1. Iodide trapping and synthesis Thyroglobulin2. Organisation of trapped iodide as iodotyrosines3. 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 T36. 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 T38. T3 and T4 have affinity in target cells

HYPOTHYROIDISMHYPOTHYROIDISMDEFINITIONDEFINITION : :

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

ETIOLOGY OF CONGENITAL HYPOTHYROIDISM

PRIMARY HYPOTHYROIDISM

TRANSIENT

PRIMARY HYPOTHYROIDISM

PERMANENT

SECONDARYHYPOTHYROIDISM

1.Thyroid dysgenesis - Aplasia - Hypoplasia - Ectopic thyroid2.Dyshormogenesis3.Maternal medica - tion of radioiodine

4.Autoimmun thyroiditis

1.Maternal medication - Goitrogen - iodine containing drugs2.Using iodine for antiseptic3.Transplacental passage of anti thyroid from mother

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

AFTER 6-8 WEEKS SYMPTOMS CLEARER

WEAKER

LOW DESIRE TO DRINK

LESSER CRY

LOWER MUSCULAR 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 HYPOTHYROIDISMINDEX OF NEONATAL HYPOTHYROIDISMSCORE

FEEDING PROBLEM 1

CONSTIPATION 1

HYPOACTIVE 1

HYPOTONIA 1

HERNIA UMBILICALIS 1

LARGE TONGUE 1

“SKIN MOTTLING” 1

SKIN DRYNESS 1.5

“OPEN POSTERIOR FONTARIELLE” 1.5

CHARACTERISTIC FACE 3

TOTAL 13

ETIOLOGY OFETIOLOGY OF ACQUIRED HYPOTHYROIDISM ACQUIRED HYPOTHYROIDISM

PRIMARY :PRIMARY :DUE TO DUE TO THYROIDECTOMYTHYROIDECTOMY

IRRADIATION, IRRADIATION, IODINE IODINE RADIOACTIVERADIOACTIVE

AUTOIMMUNE AUTOIMMUNE THYROIDITISTHYROIDITIS

SECONDARY :SECONDARY :TSH deficiency TSH deficiency (trauma, (trauma, tumor,infection)tumor,infection)Endemic iodine Endemic iodine deficiencydeficiencyGoitrogenGoitrogenResistence to Resistence to thyroid hormonesthyroid hormonesOther causes : Other causes : chromosomal chromosomal disorders, cystinosisdisorders, cystinosis

SIGNS AND SYMPTOMS OF SIGNS AND SYMPTOMS OF ACQUIRED HYPOTHYROIDISMACQUIRED HYPOTHYROIDISM

SYMPTOMS :SYMPTOMS :GROWTH RETARDATIONGROWTH RETARDATION

EDAMATOUS FACEEDAMATOUS FACE

LOW APETTITELOW APETTITE

CONSTIPATIONCONSTIPATION

““SWOLLEN THYROID SWOLLEN THYROID GLAND”GLAND”

LETHARGYLETHARGY

REDUCING SCHOOLINGREDUCING SCHOOLING

COLD INTOLERANCE COLD INTOLERANCE

GALACTORE GALACTORE MENORRHARGYMENORRHARGY

SIGNSSIGNS : :US/LS RATIOUS/LS RATIODELAYED DENTAL DELAYED DENTAL ERUPTIONERUPTIONMYXEDEMAMYXEDEMAGOITERGOITERDELAYED REFLEXDELAYED REFLEXFLAT FACIAL FLAT FACIAL EXPRESSIONEXPRESSIONFAINT, THICK, AND FAINT, THICK, AND COLD SKINCOLD SKINMUSCULAR PSEUDO- MUSCULAR PSEUDO- HYPERTROPHYHYPERTROPHYDELAYED PUBERTYDELAYED PUBERTYPRECOX PUBERTYPRECOX PUBERTY

DIAGNOSISDIAGNOSISCLINICAL SYMPTOMSCLINICAL SYMPTOMS

LABORATORY EXAMINATIONSLABORATORY EXAMINATIONS : :

- ROUTINE- ROUTINE

- TSH- TSH

- T3- T3

- T4- T4

SUPPORTIVE EXAMINATIONSSUPPORTIVE EXAMINATIONS : :

- THYROID SCANNING- THYROID SCANNING

- BONE AGE- BONE AGE

THE STEPS OF THYROID THE STEPS OF THYROID FUNCTION EXAMINATIONFUNCTION EXAMINATION

HYPERTHYROIDISM

T3 TOXICOSIS

SUBCLINICAL HYPERTHYROIDISM

EUTHYROIDISM

SUBCLINICAL HYPOTHYROIDISM

HYPOTHYROIDISM

HIGH

HIGHFREE T4

FREE T3

NORMAL

NORMAL

UNDETECTAUNDETECTABLEBLE

NORMAL

HIGHFREE T4

NORMAL

LOW

TSH

TREATMENT

CONGENITAL HYPOTHYROIDISM

- NEONATAL

SCRINNING TEST

- EARLIEST

NORMAL CHILD

GROWTH & DEVELOPMENT

ACQUIRED HYPOTHYROIDISM

IN ACCORDANCE

TO THE ETIOLOGY

DOSES OF Na-L THYROXINE DOSES OF Na-L THYROXINE SUGGESTED FORSUGGESTED FOR

HYPOTHYROIDISM THERAPY HYPOTHYROIDISM THERAPYAGE Na-L (ug/kg)

0 – 3 MONTHS 8 – 10 0 – 6 MONTHS 7 - 10 6 –10 MONTHS 6 – 8 1 – 5 YEARS 4 – 6 6 – 12 YEARS 3 – 5 > 12 YEARS 3 - 4

IMPLICATIONS DUE TO IODINE DEFICIENCY IN IMPLICATIONS DUE TO IODINE DEFICIENCY IN CHILDRENCHILDREN

IODINE DEFICIENCY

GROWTH PERIODE

IODINE DEFICIENCY RATE

FETUS NEWBORN INFANTCHILD/ADOLESCENCE

ABORTION

PERINATAL DEATH

CONGENITAL DEFORMITIES

THYROID GLAND ENLARGEMENT

NEONATAL HYPOTHYROIDISM

CRETINISM

GOITER

HYPOTHYROIDISM

MOTOR FUNCTION IMPAIRMENT

PHYSICAL GROWTH IMPAIRMENT

MENTAL RETARDATION

DEAF & DUMB

IMPAIRED ABILITY IN WALK & STEP

OTHER NERVE DISORDERS

MENTAL IMPAIRMENT

DUMB

NERVOUS IMPAIRMENT

HYPOTHYROIDISM

MYXEDEMA

SHORT STATURE DELAYED PUBERTY

NERVOSA TYPE

MYXEDEMA TYPE

ENDEMIC CRETINE

SEVERE IODINE DEFICIENCY

PREVENTION TREATMENTAND

Water and food

Iodisation

(SALT)

Screening

Neonatal

Hypothyroid

Na – L

thyroxine

Iodine