Understanding Hypothyroidism in Young Children

Congenital hypothyroidism is caused by congenital defects of the child's thyroid gland or iodine deficiency in the mother's diet during pregnancy. The former is called sporadic hypothyroidism and the latter is called endemic hypothyroidism. Its main clinical manifestations are physical and intellectual developmental disorders. It is the most common endocrine disease in children. Today I will take you to learn about the disease of hypothyroidism in young children.

Etiology and pathogenesis

The main function of the thyroid gland is to synthesize thyroxine (T4) and triiodothyronine (T3). The main raw materials of thyroid hormones are iodine and tyrosine. After iodine ions are taken up into the thyroid epithelial cells, they combine with tyrosine through the action of a series of enzymes. The synthesis and release of thyroid hormone are controlled by thyrotropin-releasing hormone (TRH) secreted by the hypothalamus and thyroid-stimulating hormone (TSH) secreted by the pituitary gland. T4 in serum can reduce the responsiveness of the pituitary gland to TRH and reduce the secretion of TSH through negative feedback.

Thyroxine accelerates the intracellular oxidation process; promotes metabolism; promotes protein synthesis and increases enzyme activity; enhances the absorption and utilization of sugar; accelerates fat decomposition and oxidation; promotes the anabolism of calcium and phosphorus in bones; and promotes the growth and development of the central nervous system. Therefore, when the thyroid gland is under-functioning, it can cause metabolic disorders, poor physiological function, growth retardation, intellectual disability, etc.

The main cause of congenital hypothyroidism is thyroid dysplasia or underdevelopment, which may be related to the presence of immunoglobulins in the body that inhibit the growth of thyroid cells; the second is enzyme deficiency in the thyroxine synthesis pathway (an autosomal recessive genetic disease); rare cases are caused by thyroid-stimulating hormone deficiency and low thyroid or target organ response. Currently, the number of people suffering from hypothyroidism due to secondary infection is increasing.

【Clinical manifestations】

People with sporadic hypothyroidism are usually asymptomatic at birth because they are affected by the healthy mother's thyroid hormones in the womb. The early or late onset and severity of symptoms are related to the amount of thyroid tissue and the degree of hypofunction in the child. Children without thyroid tissue will develop symptoms within 1 to 3 months after birth. Those with a small amount of gland will develop symptoms after 6 months, and occasionally symptoms may not appear until 4 to 5 years old.

1. Neonatal period

Prolonged physiological jaundice is often the earliest symptom that appears in newborns, accompanied by abdominal distension, constipation, umbilical sign, slow reaction, feeding difficulty, low crying, etc.

2. Typical Cases

A special facial appearance and body shape appear, characterized by a big head, short neck, rough skin, pale complexion, sparse and dry hair, swollen eyelids, wide distance between eyes, a wide and flat nose, and a large and thick tongue that often sticks out of the mouth, forming a special facial appearance. The children are short in stature, with short limbs and long trunks, delayed closure of fontanelles and delayed tooth eruption. The nervous system is manifested by delayed motor development, low intellectual development, and dull facial expressions. Poor physiological function is manifested by poor spirit and appetite, drowsiness, less crying, less movement, low body temperature, slow pulse and breathing, low and dull heart sounds, abdominal distension, constipation, and delayed appearance of secondary sexual characteristics.

3. People with endemic hypothyroidism

Due to iodine deficiency in the fetal period, the fetus cannot synthesize sufficient thyroid hormones, which seriously affects the development of the central nervous system. There are two clinical manifestations. One is dominated by neurological symptoms, with ataxia, spastic paralysis, deafness and dumbness, and mental retardation, while other manifestations of hypothyroidism are not obvious. The other type is characterized by myxedema, with a distinctive facial and body appearance, intellectual disability and normal neurological examination.

Laboratory examination of hand and wrist X-rays showed delayed bone age. Serum cholesterol increases, serum protein-bound iodine decreases, serum T4 and T3 decrease, and TSH increases. Thyroid 131 iodine absorption rate measurement and radionuclide examination can also be performed.

【Treatment principles】

Regardless of the cause, lifelong treatment with prostate tablets is required to maintain normal physiological functions.

The initial dose should vary according to the severity of the disease and age, and the dose should be adjusted at any time as the child develops. The effectiveness of treatment depends on how early or late it is started.

【Common nursing diagnoses】

1. Hypothermia is associated with reduced metabolism and decreased activity.

2. Ineffective feeding

infantfeeding pattern) is associated with small food intake and slow swallowing.

3. Constipation is associated with decreased muscle tone, slower intestinal motility, and reduced activity.

4. Changes in growth and development are associated with hypothyroidism.

After reading the above article, I believe everyone should have a good understanding of this disease. Only by understanding the disease can we prevent and treat it. Children's health is originally poor, so parents should always pay attention to their children's health. If there is anything wrong, you should go to the hospital for diagnosis and treatment in time.