The document discusses hypothyroidism and hyperthyroidism, detailing their causes, effects, and treatment options. Hypothyroidism involves insufficient thyroid hormone leading to low metabolic rates, while hyperthyroidism results from excess hormone production causing hypermetabolic conditions. Various diagnostic and therapeutic approaches, including hormone replacement therapy and antithyroid medications, are explored for managing these thyroid disorders.

1. HYPOTHYROIDISM AND
HYPERTHYROIDISM
Ms. Muskan Jaiswal
IGSCON

2. • Thyroid gland is one of the seven major
glands that makes up the endocrine system.
• Endocrine glands produce hormones that are
transported by the blood system to all parts
of the body.
• Thyroid glands scretes thyroxin (T4),
triiodothyronine (T3) and calcitonin. These
hormones promote cellular growth,
metabolism and mental development.
• Disorders of thyroid gland are broadly
classified as HYPOTHROIDISM and
HYPERTHYROIDISM.

3. Hypothalamus
Thyroid – releasing hormone (TRH)
Anterior pituitory
Thyroid – stimulating hormone (TSH)
Thyroid
T3 and T4

4. HYPOTHYROIDISM HYPERTHYROIDISM
 Hypothyroidism results
from suboptimal levels
of thyroid hormone.
 It is a condition in which
there is an inadequate
amount of
triiodothyronine (T3)
and thyroxine (T4),
leading to decrease in
metabolic rate
 Other name of
hypothyroidism in child
: (Cretinism) and in
adults : ( mysedema)
 Hyperthyroidism is a set
of disorders that involve
excess synthesis and
secretion of thyroid
hormone (T3 and T4) by
the thyroid gland, which
leads to the
hypermetabolic condition
of thyrotoxicosis.
 Other name of
hyperthyroidism is (
grave’s disease )

5. A. CONGENITAL
i. Primory hypothyroidism
a) Hoshimoto (autoimmune) thyroditis
b) Thyroid gland aplasia, hypoplasia and ectopic gland
c) Inborn errors of thyroid hormone synthesis like;
 Impaired response to TSH
 iodine trapping or transport defect
 Defect of thyroglobulin synthesis
 Lodotyrosine coupling defect
 Lodotyrosine deidination defect
d) Inherited defect of thyroid hormone receptor
e) Maternal drug
 Thionamides
 Lithium
 Anticonvulsant
 Carbimazole

6. ii. Secondory hypothyroidism;
 Deficiency of TSH
 Hypopituitarism
 Craniopharyngioma and other tumor
 Neurosergery
 Cranial irradiation
 Head trauma
iii. Tertiory hypothyroidism
 Deficiency of TRH
iv. miscellaneous
 THYROID HORMONE RESISTANCE
B. ACQUIRED
i. Iodine deficiency
ii. Autoimmune chronic lymphocytic thyroditis
iii. Irradiation
iv. Ingestion of goiterogens
v. Drug induced

7. HYPOTHYROIDISM HYPERTHYROIDISM
 Hasimoto (autoimmune)
 Not enough iodine in a child
diet
 Being born with a
nonfunctional thyroid or
without a thyroid gland
 Improper treatment of mothers
thyroid disease during
pregnancy
 Abnormal pituitary gland
 Maternal drugs
 Grave’s disease(50-60%)
 Toxic multinodular (20%)
 Toxic thyroid adenoma(5%)
 Thyroditis(15%)
 Pituitory adenoma
 Oral consumption of excess
thyroid hormone iodine can
lead to hyperthyroidism
 Medullary thyroid carcinoma
<10%

8. Due to etiology factor
Primory
thyroid
malformation Pituitory
malformation
Hypothalamic
malformation
Lack of TH negative
feedback on pituitory
TSH secretion and
hypothalamus TRH
seretion
Lack of negative feedback to
hypothalamus release of TRH
by TSH and thyroid TH
Decrease TRH
Low levels of TH & high
levels of TSH & TRH
Low levels of TSH & TH, high level of TRH
Low levels of TRH,TSH &
TH
Low level of thyroid hormone (TH)
Impaired rate of basal metabolism
HYPOTHYROIDISM

9. Due to etiological factors like grave’s disease,
toxic thyroid adenoma, medullary thyroid carcinoma
Excess release of thyroid hormone T3 &T4
High T3 & T4 circulation
hyperthyroidism
Increased basal metabolic rate
Diaphoresis, weight loss and heat intolerance

10. HYPOTHYROIDISM HYPERTHYROIDISM
A. Earlier
 Large and heavy at birth
 Open posterior fontanel &
wide sutures
 Lethargy
 Sluggishness
 Hoarse cry
 Feeding difficulties
 Hypotonia
 Over sleeping
 Constipation
 Prolong physiological
jaundice
 Abdominal distension
 Cold intolerance
 Dry
 Rough thick skin
 Umbilical hernia
 anemia
 Thyromegaly
 Polyphagia with weight loss
 Hyperactivity
 Restlessness
 Nervousness
 Hand tremors
 Sleep disturbance
 Emotion lability
 Hyperexictability
 Excessive diaphoresis
 Heat intolerance
 Exophthalmos proptosis
 Lid retraction
 Tall stature
 Poor school performance
 Palpitation
 Tachycardia>160 beats (featus)
 Wide pulse pressure

