Subclinical hypothyroidism, characterized by an elevated TSH level with normal thyroid hormone levels, is the most commonly seen thyroid dysfunction in children with Down syndrome. There is no consensus on treatment for subclinical hypothyroidism. Some guidelines recommend treatment for TSH levels over 10 mU/L, while others only recommend monitoring for levels between 5-10 mU/L. Thyroid screening and monitoring is important for children with Down syndrome due to their high risk of thyroid disorders. Treatment approaches should be based on individual factors like symptoms, growth, and presence of thyroid antibodies.
Congenital hypothyroidism is quite common in Indians and is the most common reversible congenital cause of mental retardation.
Early identification and intervention is important as Thyroid dependent brain development is complete by 3 years of age.
Universal screening is ideal as most cases are sporadic.
Positive cases on screening by filter paper test should be confirmed by serum levels estimation.
Serum Thyroid hormone levels are of primary importance in diagnosing and managing this condition, other investigations are ancillary.
Age based reference values must be followed in interpreting the results.
Timely monitoring (serum hormone levels, compliance, growth & development) and adequate counseling of care givers are key in managing this condition.
Congenital hypothyroidism is quite common in Indians and is the most common reversible congenital cause of mental retardation.
Early identification and intervention is important as Thyroid dependent brain development is complete by 3 years of age.
Universal screening is ideal as most cases are sporadic.
Positive cases on screening by filter paper test should be confirmed by serum levels estimation.
Serum Thyroid hormone levels are of primary importance in diagnosing and managing this condition, other investigations are ancillary.
Age based reference values must be followed in interpreting the results.
Timely monitoring (serum hormone levels, compliance, growth & development) and adequate counseling of care givers are key in managing this condition.
The majority of children have a head size that is appropriate for age and gender. But a few have a too-large head at birth or may be of postnatal acceleration. Macrocephaly is used when the head size exceeds the mean by more than two standard devotions of age and gender. In addition, Macrocephaly is seen in association with several cranio-skeletal dysplastic conditions.
The majority of children have a head size that is appropriate for age and gender. But a few have a too-large head at birth or may be of postnatal acceleration. Macrocephaly is used when the head size exceeds the mean by more than two standard devotions of age and gender. In addition, Macrocephaly is seen in association with several cranio-skeletal dysplastic conditions.
Hello guys,
Todays presentation aims at discussing the most common syndromic causes of short stature - Turners syndrome and Downs syndrome. We have discussed the Genetics, Phenotype and co-morbidities with their individual management strategies. I hope you find it uselful too.
I am Dr Pendo Chaula, a senior resident at University of Dodoma in Tanzania. I am working at UDOM affiliated hospitals which are Benjamin Mkapa hospital, UDOM hospital, Dodoma regional referral hospital and Iringa regional referral Hospital. Am posting it for learning purpose, you can download it if you like it
Case Study Evaluation
February 29, 2016
CASE HISTORY:
An 11-year-old female with no significant past medical history presented with symptoms suggestive of hyperthyroidism (weight loss, heat intolerance). She has also experienced a decline in grades at school. Family history is significant for thyroid disease in both grandmothers (both on thyroid replacement therapies). The clinician ordered thyroid function tests including Free T4, T3, TSH, anti-TSH receptor antibodies, antithyroglobulin and antithyroid peroxidase antibodies.
The results for the tests follow:
Free thyroxine (FT4) 2.87 ng/dL (Prepubertal 0.73-1.77 Pubertal/Adult 0.73-1.84)
Total triiodothyronine pediatric (T3) 374.00 ng/dL (123-211)
Thyroid-stimulating hormone (TSH) <0.018 uU/ml
Thyroxine (T4) 18.2 ug/dL (5.0-12.0)
Antithyroglobulin antibodies >3000 IU/ml (Negative <60 IU/mL Equivocal 60-100IU/mL Positive >100 IU/mL)
Antithyroid peroxidase antibodies 2667 IU/mL (<60) Anti-TSH receptor antibodies 69.6 % Inhibit. (<=16.0 Unit: %)
The laboratory findings confirmed the clinical impression and a diagnosis of Graves's disease (hyperthyroidism with thyrotoxicosis) was made.
The patient was started on methimazole right away but after approximately two weeks of treatment she developed severe adverse reaction to it with significant joint pain and swelling over her upper and lower extremities with hives; Methimazole was stopped immediately and she was started on Benadryl and Advil ; her symptoms improved after few days, although she did have some residual intermittent hives that were transient.
