The document discusses disorders of the thyroid gland, focusing particularly on congenital hypothyroidism, which is a deficiency of thyroid hormones present at birth, affecting approximately 1 in 400 newborns. It outlines the causes, classifications (primary, secondary, tertiary), clinical features, and diagnostic evaluations related to the condition, emphasizing symptoms such as dullness, feeding difficulties, and developmental delays. The management includes maintaining normal serum levels of T3 and T4 through the administration of synthetic levothyroxine.

1. DISORDERS OF THYROID GLAND
BY: Mr.Ganesh V. Naik
II year MSc(N)
Pediatric Dept
SDM Institute of
Nursing Science’s
Dharawad

2. THYROID GLAND
 It is located anteriorly in the neck below the cricoid
cartilage
 The thyroid gland consist of two lobes, joined by a
thin band called the isthmus
 The thyroid secretes two hormones
 Tri-iodothyronine(T3)
 Thyroxine(T4)
o Thyroid hormones are essential for normal growth
a CNS and metabolism of proteins, carbohydrates
and fats.

4. CONT..
 Hypothalamus secretes Thyrotropin releasing
hormone (TRH).
 TRH stimulates Anterior pituitary to secrete Thyroid
stimulating Hormone(TSH)
 TSH stimulates the thyroid gland to release T3 and
T4 Hormone.

5. HYPOTHYROIDISM

6. INTRODUCTION
 It is a condition of thyroid hormone deficiency
present at birth.
 Approximately 1 in 400 newborn infants has sever
deficiency of thyroid hormone
 If left untreated after birth, sever congenital
hypothyroidism can lead to growth failure, a
condition known as ‘Cretinism’

7. CLASSIFICATION
Depending on etiology
a)Primary Hypothyroidism
b)Secondary Hypothyroidism
c)Tertiary Hypothyroidism

8. A)PRIMARY HYPOTHYROIDISM
 Congenital
• Thyroid gland aplasia
• Inherited defect in thyroid hormone receptors
o Acquired
• Iodine deficiency
• Irradiation
• Autoimmune chronic lymphocytic thyroiditis
• Drug induced

9. B)SECONDARY HYPOTHYROIDISM
 Deficiency of TSH
 Hypopituitarism
c)Tertiary hypothyroidism
o Deficiency of TRH

10. PATHOPHYSIOLOGY
 Congenital hypothyroidism is most commonly
caused by developmental defect of thyroid gland
 At 8th week of gestation, the thyroid gland normally
occupies its permanent anatomic site and at term it
reaches maximum functioning
 Neonatal thyroid functioning is almost completelly
independent from that of mother

11. CONT…
 Hypothyroid fetus does not get maternal thyroid
hormones to meet its metabolic requirement
 The placenta doesnot allow passage of maternal
thyroid hormones
 As result baby of mother is born with
hypothyroidism and fetal goitre

12. CLINICAL FEATURES
 The clinical features appears first few weeks or
months of life
 Onset is gradual
 Patent fontanale and widely opened cranial sutures
 Prolonged physiologic jaundice due to delayed
maturation of glucoronide conjugation
 Birth weight is more than average
 Babies are dull, flaccid
 Pallor due to anemia
 Feeding difficulties
 Constipation

13. CONT…
Signs:
 Skin
• Yellow discoloration
• Skin is dry and cold
 Head and face
• Puffy face
• Swollen eyelids
• Open mouth with large protruding tongue
• Course brittle hair
• Neck is short
• Voice is hoarse

14. CONT…
 Trunk and extremities
• Retarded skeletal development and maturation
• Short stature
• Hands are broad and fingers are short
• Protruding abdomen
Vital signs
-Temperature is subnormal(decreased metabolic rate)
-Pulse is slow
-Dyspnea

15. CONT….
 Developmental assessment shows:
• Delayed physical and motor milestones
• Intellectual impairement

17. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Thyroid test :Serum T3 and T4 are low
Serum TSH and TRH are increased
 Thyroid scan done to detect structural abnormality
of gland

18. MANAGEMENT
Medical Management
Goal:
-To maintain circulating serum T3 and T4 level in
normal range and normalize the elevated TSH
level.
-Treatment :
 Daily dose of Thyroxin available
• Synthetic sodium levothyroxine for neonates the
dosage is 10-15mg/kg/day

19. NURSING DIAGNOSIS
 Activity intolerence related to fatigue
 Constipation related to depressed GI function
 Hypothermia related to slowed metabolic rate
 Knowledge deficiet related to disease condition

20. THANK YOU