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1.

Iodide trapping and synthesis Thyroglobulin


2. Organisation of trapped iodide as iodotyrosines
3. Coupling of the iodotyrosines to form the
iodotyronines thyroxine (T4) and triiodothyronine
(T3)
4. T3 and T4 is stored in follicular colloid
5. Endocytosis of colloid droplets and hydrolysis of
thyro-globulin to release T4 and T3
6. T3 and T4 are associated with plasma protein in
blood
( Thyroid-Binding Globulin/TBG )
7. T3 and T4 are free to implement their function, T4
is converted to T3
8. T3 and T4 have affinity in target cells

HYPOTHYROIDISM
DEFINITION :
A CONDITION THAT IS CAUSED BY EITHER
ABSOLUTE OR RELATIVE DECREASE OF
HORMONE T3 AND T4 WITH ITS
CONSEQUENCES, DUE TO IMPAIRED
THYROID GLAND FUNCTIONS

ETIOLOGY OF CONGENITAL HYPOTHYROIDISM

PRIMARY
HYPOTHYROIDISM
PERMANENT

1.Thyroid dysgenesis
- Aplasia
- Hypoplasia
- Ectopic thyroid
2.Dyshormogenesis
3.Maternal medica tion of radioiodine
4.Autoimmun thyroiditis

PRIMARY
HYPOTHYROIDISM
TRANSIENT

1.Maternal medication
- Goitrogen
- iodine containing
drugs
2.Using iodine for
antiseptic
3.Transplacental
passage of anti
thyroid from mother

SECONDARY
HYPOTHYROIDISM

Because of decreased
TSH as congenitall
midbrain development
defect, itself or with GH
and ACTH deficiency

AFTER 6-8 WEEKS SYMPTOMS CLEARER


LESSER
CRY

WEAKER

LOW DESIRE
TO DRINK

LOWER
MUSCULA
R TONE

MORE SLEEPS

DIFFICULT
BOWEL
ACTION

LATER
DEVELOPING & GROWING
OF IDIOT FACE, EDEMA,
LARGE TONGUE

DELAYS IN ABILITIES
TO SIT, STAND, WALK,
SPEAK, AND CONTACT
WITH OTHERS

INDEX OF NEONATAL HYPOTHYROIDISM


SCORE
FEEDING PROBLEM

CONSTIPATION

HYPOACTIVE

HYPOTONIA

HERNIA UMBILICALIS

LARGE TONGUE

SKIN MOTTLING

SKIN DRYNESS

1.5

OPEN POSTERIOR FONTARIELLE

1.5

CHARACTERISTIC FACE

TOTAL

13

ETIOLOGY OF
ACQUIRED HYPOTHYROIDISM
PRIMARY :
DUE TO
THYROIDECTOMY
IRRADIATION,
IODINE
RADIOACTIVE
AUTOIMMUNE
THYROIDITIS

SECONDARY :
TSH deficiency
(trauma,
tumor,infection)
Endemic iodine
deficiency
Goitrogen
Resistence to thyroid
hormones
Other causes :
chromosomal
disorders, cystinosis

SIGNS AND SYMPTOMS OF


ACQUIRED HYPOTHYROIDISM
SYMPTOMS :
GROWTH RETARDATION
EDAMATOUS FACE
LOW APETTITE
CONSTIPATION
SWOLLEN THYROID
GLAND
LETHARGY
REDUCING SCHOOLING
COLD INTOLERANCE
GALACTORE
MENORRHARGY

SIGNS :

US/LS RATIO
DELAYED DENTAL
ERUPTION
MYXEDEMA
GOITER
DELAYED REFLEX
FLAT FACIAL
EXPRESSION
FAINT, THICK, AND
COLD SKIN
MUSCULAR PSEUDOHYPERTROPHY
DELAYED PUBERTY
PRECOX PUBERTY

DIAGNOSIS
CLINICAL SYMPTOMS
LABORATORY EXAMINATIONS :
- ROUTINE
- TSH
- T3
- T4
SUPPORTIVE EXAMINATIONS :
- THYROID SCANNING
- BONE AGE

THE STEPS OF THYROID


FUNCTION EXAMINATION
HIGH
UNDETECTA
BLE

HYPERTHYROIDISM

FREE T4

NORMAL

HIGH
FREE T3

NORMAL
TSH

NORMAL

SUBCLINICAL
HYPERTHYROIDISM
EUTHYROIDISM

NORMAL
HIGH

T3 TOXICOSIS

SUBCLINICAL
HYPOTHYROIDISM

FREE T4
LOW

HYPOTHYROIDISM

TREATMENT
CONGENITAL
HYPOTHYROIDISM
- NEONATAL

ACQUIRED
HYPOTHYROIDISM
IN ACCORDANCE

SCRINNING TEST
- EARLIEST

NORMAL CHILD
GROWTH & DEVELOPMENT

TO THE ETIOLOGY

DOSES OF Na-L THYROXINE


SUGGESTED FOR
HYPOTHYROIDISM THERAPY

IMPLICATIONS DUE TO IODINE DEFICIENCY IN


CHILDREN
IODINE
DEFICIENCY
IODINE
DEFICIENCY RATE

GROWTH
PERIODE
FETUS

ABORTION
PERINATAL DEATH
CONGENITAL
DEFORMITIES

NEWBORN INFANT

THYROID GLAND
ENLARGEMENT

CHILD/ADOLES
CENCE

GOITER
HYPOTHYROIDISM

NEONATAL
HYPOTHYROIDISM

MOTOR FUNCTION
IMPAIRMENT

CRETINISM

PHYSICAL
GROWTH
IMPAIRMENT

NERVOSA
TYPE

MENTAL RETARDATION
DEAF & DUMB
IMPAIRED ABILITY IN WALK &
STEP

ENDEMIC
CRETINE

OTHER NERVE DISORDERS


MENTAL IMPAIRMENT

MYXEDEMA
TYPE

DUMB
NERVOUS IMPAIRMENT
HYPOTHYROIDISM

SEVERE
IODINE
DEFICIENCY

MYXEDEMA

SHORT STATURE

DELAYED PUBERTY

PREVENTION

Water and food


Iodisation
(SALT)

AND

Screening
Neonatal
Hypothyroid

TREATMENT

Na L
thyroxine

Iodine