11. HYPOTHYROIDISM HYPERTHYROIDISM
B. Classical feature appear
usually ( 8-12 weeks)
 Coarse facial feature
 Protruding tongue
 Large open mouth
 Thick lips
 Puffy eyelids
 Depressed nasal bridge
 Seemingly wide apart
eyes
 Wrinckle forehead
 Sparse eyebrows
 Low level hairline(
scanty,rough, dry,
brittle) if hair is present
 Neck is short
 Hands are broad but
fingers is small
 Progressive cardiomegaly
 Cardiac insufficiency
 Feeding problem
 Fatigue
 Increase frequency of bowel
movement

12. HYPOTHYROIDISM HYPERTHYROIDISM
C. Acquired or late onset
 Grow retardation
 Short stature
 Stocky appearance
 Large head
 Dull expression
 Puffy face
 Cold intolerance
 Delayed skeletal
maturation
 Goiter
 Poor school performance

13. HYPOTHYROIDISM HYPERTHYROIDISM
 Family history
 History collection
 History of antenatal period
 Physical examination
 Neonatal screening
 TFT
 Stimulating test
 X-ray
 Blood test
 Anti –thyroid antibody level
studies
 Thyroid ultrasound
 Nuclear medicine uptake & scan
 Radioactive iodine examination
 Family history
 History collection
 History of antenatal period
 Physical examination
 Laboratory investigation
 TFT
 Thyroid ultrasonography
 Fine needle aspiration
 Radionuclide scanning( for
carcinoma)
 Radioactive iodine uptake

14. HYPOTHYROIDISM HYPERTHYROIDISM
1. levothyroxine: 10 to 15 mcg/kg orally
once day, must be started immediately
& be closely monitored.
this dosages is intended to rapidaly
within (2week) bring the serumT4 level
into the upper half of normal range for
age ( between 10 mcg/dl [129nmol/l]
and 15mcg/dl [193nmol/l] and
promptly ( within 4 week) reduce the
TSH.
2. In acquired hypothyroidism :
usual starting dosages of
levothyroxine is based on body
surface area (100mcg/m2 orally once
a day)
 For age 1 to 3 years : 4 to 6 mcg/kg once a
day
 For age 3 to 10 years : 3 to 5 mcg/kg once a
day
1. Antithyroid drugs :
 propylthiouracil:
6 year child ; 50mg orally daily in
3 equally divided doses
approximately
( carefully titrate based on TSH &
free T4 levels)
6 to 10 year of age ;
50 to 150 mg orally 8 hr.
10 years or older; 150 to 300 mg
orally
 Methimazole ;
0.17 to 0.33 mg/kg orally 3
times a day
2. Beta blocker:
 Propranolol – 0.8 mg/kg
orally 3 times a day
 Atenolol- 0.5-1.2 mg/kg
orally 1 to 2 times a day

15. MONITORING:
 Every 1 to 2 months during the first
6 months
 Every 3 to 4 months between age 6
months &3 years
 Every 6 to 12 months from age 3
years to the end of growth
3. Hormone replacement
therapy
3. Hydrocortisone;
0.8 to 3.3 mg /kg orally 3
times
4. Ligol’s iodine ( potassium iodide
solution) : use in severe
thyroxicosis and this druf
indicated to inhibit the releas of
thyroid hormone
dosage 1 drop ( 0.05ml) orally 3
times
5. Radioactive iodine therapy
6. Radioactive ablation therapy- (
disposal of stool and urine as
directed by nuclear medicine
department)
7. Surgery-
 Total thyroidectomy
 Subtotal thyroidectomy

16.  Early identification
 Collecting history
 Assist laboratory test
 Drug should administer
 Teach and educate the parent about the condition
 Symptomatic treatment
 Follow up care

17. 1. Sharma rimple , essential of pediatric nursing 2nd edition the
health sciences publishers, page no. – 323-326
2. Datta parul pediatric nursing ( as per INC syllabus ) fourth edition
the health sciences publishers page no. – 364-366
3. Sudhakar a essential of pediatric nursing (as per INC syllabus ) the
health science publishers page no . 1273-1276
4. https://www.hopkinsmedicine.org/health/condition-and-
diseases/hypothyroidism-in-children
5. https:/www.msdmanuals.com/en-
in/professional/pediatrics/endocrine-disorders-in-
children/hypothyroidism-in-infants-and-children
6. https:/images.app.goo.gl/GZHt9pb8YgMztrV48
7. https://images.app.goo.gl/QdgYQJLv8Um8j5bC9
8. https://www.drugs.com/dosage/propylthiouracil.html#Usual_Pedi
atric_Dose_For_Hyperthroidism
9. https://www.msdmanuals.com/en-
in/professional/pediatrics/endocrine-disorders-in-
children/hyperthyroidism-in-infants-and-children