Hypo hyperthyroidism hypothyroidism Decreased serum free T 4

Hypo & hyperthyroidism

hypothyroidism Decreased serum free T 4 - Primary --- > thyroid gland - Secondary--- > pituitary gland - Tertiary --- > hypothalamus

Congenital hypothyroidism 1 in 2000 – 4000 live births - Dysgenesis - Dyshormonogenesis Decreased free T 4 Elevated TSH Screening test should be done.

Symptoms & Signs • Ectodermal • Neuromuscular • Metabolic

Poor growth Dull facies, thick lips, large tongue, depressed nasal bridge, periorbital edema Dry scaly skin Cold intolerance Pallor ECG changes: low- voltage QRS complex

Hypotonia Constipation Umbilical hernia Physical & mental lethargy Delayed bone age Hoarse voice( cry) Weight gain

Macrocytosis( anemia) Hypercholesterolemia Hyperprolactenemia

Treatment : levothyroxin newborn: 10 – 15 micro gram/ kg/ day childhood: 3 microgram/ kg/day

Acquired hypothyroidism - Hashimoto thyroiditis: = autoimmune or lymphocytic thyroiditis goiter - Iodine deficiency

Hashimoto thyroiditis - ( autoimmune or lymphocytic thyroiditis) - A common cause of goiter - In older children & adolescents

Clinical manifestations: A firm , nontender diffuse goiter Euthyroid, hypothroid or rarely hyperthroid Female predominance Trisomy 21 & Turner syndrome are predisposed

Diagnosis: -Serum antithyroid peroxidase & antithyroglobulin antibodies - Neither biopsy nor thyroid scan is indicated Treatment : Thyroid hormone in hypothyroidism

Hyperthyroidism Graves Disease: autoantibodies ( thyroid stimulating immunoglobulins) - Personality changes - Mood instability - Poor school performance - Tremor - Anxiety - Weight loss

- Elevated T 4 - Rare: T 3 toxicosis

Treatment : - drugs - Radioactive iodine - surgical

Drugs: -Methimazole or propylthiouracil are equally effective - Propylthiouracil is not first-line therapy because severe liver injury - A beta blocker is started if symptoms are severe

Thyroid Storm - A rare medical emergency Tachycardia Disorientation Elevated blood pressure Hyperthermia

Treatment: Cooling blanket Beta blocker Antithyroid medication Iodine