CONGENITAL

HYPOTHYROIDISM
VIJI V S
LECTURER
KIMS COLLEGE OF NURSING
 ANATOMY
&
PHYSIOLOGY
OF
THYROID
GLAND
  Congenital hypothyroidism is an important preventable
cause of mental retardation, deafness and short stature

 Incidence: 1 in 2500-4500 births

INTRODUCTION
 It is the low circulating level of thyroid hormone
 Iodine deficiency

Thyroid agenesis or Dysgenesis

Defects in thyroid hormone biosynthesis

Rarely- hypothalamic-pituitary dysfunction,

COMMON
CAUSES TSH receptor blocking antibodies,

Drug induced destruction (thionamides for treatment of

hyperthyroidism, iodine excess, intake of maternal
antithyroid drugs)

Peripheral T4 resistance
 Circulating levels of T4 are dependent on hypothalamic
stimulation (TRH/TSH) of the thyroid gland

Low levels of T4 cause a rise in TSH

PATHOPHYSIOLOGY
Absent or decreased levels of T4 result in abnormal
development of CNS in new born

In older children hypothyroidism results in a decreased in

metabolism, growth and physical maturation.
 Features are non specific and difficult to identify in the neonatal
period

These features become prominent with increasing age

Clinical manifestations are hoarse cry, facial puffiness, umbilical

CLINICAL hernia, hypotonia, mottling skin and lethargy
FEATURES Prolonged physiological jaundice, large abdomen

Constipation, unexplained hypothermia

Open posterior fontanel is an important indicator of congenital

hypothyroidism- markedly open

Feeding difficulties
 Growth failure

Large protruding tongue

Poor feeding and constipation

More sleepy

After 6 months Often getting choking spells during feeding

Noisy breathing, nasal obstruction, apnoea

Coarse facial features- puffy face, swollen eyelids,

widely separated eyes, broad nose with depressed
bridge, narrow palpebral fissures, open mouth with
broad thick protuberant tongue.
narrow palpebral fissures
  Growth retardation

 Delayed skeletal maturation

 Delayed dental development

ACQUIRED  Delayed puberty

 Myopathy

 Enlarged sella

 Pseudotumor cerebri
 Maternal thyroid disease and ingestion of antithyroid
medications should be enquired

Family history

Radionuclide uptake
DIAGNOSTIC
EVALUATION Ultrasound

Antithyroid antibodies

24 hr urine iodine

Radiotracer uptake study with radioactive iodine or

technetium
  Neonatal screening of T4 and TSH

 Elevated TSH (100 mU/mL) and low T4 may indicate

congenital hypothyroidism

DIAGNOSTIC  Thyroid nuclear scan-reduced uptake

EVALUATION  Abnormal growth rate

 Xray- delayed bone age, beaking of 12th thoracic, 1st or 2nd

lumbar vertebra, Skull x ray-Large fontanel, wide sutures

 Thyroid antibodies elevated

 Thyroid hormone replacement should be started
immediately

Levothyroxine (Synthroid, Levothroid)

Therapy goal to maintain normalcy of thyroid function

MANAGEMENT tests (tree T3, T4 concentrations)

Thyroxine (T4) in neonates:10-15 μg/kg/day, older children:

4-8μg/kg/day

The drug is available as tablets of 25, 50, 100 μg/kg/day

Drug should be taken empty stomach

 The therapy should be monitored by assessment of clinical
symptoms, gain in height with normal activity,
improvement in mental performance and periodic thyroid
function tests.

MANAGEMENT Periodic biochemical monitoring will initially show

lowering of TSH followed by normalization of T4 and T3

T4 and TSH levels are expected to normalize over one

week and one month respectively.

Follow up should be done monthly during infancy, at every

3 months between 1 and 3 years, and 6 monthly thereafter
 Mental retardation in new born who is undiagnosed or
untreated
COMPLICATIONS
Short stature, growth failure, delayed physical
maturation and development in the older child
 Assess new born for clinical manifestations listed
above

Perform behavioural assessment to include sleeping,

NURSING
eating, bowel patterns, level of alertness and school
ASSESSMENT
performance

Assess growth patterns, growth velocity, weight gain

and head circumference
  Early identification of infants with congenital hypothyroidism

 Health education regarding importance of medication

 Educate dosage, administration of medication, importance of

lifelong use
NURSING  Educate how to observe manifestations of overdosage- rapid
MANAGEMENT
pulse, vomiting, diarrhoea, sweating, fever, insomnia,
personality changes, weight loos.

 Follow up assessments- height, weight, head circumferences,

physical and neurological examinations, laboratory evaluations,
and determinations of bone age
  Continuous support and guidance for the child and
NURSING
parents throughout the treatment is the nurses
MANAGEMENT
responsibility.
 Altered growth and development related to effects of
NURSING hypothyroidism
DIAGNOSIS Knowledge deficit regarding hypothyroidism and its
treatment
 Promoting growth & development

 Teach parents to administer thyroid hormone replacement

daily

 Monitor growth & development milestones at regular

NURSING
INTERVENTIONS intervals

 Teach parents about the importance of medication

 Discourage mixing thyroid medication with liquid in bottle.

 Increasing knowledge

 Educate the parents regarding the importance of

therapy

NURSING  Teach them how to observe symptoms of overdose

INTERVENTIONS
 Stress that along with replacement therapy , child can
participate in all usual activities

 Encourage the parents to verbalize feelings about child

and condition
THANK YOU