She has been given some brief course of Prednisone as well, and Atenolol 50 mg twice a day was also started.
After approximately two weeks, due to the fact that the medical management for hyperthyroidism failed, the patient was considered to have radioiodine ablation of her thyroid next day and for that she underwent a thyroid imaging with uptake showing enlarged thyroid gland, with homogeneous increased uptake, consistent with Graves disease with 24-hour uptake equaling 86%.
The patient underwent radio-iodine ablation as scheduled and she was stable on Atenolol 50 mg twice a day. She was discharged home.
At her next follow-up appointment in 2 weeks her thyroid functions tests lab values were as follows:
T4, Free, >12.00 ng/dl (Prepubertal 0.73-1.77 Pubertal/Adult 0.73-1.84)
T3, 1173.00 ng/dL (123-211 ng/dL)
TSH, <0.018 uIU/mL
DISCUSSION:
"Thyrotoxicosis in a Pre-adolescent Patient with Averted Thyroid Storm Following Radio-pharmaceutically Induced Therapeutic Lysis of Thyroid Gland"
Laboratory evaluation of thyroid function in various clinical situations. Adapted from The Merck Manuals, Online Medical Library, Endocrine and Metabolic Disorder, November 2005 revision
Graves' disease is the most common cause of thyrotoxicosis in children. The disorder is rare before the age of 3 and increases progressively ...
Thyroid and critical illness
Non Thyroidal Illness Syndrome (NTIS)
Sick Euthyroid Syndrome
Euthyroid Sick Syndrome (ESS)
Low T3 Syndrome
NTIS, formerly known as euthyroid sick syndrome, often occurs in patients who have severe, prolonged critical illness and is essentially a laboratory abnormality to be monitored.
By Usama Ragab Youssif
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
3.
subclinical hypothyroidism ,compensated
hypothyrodisim ,mild thyrotropenemia, IRT
isolated thyroropenemia :an elevated TSH
level more than 5 mU/L with normal T3 and
T4 levels.
Overt hypothyrodism,decompensated
hypothyrodism: an elevated TSH level higher
than 10-20 mU/L with low T4 levels.
4.
down syndrome is the most common
chromosomal anomaly in live births.
incidence of 1:800 live births.
it consists of a constellation of clinical signs
and symptoms as well as biochemical,
metabolic, endocrine dysfunctions.
5.
Because of medical advances and
improvements in overall medical care, the
median survival of individuals with DS has
increased considerably.
This longer life expectancy requires giving
the necessary care to the individual with DS
over their total longer lifespan.
6.
Thyroid dysfunction is highly prevalent in
Down's syndrome.
Thyroid disorders have been reported in up
to 28–40% of children with DS, and they
increase in frequency, up to 54%, as the
children age .
8.
Patients with DS have an increased prevalence
of both congenital hypothyroidism (CH) and
acquired thyroid dysfunction
incidence of congenital hypothyroidism in
Down syndrome cases is 30 times higher
than that in the general population.
9.
The clinical symptoms and signs of both
Downs syndrome and hypothyroidism are
overlapping to some extent
10.
The I.Q. in Down syndrome cases ranges
from 25 – 70 with higher values (50 – 59) in
younger subjects than in the older subjects
(25 – 49) .
Hypothyroidism may compromise the
physical and mental development in patients
with DS.
11.
The mean D.Q. in the Down syndrome
children with hypothyroidism was 49.5 ± 5.5,
while that in the Down syndrome children
without evidence of thyroid dysfunction was
52 ± 5.54.
Shaw CK, Thapalial A. Thyroid dysfunction in Down syndrome.
Kathmandu University Medical Journal (2006), Vol. 4, No. 2, Issue 14,
182-186
13.
Subclinical hypothyroidism: Transient mild
TSH elevation is the most commonly seen
thyroid dysfunction in children with DS
The reason is not known and is a common
therapeutic dilemma.
C Henk Konings, A S Paul van Trotsenburg. Plasma thyrotropin
bioactivity in Down's syndrome children with subclinical
hypothyroidism. European Journal of Endocrinology (2001) 144 1±4
14.
The proposed mechanisim :
could be due to the delayed maturation of the
hypothalamic pituitary axis which in turn
could be due to delayed switching over of the
somatomedines from the foetal to the adult
forms.
15.
It has been postulated that infants with
transient TSH elevation have a higher
incidence of congenital malformations than
infants with permanent CH
Oakley GA, Muir T. Increased incidence of congenital
malformations in children with transient thyroid-stimulating
hormone elevation on neonatal screening. J Pediatr 1998;132:726730.
