oxygen requirementsand decreased production oferythropoietinAnemiaMyxedema of eight nerveDefect in organic bindingHearing lossDelayed maturation of glucuronideconjugationProlonged jaundiceD. THYROID SCREENING IN NEWBORNSConfirmatory test isquantitative TSH (high TSH, low FT4)Heel prick samplesto pick up cases earlyWhat is being screened:TSH levelRaised TSH level> 10 IU/Lpositive resultFollowed by aconfirmatory testE. LABORATORY WORK-UPConfirmatory tests:decreasedlevels of serum thyroid hormone(total or free T4) andelevated levels of TSHThyroid scanning(using technetium Tc-99m or Iodine I-131)Agenesis/Hypoplasiaif decreased uptakeThyroid ultrasonographyLateral radiograph of the kneeIf delayed, significantly affected in-utero as wellPerchlorate discharge testif suspected thyroid peroxidase defector Pendred syndromeFigure 6.Left: Tc-99m Pertechnetate Scan of Normal Thyroid - Normal uptake(ASMPH 2020, 2017) Right: High Uptake of Tc-99m as in Graves’Disease (radiopedia.org)F. TREATMENTBegin as soon as possibleL-Thyroxine treatment started within 2 weeks of age can normalizecognitive developmentAAP RecommendationInitial dosage ofL-thyroxineis 10-15ug/kgGoal of treatment is tonormalize the serum thyroxinelevelswithin 2 weeks andTSH levelswithin 1 monthThefree thyroxine levelsshould be maintained in the upper part ofreference rangeLifelong treatmentIf cannot establish firm diagnosis, treat first till3 years of agethenreassess (stop medication)Administration:Tablets must be crushed and suspended in a few milliliters ofwater, formula, and breastmilkSubstances that interfere with absorption: Soy, iron, fiber,calciumAdjust dosage according tofrequent blood tests(fT4, TSH)Monthly for the first 6 monthsEvery 2-3 months between 6 months to 2 years of age

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Term
Fall
Professor
Bong Ordaneza
Tags
Solitary thyroid nodule, The Grave,

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