Levothyroxine both congenital noncongenital HYPERthyroidism Graves Disease

Levothyroxine both congenital noncongenital

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Levothyroxine (both congenital & noncongenital) HYPERthyroidism (Graves Disease) Decreased TSH, increased T4, increased T3 Enlarged thyroid gland Think autoimmune response to the TSH receptors but no etiology has been identified Most often between 6-15 y/o 5x more likely in girls S/S See picture below Thyrotoxicosis (Thyroid Storm or Thyroid Crisis) happens with a sudden release in TH Unusual in children but can be life threatening S/Ssevere irritability and restlessness, n/v, diarrhea, HYPERthermia, HTN, tachycardia Treatment of Hyperthyroidism Anti-thyroid medications Methimazole Can induce remission and then stop medications, although a relapse can occur Thyroidectomy surgical removal of thyroid; used when other methods are not effective Ablation with radioiodine Response may be slower; concerns about link to thyroid cancer
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-They said there will be questions regarding these two charts Parathyroid Disorders - Know the inverse relationships HYPOparathyroidism Decrease in serum calcium and an increase in phosphorus S/S—SEE TB BOX 29-8 HYPERparathyroidism rare in children Treatment Give calcium and VitD; want to maintain normal range of Ca2+ and mineralization of the bones Adrenal Gland Disorders Adrenal Cortex secretes three types of hormones/steroids Glucocorticoids – mainly hydrocortisone Blood sugar regulation, response to stress Mineralocorticoids – mainly aldosterone Regulates water in cells Sex steroids – androgens Overproduction = masculinization Adrenal Medulla Catecholamines = epinephrine and norepinephrine Cushing Syndrome excessive Cortisol May be due to an adrenal tumor Requires surgical removal May be due to excessive steroid therapy Uncommon in children Congenital Adrenal Hyperplasia (CAH) Deficiency in 21-hydroxylase enzyme needed for cortisol production Types: Salt wasting decreased hydrocortisone, decreased aldosterone S/S = vomiting, poor weight gain, poor feedings, drowsiness, dehydration, LBP Ambiguous genitalia of female Non Salt-wasting decreased hydrocortisone
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Aldosterone = WNL so less problems with Na+ regulation External female genitalia may appear male-like Late onset can cause precocious puberty Treatment—no cure; cortisol replacement, fluorine (for salt wasters), surgery **Important to 2x or 3x baseline cortisol at times of stress ** (fever, vomiting, injury, surgery) Pheochromocytoma Adrenal Medulla Tumor (nonmalignant) Secretes excessive adrenaline and noradrenaline (increased catecholamines) Persistent elevated BP Treatment—surgery; may need lifelong glucocorticoid and mineralocorticoid therapy High risk during surgery r/t excessive release of catecholamine then catecholamine withdrawal/shock Turner Syndrome – absence of one of the X chromosomes Often diagnosed in preschool children because of growth delay; more common in girls Treatment – female hormone therapy and counseling/support for child and family S/S—short stature, webbed neck, low set ears, delayed sexual development, amenorrhea
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  • Spring '14
  • Roberts,CristineAnn
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