SLU - SOM Pediatrics Prelim Exams: THYROID
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| Hypothyroidism results from? | 1. Deficient production from:
a) gland (primary Hypothyroidism)
b) reduced TSH (Secondary)
2. Defect in receptor activity
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| Cause of CONGENITAL HYPOTHYROIDISM? | >Thyroid Dysgenesis - 85%
> Inborn errors of Thyroxine Synthesis - 10%
>Transplacental maternal thyrotropine - receptor blocking antibody - 5%
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| Familial Congenital Hypothyroidism is caused by? | Inborn Errors of thyroid hormone synthesis
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| Appearance of manifestations of SEVERE Congenital Hypothyroidism Appears? Less Severe? | Early manifestations - SEVERE
Late Manifestations - Less Severe
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| Epidemiology: a) Race b) gender | a) Hispanic and Native Americans > Blacks
b) F>M (2:1)
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| Clinical manifestations: | > Large anterior and posterior fontanels - first clues secondary to myxedema of the brain
> Prolonged Physiologic Jaundice - >2 weeks, may be the earliest signs
> 1st month: feeding difficulties, choking spells, lac of interest, sluggish, somnolence
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| Anemia associated with congenital hypothyroidism | Macrocytic anemia
- intractable to treatment
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| Most common Manifestation/s for Congenital Hypothyroidism? | Cardiac Anomalies
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| If untreated or undetected (more than 1 month) | > Retardation of mental and physical development
> Stunted growth, HC normal or increased
> Fontanels- opened
> Dry skin
> Fat deposition above clavicles
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| Diseases Detected by Newborn Screening? | > Phenylketonuria
> G6PD
> Congenital Adrenal Hyperplasia
> Congenital Hypothyroidism
> Galactosemia
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| Diagnostics for Congenital Hypothyroidism? | > Newborn Screening
> (American) T4 determination --> TSH if T4 is low
> (European and Japanese) TSH measurement - detects primary hypo and subclinical hypo
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| Thyroid hormones Profile for Congenital Hypothyroidism? | T4 - LOW
T3 - NORMAL
TSH - HIGH
Serum THYROGLOBULIN - LOW
** Serum Prolactin - High
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| Radiologic Findings CHypoThy | >Distal Femoral Epiphysis is ABSENT (epiphyseal dysgenesis)
. BEAKING Deformity - T12, L1, L2
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| ECG findings for CHypoThy | Low voltage P and T waves
Diminished Amplitude of QRS
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| Treatment for CHypoThy | ORAL LEVOTHYROXINE
- 10-25 mcg/kg
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| Monitoring after treatment | T4 and TSH monthly for the first 6 months, then every 2-3 months until 2 y/o
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| How many points in the IQ is reduced? | 5-20 points
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| Neuropsychological Sequelae of congenital Hypothyroidism? | > Incoordination
> hypotonia/ hypertonia
> Short attention span
> Speech Problems
> neurosensory hearing defects
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| ACQUIRED HYPOTHYROIDISM Epidemiology | > more common that Congenital
> F>M (2:1)
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| Cause of Acquired Hypothyroidism | Chronic Lymphocytic Thyroiditis (Hashimoto's Thyroiditis)
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| Other causes of Hypothyroiditis (acquired) | - Autoimmune: Pernicious Anemia, Klinefelter, Down's
- Irradiation
- Meds: AMIODARONE
- liver hemangioma - inc. type III deiodinase
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| Manifestations: | - decelerated growth - 1st clinical sign
- Goiter - Enlarged gland, non-tender, firm, rubbery consistency
- hypothyroidism s/sx
- precocious puberty - inc. TSH
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| What is Goiter? | Enlarged thyroid gland
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| T/F: Goiter is caused by increased thyroid hormone secretion? | FALSE. Increased PITUITARY SECRETION (TSH)
can be Euthyroid, Hypothyroid, Hypothyroid, Congenital or acquired , endemic or sporadic
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| Congenital Goiter is caused by? | > Fetal thyroxine Synthetic defect
> Administration of Anithyroid drugs during pregnancy
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| Radiologic findings? | Anterior deviation of the Trachea
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| Acquired Goiter is caused by? | > Lyphocytic Thyroiditis (Hashimoto)
> Iodine Ingestion
> Drugs
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| Thyroid picture of Acquired Goiter? | Euthyroid or Hypothyroid
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| Other name for ENDEMIC GOITER? | Cretinism
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| Cause of Cretinism | IODINE DEFICIENCY
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| Clinical Manifestations | > Mild - no noticeable neck mass
