hypothyroidism%20(pediatric)
HYPOTHYROIDISM (PEDIATRIC)
Hypothyroidism is due to decreased or absent production of thyroid hormone.
Primary hypothyroidism is caused by generalized tissue resistance to thyroid hormone and disorders that affect the thyroid gland directly. It is responsible for majority of hypothyroid cases.
Central hypothyroidism is caused by hypothalamic or pituitary disorders.

Principles of Therapy

  • Treatment should be started if obtained capillary thyroid stimulating hormone (TSH) concentration on neonatal screening is ≥40 mU/L & another venous blood sample has been obtained
  • Treatment may be delayed until thyroid function test results are available if the capillary TSH concentration is <40 mU/I
  • Patients w/ low venous free thyroxine (FT4) concentrations & venous thyroid stimulating hormone (TSH) concentration of >20 mU/L should receive treatment immediately
  • Transient hypothyroidism (eg subacute & drug-induced thyroiditis) should be treated during the hypothyroid phase
  • Newborns w/ elevated TSH should be treated empirically w/ thyroid hormone replacement until 2 years of age to avoid permanent cognitive deficits due to hypothyroidism
    • Treatment started w/in 2 weeks after birth increases better optimal long-term outcome

Treatment Goals

  • To restore a euthyroid state by normalizing the serum TSH
  • To improve the hypothyroid symptoms & decrease goiter size

Pharmacotherapy

Levothyroxine (T4)

  • Used as replacement therapy for hypothyroidism
  • Available in pure form, stable & inexpensive, w/ half-life of 7 days
  • Dose varies depending on the age, body weight, cardiac status, & disease severity
    • Neonates & children require larger replacement doses due to their rapid metabolism
    • Infants w/ very low total T4 or FT4 concentration prior to initiation of therapy should receive the highest initial dose
  • In most patients w/ hypothyroidism, treatment can be initiated w/ the full estimated dose requirement
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Joyce Lam Ching Mei, 28 Mar 2019
April 17 marks World Haemophilia Day, and this year’s theme is  “Reaching Out – The First Step to Care”. Adjunct Assoc Prof Joyce Lam Ching Mei, head of the Haematology Laboratory and Blood Bank and senior consultant from the Paediatric Haematology/Oncology Service at KK Women’s and Children’s Hospital, Singapore, speaks to Elaine Soliven on the importance of recognizing and managing bleeding disorders in primary care.
02 Apr 2019
Using preventive zinc and micronutrient powder supplementation does not appear to improve growth in children, a recent study has found.
Pearl Toh, 01 May 2019
Preterm infants with very low birth weight (VLBW) who were breastfed have significantly higher levels of metabolites important for brain growth and development in their brain tissue compared with formula-fed infants, suggesting that breastfed infants have improved cerebral metabolism at term-equivalent age, according to a study presented at the PAS 2019 Meeting.