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
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