> Moderate - evident neck mass and may disappear with maturity may reappear during pregnancy
> Severe - large neck mass
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| Types of Endemic Cretinism? | 1. Neurologic Type - Zaire
2. Myxedematous Type - Papua New Guinea
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| Manifestations of Neurologic Type? | > MR
> Deaf mutism
> gait and standing disturbances
> normal pubertal development
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| Pyramidal Signs of Neurologic type? | > Babinski
> hyperreflexia
> ankle clonus
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| Thyroid Picture of Neurologic type? | EUTHYROID
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| Manifestations of Myxedematous type? | > MR
> deaf with neurologic symptoms
> delayed growth and sexual development
> absent goiter on UTZ
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| Thyroid picture? | T4 LOW; TSH marked elevation
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| Pathogenesis of Neurologic type? | Direct effects of maternal and fetal iodine deficiency (hypothyroxinemia)
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| Pathogenesis of Myxedematous type? | >Selenium Deficiency
> auto-antibodies/ autoimmune
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| Treatment for Cretinism? | IODINATED POPPY SEED OIL to women - prevents iodine deficiency in future pregnancies for 5 years
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| HYPERTHYROIDISM | excessive secretion of Thyroid Hormones
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| Cause of GRAVE'S DISEASE? | production of thyroid stimulating immunoglobulin
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| Peak incidence? | 11-15 y/o
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| Gender ratio? | F>M (5:1)
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| Earliest manifestation of Grave's? | Emotional Disturbances with motor hyperactivity
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| Description of Exophthalmos | > lagging upper eyelid
> impaired convergence
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| Anxious Stare | EXOPHTHALMOS
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| An acute condition that is manifested by hyperthermia, severe tachardia, rapid progression of coma, and is precipitated by stressful conditions. Hx: Hyperthyroidism | Thyroid crisis/Thyroid Storm
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| diagnostics for Thyroid storm? | > inc Serum T4, Free T4 and T3
> low TSH
> (+) antithyroid antibodies and thyroid peroxidase antibodies
> (+) thyrotropin stimulating antibodies
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| Treatment for Thyroid storm? | > Anti-thyroid: PTU
> Hydrocortisone
> Propanolol
> Supportive mngt. (treat underlying cause)
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| conditions for radioiodine treatment of surgery? | > cooperation for medical management is not possible
> trial of meds has failed
> side effects preclude futher use of antithyroid meds
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| Ocular manifestations of Grave's Disease? | Pain, Lid erythema, Chemosis, decrease EOM function, Decreased Visual Acuity
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| Papillary Carcinoma | - RET rearrangements
- Familial; Autosomal Dominant
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| Anaplastic Thyroid Carcinoma | - p53 point mutations
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| Procedure that causes Thyroid carcinomas? | Radiation Therapy
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| Amount of Grey that causes a 7.7 relative risk | 1 Gy
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| Most Common Histologic type of Thyroid Ca | Papillary/Follicular
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| Most fatal Histologic type? | Anaplastic
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| MC site of mets | Lungs
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| Gold standard for diagnosis | FNAB
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| Determines Solidity of the tumor | Ultrasound
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| Determines radionucleid uptake | Thyroid Scan
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| Radioisotopes used for DIAGNOSIS | Iodine - 123
99m Technetium pertechnetate
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| cold nodules | most are BENIGN
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| Hot Nodules | Malignant
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| Treatment for tumors <1 cm | subtotal thyroidectomy followed by suppressive doses of thyroid hormone
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| Small but multicentric tumors | Total Thyroidectomy
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| Tumors >1 cm | Total thyroidectomy with LN excision
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| Radioisotopes used for TREATMENT | Iodine - 131 (30-100 mCi)
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| Drugs given after Surgery? | Na L - thyroxine
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