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Paediatric

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Endocrinology

Question
8 out of 35
 

A 1 year old child is brought to the hospital with thyroid swelling. The child has abnormal weight gain and has poor activities. His TSH are found raised and T4 is very low. Which of the following is most likey cause of his disease? (AIPG 2011)



A Hypothalamic disease
B Thyroid dysgenesis

C Dyshormonogenesis
D End organ receptor insensitivity

Ans. B

Thyroid dysgenesis

“The most common cause of non-endemic Cong Hypothyroidism, accounting for 85–90 % of cases, is thyroid dysgenesis, almost always a sporadic disease”.

Congential Hypothyroidism (cretinism)

1. Etiology

a. Endemic region: iodine deficiency during intrauterine and

i. neonatal life ( worldwide)

b. Non endemic regions: thyroid dysgenesis

2. Presentation

a. Failure to thrive

b. Stunted bone growth and dwarfism

-Commonly absent distal femoral epiphysis

c. Spasticity and motor incoordination

d. Mental retardation

e. Goiter (endemic cretinism)

i. Endemic goiter

1) Uncommon in the US

2) Etiology: dietary deficiency of iodine

3. Clinical Manifestation congenital Hypothyroidism

a. Occurs in 1/4000 Worldwide

b. Most infant are asymptomatic at birth because of transplacental passage of T4 (usu 3rd day of life)

c. Most common cause is thyroid dysgenesis

d. Presentation: hypoglycemia, jaundice

i. micropenis, midline facial

ii. anomalies, enlarge posterior

iii. fontanelle, macroglossia

4. Rx: Initial dose: Sodium L-tyroxine 10-15

i. microgrms/kg/day( should not be mixed soy protien or iron) Then, 4 micrgms/kg/day

Endocrinology Flashcard List

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