‫ﺑﺴﻤﻪ ﺗﻌﺎﻟﻰ‬

HYPOTHYROIDISM

Dr. Rihab Faisal

Assistant professor
FICMS - pediatric endocrinologist and diabetelogist
 DEFINITION

Deficiency of thyroid hormone production that result

from either defect in thyroid gland itself (primary

hypothyroidism) or reduced TSH stimulation (central

hypothyroidism).
 CLASSIFICATION
 Congenital hypothyroidism: primary or central.

Thyroid dysgenesis

 Acquired hypothyroidism: primary or central.

Autoimmune thyroiditis
 CLINICAL FEATURES
Congenital hypothyroidism

Most infants with congenital hypothyroidism are

asymptomatic at birth.
 Thyroid Hormon
Trans-placental Breast milk

• protect the hypothyroid • not protect the

infant. hypothyroid infant.

• not interfere with neonatal • not interfere with neonatal

thyroid screening tests. thyroid screening tests.

At birth

birth weight and length are

normal, the anterior and

posterior fontanels are

open widely.
During the 1st mo of life

prolongation of physiologic

jaundice, feeding difficulties

and respiratory difficulties

partly caused by the large

tongue.
During infancy

respiratory distress, cry little, sleep much, have poor

appetites, and are generally sluggish.

if congenital hypothyroidism goes undetected and

untreated, by 3-6 mo of age the clinical picture is fully

developed.
Approximately 10% of infants with congenital

hypothyroidism have associated congenital anomalies

Cardiac anomalies is the most common

 Acquired hypothyroidism

deceleration of growth

goiter

weight gain

myxedematous changes of the skin,

constipation, cold intolerance, decreased energy, and an

increased need for sleep.

schoolwork and grades usually do not suffer, even in

severely hypothyroid children.
8 years old child

presented with short

stature and muscular

appearance
 Regarding Puberty

Older adolescent girls: menorrhagia.

Adolescents: delayed puberty.

Younger children: might present with

• galactorrhea or

• pseudoprecocious puberty.
 Newborn Screening

• The early approach: measure of of T4, followed by TSH

when T4 is low. Over time switched to an initial TSH

measurement.

• In identical twins; many newborn screening programs

perform second test in same-sex twin

 Investigations
Congenital Acquired
1. TFT 1. TFT

2. Serum levels of thyroglobulin 2. Thyroid antibodies:

3. X ray 3. Thyroid sonography:
4. Scintigraphy and ultrasonar.
4. X ray for bone age:
5. ECG
5. Others: hyponatremia and
6. Echocardiography
macrocytic anemia
7. EEG:
8. serum cholesterol level
 TREATMENT
Oral levothyroxin

• once daily.

• fixed time.

• on an empty stomach.
BASIC interfere with thyroxin absorption

• B bile acid binding resin.

• A aluminum containing antacids.

• S soy.

• I iron.

• C calcium and caffeine.

 Monitoring of therapy

• By: measuring serum free T4 and TSH

• Target: normalization of both T4and TSH

• Frequency: every 4-6 mo

6 wk after any change in dosage.

‫رب ارزﻗﻨﻲ ﻋﻠﻤﺎ ﻧﺎﻓﻌﺎ‬
‫‪Thank you‬‬