1. Iodide trapping and synthesis Thyroglobulin 2. Organisation of trapped iodide as iodotyrosines 3.

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 thyroglobulin to release T4 and T3 6. 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 T3 8. T3 and T4 have affinity in target cells

HYPOTHYROIDISM
DEFINITION : A CONDITION THAT IS CAUSED BY EITHER ABSOLUTE OR RELATIVE DECREASE OF HORMONE T3 AND T4 WITH ITS CONSEQUENCES, DUE TO IMPAIRED THYROID GLAND FUNCTIONS

ETIOLOGY OF CONGENITAL HYPOTHYROIDISM

PRIMARY HYPOTHYROIDISM PERMANENT

PRIMARY HYPOTHYROIDISM TRANSIENT

SECONDARY HYPOTHYROIDISM

1.Thyroid dysgenesis - Aplasia - Hypoplasia - Ectopic thyroid 2.Dyshormogenesis 3.Maternal medica tion of radioiodine 4.Autoimmun thyroiditis

1.Maternal medication - Goitrogen - iodine containing drugs 2.Using iodine for antiseptic 3.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 LESSER CRY MORE SLEEPS

LOW DESIRE TO DRINK

LOWER MUSCULAR TONE

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 HYPOTHYROIDISM

SCORE FEEDING PROBLEM CONSTIPATION HYPOACTIVE HYPOTONIA HERNIA UMBILICALIS LARGE TONGUE SKIN MOTTLING SKIN DRYNESS OPEN POSTERIOR FONTARIELLE CHARACTERISTIC FACE TOTAL 1 1 1 1 1 1 1 1.5 1.5 3 13

ETIOLOGY OF ACQUIRED HYPOTHYROIDISM

PRIMARY :
DUE TO THYROIDECTOMY

IRRADIATION, IODINE RADIOACTIVE

AUTOIMMUNE THYROIDITIS

SECONDARY : TSH deficiency (trauma, tumor,infection) Endemic iodine deficiency Goitrogen Resistence to thyroid hormones Other causes : chromosomal disorders, cystinosis

SIGNS AND SYMPTOMS OF ACQUIRED HYPOTHYROIDISM

SYMPTOMS :
GROWTH RETARDATION EDAMATOUS FACE LOW APETTITE CONSTIPATION SWOLLEN THYROID GLAND LETHARGY REDUCING SCHOOLING COLD INTOLERANCE GALACTORE MENORRHARGY

SIGNS :
US/LS RATIO DELAYED DENTAL ERUPTION MYXEDEMA GOITER DELAYED REFLEX FLAT FACIAL EXPRESSION FAINT, THICK, AND COLD SKIN MUSCULAR PSEUDOHYPERTROPHY DELAYED PUBERTY PRECOX PUBERTY

DIAGNOSIS
CLINICAL SYMPTOMS LABORATORY EXAMINATIONS : - ROUTINE - TSH - T3 - T4 SUPPORTIVE EXAMINATIONS : - THYROID SCANNING - BONE AGE

THE STEPS OF THYROID FUNCTION EXAMINATION

HIGH
UNDETECTA BLE

HYPERTHYROIDISM HIGH FREE T3 T3 TOXICOSIS

FREE T4

NORMAL

NORMAL
TSH NORMAL NORMAL HIGH FREE T4 LOW

SUBCLINICAL HYPERTHYROIDISM EUTHYROIDISM SUBCLINICAL HYPOTHYROIDISM

HYPOTHYROIDISM

TREATMENT
CONGENITAL HYPOTHYROIDISM - NEONATAL SCRINNING TEST - EARLIEST ACQUIRED HYPOTHYROIDISM IN ACCORDANCE TO THE ETIOLOGY

NORMAL CHILD GROWTH & DEVELOPMENT

DOSES OF Na-L THYROXINE SUGGESTED FOR HYPOTHYROIDISM THERAPY AGE Na-L (ug/kg) 0 3 MONTHS 8 10 0 6 MONTHS 7 - 10 6 10 MONTHS 68 1 5 YEARS 46 6 12 YEARS 35 > 12 YEARS 3-4

IMPLICATIONS DUE TO IODINE DEFICIENCY IN CHILDREN

IODINE DEFICIENCY GROWTH PERIODE IODINE DEFICIENCY RATE CHILD/ADOLES CENCE

FETUS

NEWBORN INFANT

ABORTION PERINATAL DEATH CONGENITAL DEFORMITIES

THYROID GLAND ENLARGEMENT

GOITER HYPOTHYROIDISM

NEONATAL HYPOTHYROIDISM
CRETINISM

MOTOR FUNCTION IMPAIRMENT

PHYSICAL GROWTH IMPAIRMENT

NERVOSA TYPE
ENDEMIC CRETINE

MENTAL RETARDATION DEAF & DUMB IMPAIRED ABILITY IN WALK & STEP OTHER NERVE DISORDERS MENTAL IMPAIRMENT

MYXEDEMA TYPE

DUMB NERVOUS IMPAIRMENT HYPOTHYROIDISM

SEVERE IODINE DEFICIENCY

MYXEDEMA

SHORT STATURE

DELAYED PUBERTY

PREVENTION

AND

TREATMENT

Water and food

Screening

Iodisation
(SALT)

Neonatal
Hypothyroid

Na L thyroxine

Iodine