Hypothyroidism is a thyroid hormone deficiency. Symptoms in infants include poor eating habits and growth arrest. The symptoms in children and adolescents are similar to those of adults, but also include growth arrest, delayed puberty, or both. The diagnosis is made (eg., Thyroxine, TSH) due to thyroid hormones. Treatment is by substitution of thyroid hormones.
Hypothyroidism is a thyroid hormone deficiency. Symptoms in infants include poor eating habits and growth arrest. The symptoms in children and adolescents are similar to those of adults, but also include growth arrest, delayed puberty, or both. The diagnosis is made (eg., Thyroxine, TSH) due to thyroid hormones. Treatment is by substitution of thyroid hormones. Etiology hypothyroidism in infants and young children may be congenital or neonatal. Congenital hypothyroidism Congenital hypothyroidism is about before in 1/2000 to 1/4000 live births. Most congenital cases are sporadic, about 10-20% are inherited. The causes usually comprise dysgenesis of the gland (85% of cases) Decreased thyroid hormone production (abnormal thyroid hormone production, 10 to 15% of cases) dysgenesis can ectopy (two-thirds of the cases), absence (agenesis) or underdevelopment (hypoplasia) include the thyroid gland. Decreased thyroid hormone production has several types, which may result from failures in each of the steps of the thyroid hormone biosynthesis (Congenital goiter). In the US, rare, but common in some developing countries, hypothyroidism is caused by a maternal iodine deficiency. In rare cases, hypothyroidism by transplacental transfer of antibodies, struma causative factors (z. B. amiodarone) or anti-thyroid drugs (eg. B. propylthiouracil, thiamazole) gives. Another rare cause is a central hypothyroidism, which is caused by structural abnormalities in the pituitary gland; patients usually have other Hypophysenhormonmängel.Erworbene hypothyroidism acquired hypothyroidism typically by an autoimmune thyroiditis (Hashimoto’s thyroiditis Thyreoiditis- Hashimoto’s) is caused and occurs later in childhood and adolescence. Symptoms and signs Signs and Symptoms in infants and young children differ from the disposal of any in older children and adults. When an iodine deficiency is present in early pregnancy, babies can show a serious growth retardation, coarse facial features, mental retardation and spasticity. Most other hypothyroid infants initially have few or no symptoms or signs and are only recognized by a newborn screening. Symptoms can be subtle or develop slowly because some maternal thyroid hormones transmitted through the placenta. If the maternal thyroid hormone is then metabolized, continues the underlying cause for hypothyroidism and the hypothyroidism is undiagnosed or left untreated, this leads to a moderate to sharp slowdown in CNS development, which, of reduced muscle tone, central hearing loss, prolonged hyperbilirubinemia umbilical hernia, difficulty breathing, macroglossia, large fontanelle, may be accompanied bad eating habits and hoarse screams. In rare cases, a delayed diagnosis or treatment leads to mental retardation and dwarfism. Some Symptoms are similar to those in older children and adults (eg weight gain, fatigue, constipation, scruffy, dry hair, yellowish, cool or mottled, rough skin hypothyroidism. Symptoms and complaints). The findings in children are growth retardation, delayed skeletal maturity and usually a delayed puberty. Diagnosis Routineßäßiges newborn screening thyroid function tests Sometimes thyroid ultrasonography or radionuclide scan Routine newborn screening detects hypothyroidism before clinical signs are apparent. If the screening is positive, a confirmation with functional tests of the thyroid is necessary, including a measurement of serum thyroxine (T4), the free T4 and thyroid stimulating hormone (TSH). These tests are also carried out in older children and adolescents, where hypothyroidism is suspected. A severe congenital hypothyroidism can cause subtle developmental disabilities and hearing loss despite rapid therapy. The hearing loss may be so weak that it is not detected in the initial screening, but it can inhibit language acquisition yet. A reconsideration after infancy is recommended to detect subtle hearing loss. If congenital hypothyroidism is diagnosed, a radionuclide scan (either 99mTc-pertechnetate or 123I) or ultrasound may be performed to assess the size and location of the thyroid gland and thus to help a structural abnormality (ie Schilddrüsendysgenesie) of a reduced thyroid hormone production and temporary abnormalities to distinguish. In older children and adolescents with suspected hypothyroidism (elevated TSH, low T4 or free T4) thyroid antibody titers (thyroid peroxidase and thyroglobulin) should be measured to check for autoimmune thyroiditis. A thyroid ultrasound is not necessary to make the diagnosis of autoimmune thyroiditis safe, and should be limited to children with thyroid imbalance or palpable thyroid nodules. Treatment Treatment is by substitution of thyroid hormones. For most infants, the motor and mental development is normal. When should be treated in most cases of congenital hypothyroidism a lifelong thyroid replacement is required. However, if the initial TSH level is <40 mU / L, no organic basis was found and it is not believed that the disease is temporary, clinicians may be able to try to stop the treatment after 3 years, since the test run at this time no constitute a risk to the developing CNS. If the TSH rises once the therapy is stopped, and the free T4 or T4 is low, a permanent congenital hypothyroidism as confirmed and treatment should be started again applies. A lack of thyroxine-binding globulin (TBG), which is primarily found in the screening based on the determination of total T4 in serum is not treatment-subject, as the affected infants have normal free T4 and normal TSH levels and are therefore euthyroid , have in older children, the only low TSH elevations (<10 mU / L) and normal T4 or free T4 levels, subclinical hypothyroidism is assumed regardless of whether they have thyroid autoantibodies or not. Such children do not need thyroid hormone replacement, if they develop any symptoms of hypothyroidism or goiter or her TSH levels steigen.Therapieregime case of congenital hypothyroidism is the treatment immediately with L-thyroxine 10-15 ug / kg p.o. started one times a day and closely monitored. This dose is to bring the T4 levels in serum rapidly (within 2 weeks) in the upper half of the normal age range (between 10 g / dl and 15 g / dl) and promptly reduce the TSH (within 4 weeks). After the first year of life is the usual starting dose of L-Thyroxinvon 4-6 mcg / kg p.o. 1 times a day and serum levels of TSH and T4 are adjusted normal values ??for this age. This dosage is also used for acquired hypothyroidism in children. In later childhood or adolescence, the initial dose is 2-3 g / kg p.o. 1 times a day. Thyroid hormone replacement should only be administered in tablet form, the crushed for infants and can be made into a paste; he should not be administered concurrently with a soy formula or iron or calcium supplements, all können.Überwachung reduce the thyroid hormone absorption children are monitored frequently during the first years of life: Every 1-2 months during the first 6 months Every 3-4 months between the age of 6 months and 3 years every 6-12 months from the age of 3 years until the end of the size growth Older children can be monitored more frequently if there are concerns about compliance. After a dose adjustment in older children TSH and T4 levels are measured in 6-8 weeks. Important points hypothyroidism in infants is usually congenital; Acquired causes are more common with age. Most congenital causes include dysgenesis of the gland, but genetic disorders that affect the thyroid hormone synthesis can occur. Most infants with hypothyroidism are detected by routine newborn screening. The diagnosis is confirmed, free T4 and thyroid stimulating hormone (TSH) in serum thyroxine (T4); if confirmed, imaging tests to detect structural disorders of the thyroid gland are performed. The treatment is carried out with L-thyroxine, wherein the dose is adjusted to keep the TSH and T4 levels in the normal range for age.