Acquired hypothyroidism
A relatively common condition with
an estimated prevalence of 0.1–0.2% in the population. The incidence in girls
is 5–10 times greater than boys.
Acquired hypothyroidism may be due
to a primary thyroid problem or indirectly to a central disorder of
hypothalamic–pituitary function.
· Autoimmune (Hashimoto’s or chronic
lymphocytic thyroiditis).
· Iodine deficiency: most common
cause worldwide.
· Subacute thyroiditis.
· Drugs (e.g. amiodarone, lithium).
· Post-irradiation thyroid (e.g.
bone marrow transplant—total body irradiation).
· Post-ablative (radioiodine therapy
or surgery).
Hypothyroidism due to either pituitary or hypothalamic
dysfunction.
· Intracranial tumours/masses.
· Post-cranial radiotherapy/surgery.
· Developmental pituitary defects
(genetic, e.g. PROP-1, Pit-1 genes): isolated TSH deficiency; multiple
pituitary hormone deficiencies.
The symptoms and signs of acquired
hypothyroidism are usually insidious and can be extremely difficult to diagnose
clinically. A high index of sus-picion is needed.
· Goitre:
primary hypothyroidism.
· Increased weight gain/obesity.
· Decreased growth velocity/delayed
puberty.
· Delayed skeletal maturation (bone
age).
· Fatigue:
mental slowness; deteriorating
school performance.
· Constipation:
cold intolerance; bradycardia.
· Dry
skin: coarse hair.
· Pseudo-puberty:
girls—isolated breast development;
boys—isolated testicular enlargement.
· Slipped
upper (capital) femoral epiphysis: hip pain/limp.
Diagnosis is dependent on
biochemical confirmation of hypothyroid state.
· Thyroid function tests: high TSH/low
T4/low T3.
· Thyroid antibody screen. Raised
antibody titres:
· antithyroid peroxidase;
· anti-thyroglobulin;
· TSH receptor (blocking type).
· Oral Levothyroxine (25–200
micrograms/day).
· Monitor thyroid function test
every 4–6mths during childhood.
Monitor growth and
neurodevelopment.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.