16.
the most common cause of CH in DS is
thyroid dysgenesis.
Devos H, Rodd C, Gagne N, et al. A search for
the possible molecular mechanisms of thyroid
dysgenesis: sex ratios and associated
malformations. J Clin Endocrinol Metab
–
;
17.
The acquired form of hypothyroidism is
usually associated with thyroid antibodies of
different types and is more common in
children above 8 years.
Autoimmune thyroiditis leading to
hypothyroidism occurring in young children
with Down syndrome
B Karlsson, J Gustafsson,Thyroid dysfunction in
Down’s syndrome:
relation to age and thyroid autoimmunityArch Dis
Child 1998;79:242–245
18.
Down's syndrome has been linked with other
autoimmune disorders
ex. Alopecia areata and vitiligo ,Diabetes
mellitus, adrenal dysfunction, pernicious
anaemia with chronic active
hepatitis,haemolytic anaemia and gluten
enteropathy
It is thought to be due to a genetically
determined, organ specific defect in
suppressor T-lymphocytes.
19.
Thyroid antibodies are found in around 30%
of people with Down’s syndrome and have
been detected in children with the syndrome
as early as age 2 years.
The presence of antibodies does not
necessarily imply thyroid dysfunction but
should be taken as an indication to check
thyroxine levels frequently.
20.
For example, in the NHANES III study in the
US, 13% of the total population had thyroid
peroxidase, and 11.5% had thyroglobulin
antibodies; for the subset of 12–19 year olds
(children under 12 were not included), the
figures were 4.8% and 6.3%, with higher rates
of positivity in females than in males [31].
J. G. Hollowell, N.W. Staehling,W. D. Flanders, et al., “Serum
TSH, T, and thyroid antibodies in theUnited States population
(1988 to 1994): National Health and Nutrition Examination
Survey (NHANES III),” Journal of Clinical Endocrinology and
Metabolism, vol. 87, no. 2, pp. 489–499, 2002.
22.
Mitchell C (1994) recommended a schedule of
screening Down syndrome patients at 6
weeks 4, 10,16, 24 months and annually
thereafter.
Mitchell C, Blachford J, Carlyle JM.Arch
Pediatr Adolesc Med 1994;148: 441- 442.
23.
Tuyuz B et al (2001)22 suggested that Down
syndrome patients with normal thyroid
functions and those with compensated
hypothyroidism should be followed annually
and every 3 months.
Tuyuz B and Beker DB.. Thyroid dysfunction
in children Down Syndrome. Acta Pediatrica2001
24.
Gibson PA et al (2005) suggest initial testing
results could be used as a basis to select a
subgroup for further testing at say five yearly
intervals unless new symptoms emerge
Gibson PA, Newton RW. Longitudinal study of thyroid
function in Down's Syndrome in the first two decades.
Arch Dis Child. 2005 Jun;90(6):557-8.
25.
the American Academy of Paediatrics,
2001recommended yearly screening.
The incidence of medically treated thyroid
disease in children with Down syndrome in
the TennCare cohort from 1995 to 2005 was
10.8%.
A 73% increase in rate occurred following rerelease of American Academy of Pediatrics
guidelines.
.Kecia N. Carroll, MD, MPH1Increase in Incidence of MedicallyTreated Thyroid Disease in Children with Down Syndrome
Following Re-release of American Academy of Pediatrics Health
Supervision Guidelines. Pediatrics. 2008 August ; 122(2): e493–
e498. doi:10.1542/peds.2007-3252
28.
the treatment approach to persistent
compensated hypothyrodism is
controversial.
McDermott MT, Ridgway EC. Subclinical hypothyroidism is
mild thyroid failure and should be treated. J Clin Endocrinol
Metab 2001;86:4585-90.
Chu JW, Crapo LM. The treatment of subclinical
hypothyroidism is seldom necessary. J Clin
Endocrinol Metabolisim 2001
29.
especially in view of the fact that they do not
seem to be associated with abnormal
myocardial structure and function.
Toscano E, Pacileo G, Limongelli G, et al.
