Thyroid disorders in children

AAU-CH
DPCH
Isthmus
Thyroid hormone FUNCTIONS
CNS alertness
Brain development
Sebaceous gland
activity
Ionotropic control

Peristalsis control

Brown fat activity

Metabolism
Osseous maturation
Muscle tone
HPT -axis
What investigations you will do for
a child you have suspected Thyroid
disease?
 Thyroid studies
• TSH,T4/Ft4,T3/FT3
• Age must be considered
• TSH is extremely sensitive for hypothyroidism
• Thyroid globulin( when stimulated by TSH, Neonates,
Graves disease, endemic goiter and differentiated CA)
• Athyreotic infants have markedly reduced levels of
thyroglobulin in serum
• RADIONUCLIDE STUDIES
• u/s
 Dysfunction of thyroid gland
1. Too little thyroxin, hypothyroidism
short stature, developmental delay
2. Too much thyroxin, hyperthyroidism
hyperactivity, agitation, weight loss,
irritability
 hypothyroidism
• Deficient production of thyroid hormones
• Defect in the gland(primary)
• Reduced TSH stimulation(central/hypo
pituitary hypothyroidism)
• Acquired/congenital
Congenital hypothyroidism
• The most common cause of preventable MR
• 1: 4000 births
• HPT-insufficiency (5%)
• Thyroid dysgenesis (80%)
– Agenesis, hypoplasia, ectopy
• Thyroid dyshormonogenesis (5-10%)
• Transient (5-10%)
– Iodine overload,
– Drugs (Lithium, amiodarone,
antidepressants)
– maternal antibodies (blocking TSH receptor)
What are the clinical features of
congenital hypothyroidism?
 Clinical features
• Asymptomatic at birth(trans placental transfer of T4)
• HC may increase
• M:F,1:2
• Prolonged physiologic jaundice
• Hypothermia
• Low pulse rate
• Widely open fontanel
• Depressed nasal bridge
• Thick broad tongue
• Delayed dentation
• Thickened and coarse hair, low hair line
• Anemia(macrocytic)
• Respiratory difficulties(large tongue),apneic
episodes, noisy breathing
• Feeding difficulties, sluggishness, chocking
• Constipation
• Large abdomen with umbilical hernia
• Associated congenital anomaly(10%)
• Short extremities, broad hand and short finger
• Myxedema(eye lids, hands, external genitalia)
• Cry little, sleep much and poor appetite
• Mental and physical retardation
• Hoarse voice, delayed speech
• Mild deficiency mild symptoms
Can you estimate the age of this girl?
What abnormalities can you see on this
photo?
 Diagnosis
• High index of suspicion in all infants
with increased risk
• Overt clinical presentation
• Confirm diagnosis by appropriate lab
and radiological tests
 Laboratory investigations
• New born screening,T4 or TSH
• Defects in the thyroid……TSH will be elevated
• In the absence of newborn screening new borns with high risk
should be screened(family HX of thyroid disease, history thyroid
disease or anti thyroid medication by the mother and other
medical conditions associated with hypothyroidism)
• X-ray delayed osseous development
• Thyroid scanning
• U/S

RX- Thyroxin
 Acquired hypothyroidism
Cause:
 chronic lymphocytic
thyroiditis( autoimmune thyroiditis,
HASHIMOTO THYROIDITIS)
 Iodine deficiency
 Thyroidectomy or RAI therapy
 TSH or TRH deficiency
• M:F, 1:5
• Risk factors: Down syndrome, Turner, Diabetes
 Clinical features

 More common after 6 years

✓ Goiter
✓ Brady cardiac
 Pubertal disorders( delayed or
precocious)
✓ Deceleration of growth
 Muscle pseudo hypertrophy
✓ Weight gain
✓ Cold intolerance
✓ Galactorrhea……TRH
 laboratory
• Anemia
• Ft4/TSH
• U/S
• Bone age
RX thyroxin
 GOITER
Goiter is defined a thyroid
Gland where the size of the
The lateral lobes exceeds the
Volume of terminal phalanx of TH
The patient examined
Goiter
 hypothyroid
 Euthyroid
 Hyperthyroid
Goiter
 Acquired
 Congenital
Causes
 TSH stimulation
 Infiltration
 TRSab
• Simple goiter is not associated with any thyroid dysfunction
or AITD
• Goiter is predominant in girls(m:F,1:3) and it peaks in
adolescence.
Causes;
Diffuse thyromegaly: AITD, thyrotoxicosis, iodine
deficiency,goitrogens,familial dyshormonognesis, idiopathic
simple colloid goiter
Inflammatory: acute suprative, sub acute thyroiditis
Nodular thyromegaly;AITD,benign adenoma, thyroid cyst,
thyroid neoplasia
• Clinical evaluation
HX; family history thyroid disease ,geographical
area of residence, medication,goitrogens,history of
maternal exposure to antithyriod drugs,
P/E; nodularity, consistency, surface,texture,signs of
compression, enlargment of lymphnodes and briut
Lab. TSH/TFT, U/S,FNAC
 Thyroid nodule
• It is discreet lesion with in thyroid gland, which is distinct from
the surrounding thyroid parenchyma
• Difficult to differentiate between benign and malignant nodules
• CLT and graves disease may have nodularity
• It may be cystic or solid
• Follicular adenoma and colloid cysts account for the majority of
cases
• The risk of developing malignant thyroid disease is higher for
children than adults(30-50%)
• Inv. TSH/TFT,U/S,FNAC, scanning
MX: total thyroidectomy/ excision
 Iodine deficiency disorders
• Iodine deficiency
• Iodine is essential for thyroid hormone synthesis
• Iodine deficiency is global public health problem
• Consequence of Iodine deficiency: goiter, hypothyroidism and intellectual
disability
• Moderate deficiency…..goiter and intellectual disability
• Severe deficiency…..hypothyroidism
• Clinical hypothyroidism is very rare
• Low T4,TSH often normal, and T3 is elevated
• Endemic cretinism…..most serious complication
Neurologic (pyramidal signs, mental retardation, goiterous, euthyroid)
Myxedematous(myxedema ,no goiter, low T4 and high TSH
Prevention---iodized salt
 Graves disease
• Autoimmune disorder
• Production of thyroid stimulating antibody(TSAB) results diffuse toxic goiter
• Peak incidence 11-15 years
• M: F ,1:5
• C/F
 Weight loss despite good appetite
 Heat intolerance
 Exophtalmos
 Diarrhea
 Restless ness
 Emotional instability
 LAB. T4,T3,Ft4,ft3 are elevated and TSH is low
 Antithyriod antibody(thyroid peroxidase)
RX- antithyroid drugs
-surgery
-RAT
THANK YOU