hypothyroidism

Hypothyroidism - a disease caused by a decrease in thyroid function.

Etiology, pathogenesis. Hypothyroidism may develop as a result of direct destruction gland (primary hypothyroidism), and as a result of impaired thyrotrophic regulatory function of the hypothalamic-pituitary axis (secondary hypothyroidism). Hypothyroidism can be congenital or acquired. For children more important primary congenital hypothyroidism - the result of violations of fetal development of the thyroid gland, or (rarely) a genetic defect in the synthesis of thyroid hormones (autosomal recessive inheritance). Decrease of thyroid function strongly affects the metabolism of proteins, carbohydrates and lipids. Reduced basal metabolic rate, the tone of the sympathetic nervous system, the fluid retained in the tissues, which in turn affects the functioning of all body systems. The most severe changes were observed on the part of the brain: reduction of its size and mass, degenerative changes in the blood vessels and nerve cells, delayed myelination conductive pathways, ultimately developing mental retardation.

The clinical picture. Children have the typical appearance: short stature, broad bridge of the nose, Greg syndrome (hypertelorism), enlarged tongue, thick lips, puffy face, dry skin, brittle hair hard, rough voice. The teeth erupt late, delayed closure of fontanelles, children long to keep your head, late start to sit, walk, talk, intelligence is reduced. If hypothyroidism developed in the age of 2-3 years, serious violations of intelligence there. The ECG bradycardia, slowing intraventricular conduction, low voltage peaks. Nephrocalcinosis phenomenon may be (due to lack of calcitonin), anemia.

Diagnosis is based on the history and clinical symptoms. To clarify the diagnosis determined thyroxine (E4-rate for children older than 2 months 50-140nmol / l) and triiodothyronine (Tg- 1,50-3,85 mmol / l). With hypothyroidism, their level is reduced in proportion to the severity of the disease, sharply increased the level of TSH.

The differential diagnosis is carried out with a delay of growth and dwarfism, encephalopathies, Down's syndrome, Chondrodystrophy, rickets, Hirschsprung's disease.

Treatment. Lifetime replacement therapy with thyroid medications (tireoidin, tireotom, thyroxine) with individual selection of doses until the first signs of overdose (tachycardia, anxiety, sweating, frequent urination). Thereafter, the dose was gradually reduced until the disappearance of the symptoms. Assign vitamins A, B12, glutamic acid, nutrition, medications nootropic number, LFK.

The prognosis of early treatment is favorable. In order to prevent a mass screening program offered to all newborns at T3 and TSH, and early use of thyroid hormones