Subclinical hypothyroidism and Down’s
syndrome; studies on myocardial
structure and function. Arch Dis Child 2003
30.
van Trotsenburg et al demonstrated that LT4 replacement for the first two years of life
could improve psychomotor development and
growth in infants with DS
van Trotsenburg AS, Vulsma T. The effect of thyroxine treatment
started in the neonatal period on development and growth of twoyear-old Down syndrome children= a randomized clinical trial. J Clin
Endocrinol Metab 2005;90:3304-3311. Epub 2005 Mar 8
31.
that subclinical hypothyroidism and lownormal fT4 levels in patients with DS may
have significant clinical sequelae, such as
hypotonia and anemia,
Lebel EW, Tenenbaum A. Low-normal FT4 and subclinical
hypothyroidism may have a detrimental clinical effect in
Down syndrome. Horm Res Paediatr 2011;76(Suppl 2):46-47.
32.
Scottish Down Syndrome Thyroid Screening
Group recently suggested that most patients
with mildly elevated TSH levels (6-10 mU/L)
do not require treatment but only surveillance
initially.
McGowan S, Jones J,; Scottish Down Syndrome
Thyroid Screening Group. Capillary TSH screening
programme for Down’s syndrome in Scotland,
1997-2009. Arch Dis Child 2011;96:1113-1117. Epub
2011 Sep 30
33.
Some children with DS demonstrate a
persistently elevated TSH level for at least
several years without developing overt
hypothyroidism, whereas others revert to
normal.
The mean TSH level (45.6 ± 33.4 mU/L)
was statistically significantly higher
Dilek Sarici, Mustafa Ali Akin. Thyroid functions of neonates with
Down syndrome, Italian Journal of Pediatrics 2012, 38:44
34.
all patients with DS should be screened for
thyroid dysgenesis, and if present, lifelong
treatment with L-T4 should immediately be
started.
Ayşe Nurcan Cebeci, Ayla Güven, Metin Yıldız. Profile of
Hypothyroidism in Down’s Syndrome. J Clin Res Pediatr Endocrinol
2013;5(2):116-120
37.
Results Eighty-nine articles were retrieved
and reviewed for inclusion.
The guidelines on the medical management
of children with Down syndrome of five
expert groups have also been retrieved and
reviewed for this discussion.
38.
(1) whether subclinical hypothyroidism
requires treatment;
(2) at what TSH level treatment should be
commenced;
(3) the optimal frequency of monitoring TFTs
(4) whether treating subclinical
hypothyroidism has any benefits for growth,
puberty and intellectual development.
39.
Some recommend treatment with thyroxine
even in marginal cases of subclinical
hypothyroidism, to prevent progression to
more severe hypothyroidism.
Most authors who suggest treating
subclinical hypothyroidism suggest doing so
at TSH levels greater than 10 mU/L.
40.
Arguments in favour of treatment include the
lack of adverse side effects associated with
thyroxine treatment and the possible
beneficial effects on the growth and
development of the affected child
41.
Other found that TSH elevation was more
frequently associated with growth retardation
in those<4 years of age in comparison to
children with normal TSH levels.
42.
Suggests beginning a trial treatment of
thyroxine in symptomatic cases of subclinical
hypothyroidism or those with positive thyroid
peroxidase antibodies
43.
The 2001 Irish and 2001 UK guidelines both
recommend performing thyroid antibody
testing at each thyroid screen
The U.S. ,australian and Canadian guidelines
do not refer to thyroid antibody testing.
44.
45.
In conclusion, more evidence is required
regarding the optimal course of treatment for
subclinical hypothyroidism.
Such evidence may be best obtained by
conducting a prospective randomized control
trial.
47.
Clinical diagnosis unreliable
Biochemical screening protocols essential
– venous protocol at age 1 and 2 yearly for
life OR
– annual fingerprick screen if available
Young children may have transitory high
TSH without hypothyroidism
Thyroxine treatment only indicated if
hypothyroidism is biochemically confirmed
Treatment as for general population
48.
cost of a free T4 is $144, and the TSH test
costs $170;
thyroid hormone costs only $100–$200 per
year
49.
The normal TSH range is defined as range in
which 95% of values in healthy people fall;
thus about 2.5% of normal individuals will
have and maintain a TSH at or slightly above
the upper end of the normal range.
50.
Random TSH Variation.
TSH levels in healthy individuals tend to
fluctuate during the day as well as over
time. One study compared early morning
fasting and late morning TSH levels in
100 patients. In 97, TSH declined during
the morning, by a mean of 26%
51.
Non-Thyroidal Illness. A child with an active
or recent acute illness may have a transient
drop in thyroid hormone production. During
the recovery phase, a transient increase in
TSH is the normal mechanism for restoring
normal free T4 levels, and TSH will