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Hypo Thyroid is materpsker
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1. Iodide trapping and synthesis Thyroglobulin2. Organisation of trapped iodide as iodotyrosines3. Coupling of the iodotyrosines to form the
iodotyronines thyroxine (T4) and triiodothyronine (T3)
4. T3 and T4 is stored in follicular colloid 5. Endocytosis of colloid droplets and hydrolysis of
thyro-globulin to release T4 and T36. T3 and T4 are associated with plasma protein in
blood ( Thyroid-Binding Globulin/TBG )7. T3 and T4 are free to implement their function, T4
is converted to T38. T3 and T4 have affinity in target cells
HYPOTHYROIDISMHYPOTHYROIDISMDEFINITIONDEFINITION : :
A CONDITION THAT IS CAUSED BY EITHER A CONDITION THAT IS CAUSED BY EITHER ABSOLUTE OR RELATIVE DECREASE OF ABSOLUTE OR RELATIVE DECREASE OF HORMONE T3 AND T4 WITH ITS HORMONE T3 AND T4 WITH ITS CONSEQUENCES, DUE TO IMPAIRED THYROID CONSEQUENCES, DUE TO IMPAIRED THYROID GLAND FUNCTIONS GLAND FUNCTIONS
ETIOLOGY OF CONGENITAL HYPOTHYROIDISM
PRIMARY HYPOTHYROIDISM
TRANSIENT
PRIMARY HYPOTHYROIDISM
PERMANENT
SECONDARYHYPOTHYROIDISM
1.Thyroid dysgenesis - Aplasia - Hypoplasia - Ectopic thyroid2.Dyshormogenesis3.Maternal medica - tion of radioiodine
4.Autoimmun thyroiditis
1.Maternal medication - Goitrogen - iodine containing drugs2.Using iodine for antiseptic3.Transplacental passage of anti thyroid from mother
Because of decreased TSH as congenitall midbrain development defect, itself or with GH and ACTH deficiency
AFTER 6-8 WEEKS SYMPTOMS CLEARER
WEAKER
LOW DESIRE TO DRINK
LESSER CRY
LOWER MUSCULAR TONE
MORE SLEEPS
DIFFICULT BOWEL ACTION
LATER
DEVELOPING & GROWING OF IDIOT FACE, EDEMA, LARGE TONGUE
DELAYS IN ABILITIES TO SIT, STAND, WALK, SPEAK, AND CONTACT WITH OTHERS
INDEX OF NEONATAL HYPOTHYROIDISMINDEX OF NEONATAL HYPOTHYROIDISMSCORE
FEEDING PROBLEM 1
CONSTIPATION 1
HYPOACTIVE 1
HYPOTONIA 1
HERNIA UMBILICALIS 1
LARGE TONGUE 1
“SKIN MOTTLING” 1
SKIN DRYNESS 1.5
“OPEN POSTERIOR FONTARIELLE” 1.5
CHARACTERISTIC FACE 3
TOTAL 13
ETIOLOGY OFETIOLOGY OF ACQUIRED HYPOTHYROIDISM ACQUIRED HYPOTHYROIDISM
PRIMARY :PRIMARY :DUE TO DUE TO THYROIDECTOMYTHYROIDECTOMY
IRRADIATION, IRRADIATION, IODINE IODINE RADIOACTIVERADIOACTIVE
AUTOIMMUNE AUTOIMMUNE THYROIDITISTHYROIDITIS
SECONDARY :SECONDARY :TSH deficiency TSH deficiency (trauma, (trauma, tumor,infection)tumor,infection)Endemic iodine Endemic iodine deficiencydeficiencyGoitrogenGoitrogenResistence to Resistence to thyroid hormonesthyroid hormonesOther causes : Other causes : chromosomal chromosomal disorders, cystinosisdisorders, cystinosis
