Levothyroxine both congenital noncongenital

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/S → severe 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

- 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

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