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this presentation covers extensive pictures for clear explanation. this includes the anatomy & physiology of thyroid gland, a case review, types, clinical features and treatment of thyrotoxicosis. and the most intersting part it, it also includes Recent Advances in field of thyrotoxicosis
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this presentation covers extensive pictures for clear explanation. this includes the anatomy & physiology of thyroid gland, a case review, types, clinical features and treatment of thyrotoxicosis. and the most intersting part it, it also includes Recent Advances in field of thyrotoxicosis
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1. .
Common Thyroid Disorders in
Children
Dr Sarar Mohamed
FRCPCH (UK), MRCP (UK), CCST (Ire), CPT (Ire),
DCH (Ire), MD
Consultant Paediatric Endocrinologist & Metabolist
Assistant Professor of Pediatrics
King Saud University
5. THYROID GLAND
Location: Located close to thyroid cartilage. Has two lateral
lobes connected by thyroid isthmus medially.
Development: first endocrine gland to appear during
development. Develops from endodermal floor of early
pharynx
6. THYROID GLAND
Innervation: Vagus Nerve (X)
Arterial Supply: superior thyroid artery (branch of external carotid
artery).
Functions:
THYROXIN – regulate rate of metabolism
CALCITONIN – decreases levels of calcium and phosphate in the blood
(partially antagonistic to parathyroid hormone).
11. T4
T3
85% (peripheral conversion)
15%
Protein binding + 0.03% free T4
Protein binding + 0.3% free T3
(10-20x less than T4)
Normal Daily Thyroid Secretion Rate:
T4 = 100 ug/day
T3 = 6 ug/day
( ratio T4:T3 = 14:1 )
12. T4 T3
Potency 1 10
Protein Bound 10-20 1
Half-Life 5-7d < 24h
Secreted by
thyroid
100 ug/d 6 ug/d
15. Effects of thyroid hormones
• Fetal brain & skeletal maturation
• Increase in basal metabolic rate
• Inotropic & chronotropic effects on heart
• Stimulates gut motility
• Increase bone turnover
• Increase in serum glucose, decrease in
serum cholesterol
• Play role in thermal regulation
16. Dysfunction Thyroid Gland
1. Too little thyroxin – hypothyroidism
a. short stature (aquiered), developmental delay (congenital)
2. Too much thyroxin – hyperthyroidism
a. Agitation, irritability, & weight loss
22. Hashimoto’s Disease
• Most common cause of hypothyroidism
• Autoimmune lymphocytic thyroiditis
• Antithyroid antibodies:
• Thyroglobulin Ab
• Microsomal Ab
• TSH-R Ab (block)
• Females > Males
• Runs in Families!
23.
24. Subacute (de Quervain’s) Thyroiditis
• Preceding viral infection
• Infiltration of the gland with granulomas
• Painful goitre
• Hyperthyroid phase Hypothyroid phase
32. Newborn Screening
High TSH & Low T4
Management
Primary Congenital Hypothyroidism
Thyroxine
10 -15 ug/kg/day
12 -17 ug/kg/day
37.5 – 50 ug/day
Higher dose in
Severe cases
T4< 5ug/dl
Tablets
25-50-75 ug
Crush it, add to
5-10 cc water
Or milk
Normal T4
In 2 wks
(upper ½ of N)
Normal TSH
In one month
(lower ½ of N)
Dose Form Goals
39. Newborn Screening
Congenital Hypothyroidism
One of the most common Treatable causes of MR
CH Screening is the most cost effective program
Almost all affected NB have no S/S at birth
Congenital Anomalies increased by 10%(cardiac)
In more than 90% of the cases it is permanent
The earlier dx the better IQ
46. Newborn Screening
Method & Timing of Thyroid Screening
Primary-TSH
Backup-T4
Both
TSH&T4
Primary-T4
Backup-TSH
Cord
Blood
Venous
Blood
Age
At Birth
Age
2-5 days
52. Causes of hyperthroidism
• Graves Disease
• Overtreatment with thyroxine
• Thyroid adenoma (rare)
• Transient neonatal thyrotoxicosis
.
53. Graves’ Disease
• Most common cause of hyperthyroidism
• Goitre, proptosis
• TSH-R antibody (stimulating)
• 40-70% relapse after 2 years of treatment
54. Hyperthyroidism S&S
• Heat intolerance
• Hyperactivity, irritability
• Weight loss (normal to increased appetite)
• diarrhea
• Tremor, Palpitations
• Diaphoresis (sweating)
• Lid retraction & Lid Lag (thyroid stare)
• proptosis
• menstrual irregularity
• Goitre
• Tachcardia
55. Tremor of the hand
A Color Atlas of Endocrinology p49