SIGNS AND SYMPTOMS OF SIGNS AND SYMPTOMS OF ACQUIRED HYPOTHYROIDISMACQUIRED HYPOTHYROIDISM
SYMPTOMS :SYMPTOMS :GROWTH RETARDATIONGROWTH RETARDATION
EDAMATOUS FACEEDAMATOUS FACE
LOW APETTITELOW APETTITE
CONSTIPATIONCONSTIPATION
““SWOLLEN THYROID SWOLLEN THYROID GLAND”GLAND”
LETHARGYLETHARGY
REDUCING SCHOOLINGREDUCING SCHOOLING
COLD INTOLERANCE COLD INTOLERANCE
GALACTORE GALACTORE MENORRHARGYMENORRHARGY
SIGNSSIGNS : :US/LS RATIOUS/LS RATIODELAYED DENTAL DELAYED DENTAL ERUPTIONERUPTIONMYXEDEMAMYXEDEMAGOITERGOITERDELAYED REFLEXDELAYED REFLEXFLAT FACIAL FLAT FACIAL EXPRESSIONEXPRESSIONFAINT, THICK, AND FAINT, THICK, AND COLD SKINCOLD SKINMUSCULAR PSEUDO- MUSCULAR PSEUDO- HYPERTROPHYHYPERTROPHYDELAYED PUBERTYDELAYED PUBERTYPRECOX PUBERTYPRECOX PUBERTY
DIAGNOSISDIAGNOSISCLINICAL SYMPTOMSCLINICAL SYMPTOMS
LABORATORY EXAMINATIONSLABORATORY EXAMINATIONS : :
- ROUTINE- ROUTINE
- TSH- TSH
- T3- T3
- T4- T4
SUPPORTIVE EXAMINATIONSSUPPORTIVE EXAMINATIONS : :
- THYROID SCANNING- THYROID SCANNING
- BONE AGE- BONE AGE
THE STEPS OF THYROID THE STEPS OF THYROID FUNCTION EXAMINATIONFUNCTION EXAMINATION
HYPERTHYROIDISM
T3 TOXICOSIS
SUBCLINICAL HYPERTHYROIDISM
EUTHYROIDISM
SUBCLINICAL HYPOTHYROIDISM
HYPOTHYROIDISM
HIGH
HIGHFREE T4
FREE T3
NORMAL
NORMAL
UNDETECTAUNDETECTABLEBLE
NORMAL
HIGHFREE T4
NORMAL
LOW
TSH
TREATMENT
CONGENITAL HYPOTHYROIDISM
- NEONATAL
SCRINNING TEST
- EARLIEST
NORMAL CHILD
GROWTH & DEVELOPMENT
ACQUIRED HYPOTHYROIDISM
IN ACCORDANCE
TO THE ETIOLOGY
DOSES OF Na-L THYROXINE DOSES OF Na-L THYROXINE SUGGESTED FORSUGGESTED FOR
HYPOTHYROIDISM THERAPY HYPOTHYROIDISM THERAPYAGE Na-L (ug/kg)
0 – 3 MONTHS 8 – 10 0 – 6 MONTHS 7 - 10 6 –10 MONTHS 6 – 8 1 – 5 YEARS 4 – 6 6 – 12 YEARS 3 – 5 > 12 YEARS 3 - 4
IMPLICATIONS DUE TO IODINE DEFICIENCY IN IMPLICATIONS DUE TO IODINE DEFICIENCY IN CHILDRENCHILDREN
IODINE DEFICIENCY
GROWTH PERIODE
IODINE DEFICIENCY RATE
FETUS NEWBORN INFANTCHILD/ADOLESCENCE
ABORTION
PERINATAL DEATH
CONGENITAL DEFORMITIES
THYROID GLAND ENLARGEMENT
NEONATAL HYPOTHYROIDISM
CRETINISM
GOITER
HYPOTHYROIDISM
MOTOR FUNCTION IMPAIRMENT
PHYSICAL GROWTH IMPAIRMENT
MENTAL RETARDATION
DEAF & DUMB
IMPAIRED ABILITY IN WALK & STEP
OTHER NERVE DISORDERS
MENTAL IMPAIRMENT
DUMB
NERVOUS IMPAIRMENT
HYPOTHYROIDISM
MYXEDEMA
SHORT STATURE DELAYED PUBERTY
NERVOSA TYPE
MYXEDEMA TYPE
ENDEMIC CRETINE
SEVERE IODINE DEFICIENCY
PREVENTION TREATMENTAND
Water and food
Iodisation
(SALT)
Screening
Neonatal
Hypothyroid
Na – L
thyroxine
Iodine