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Congenital hypothyroidism in infants: symptoms, causes and treatment

Hypothyroidism in newborns is one of the types of pathologies of the thyroid gland. The main danger lies in its influence on the mental and physical development of the child, so it is very important to know which kids are at risk, as well as the main symptoms of the disease.

What it is?

Congenital hypothyroidism is an endocrine disease during which thyroid function decreases. Statistics says that for every 5,000 children, 1-2 children are born with this pathology. Accordingly, this disease is difficult to attribute to frequent, but every mother should be aware of it. Girls are predominantly diagnosed, although boys may be ill.

The thyroid gland is of great importance in the work of the whole organism, even if it is newly born. She is responsible for controlling and temperature metabolism, regulating fat, protein and carbohydrate balance, calcium metabolism and, most importantly, participating in the formation of intelligence.

When hypothyroidism is found in a newborn, the level of hormones sharply decreases, as a result of which the thyroid gland does not work at full strength, leading to unpleasant consequences.

The emergence of the disease can contribute to various reasons, as well as their combination. Among them are the following:

  • Heredity. Often, the baby is confronted with the disease precisely because of genetics - some genetic mutations influence the development of the disease, disrupting the activity of the thyroid gland at the stage of intrauterine development.
  • Hormonal disorders - in this case, the sensitivity of the gland cells to iodine is reduced, or iodine metabolism is disturbed.
  • Impairment of the hypothalamus is an important center of the nervous system responsible for the functioning of the thyroid, with any abnormalities and lesions affect the endocrine system, disrupting its work.
  • Decreased sensitivity to thyroid hormones - this is observed after taking a pregnant antithyroid drug. Such a need arises when the future mother is ill with some diagnoses, such as goiter
  • Iodine deficiency in pregnant women - usually women who live in large industrial cities face this phenomenon. If, for prophylactic purposes, the gynecologist prescribed an additional use of iodine, then there are reasons for this and you should not ignore the recommendations of the doctor.

Thus, absolutely healthy parents, in the family of which there were no problems with endocrinology, and during gestation, who are not confronted with violations, will most likely bring up a healthy baby. However, it is worth remembering that this pathology is acquired - that is, the born baby will be healthy, and in a few years he will have signs of the disease.

The presence of pathology, as a rule, is reported back in the maternity hospital, since its signs are quite pronounced. These include:

  • a large birth weight is 4 kg or more, in some cases 3.5 kg or more,
  • excessively swollen face and head,
  • the mouth is almost always open,
  • pronounced edema, resembling pads,
  • neonatal jaundice, not passing even after the procedures under the lamps and increasing the consumption of water and fluid to the baby,
  • cyanosis of the nasolabial triangle is observed,
  • the baby’s cry is unnaturally rude to a baby.

If in the first days the child’s condition is good, the above signs are not observed, you should pay attention to the first months of life. The disease is not for nothing called insidious, because it is not always manifested in the first days of life. Symptoms that should be addressed when the baby is 3-4 months old:

  • loss of appetite or a complete lack of interest in food and fluids, including breast milk,
  • weak sucking reflex,
  • umbilical hernia (not in all cases),
  • the edges of the eyelids seem unnaturally thick
  • long healing of the umbilical wound or late falling off of the cord of the umbilical cord,
  • lack of necessary reflexes,
  • fatigue, constant moods,
  • the child is freezing all the time
  • lag in height, weight and head volume norms,
  • weak pulse
  • low pressure,
  • constipation and frequent bloating,
  • dry skin, peeling,
  • paleness of the skin,
  • obesity,
  • an increase in face, tongue,
  • goiter - a disease of the thyroid gland.

Since the causes of the pathology are different, and the complications lead to serious disorders, the disease is tried, as soon as possible, to reveal, in order to begin appropriate therapy. For this reason, screening is conducted in the maternity hospital, on the basis of which a diagnosis is made or rejected. Sometimes transient hypothyroidism occurs in newborns, but, as a rule, this is a temporary phenomenon, and it passes on its own, without requiring treatment after removing the cause of its occurrence.

As soon as a diagnosis is made, the symptoms are evaluated and the patient’s condition is assessed, treatment is started. It consists of hormone replacement therapy. The thyroid gland is arranged in such a way that if it ceases to produce the necessary hormones, it is not possible to resume the natural process in most cases. Therefore, only the use of hormonal drugs in the dosage prescribed by the doctor can help the newborn.

Treatment is carried out throughout life - maintenance therapy requires constant monitoring, otherwise at any time another failure in the endocrine system and the body as a whole may occur. At the same time, a correctly calculated dosage of drugs will allow the child to calmly develop and learn on an equal footing with peers, keep up with his studies and be physically fit and strong.

It is necessary to pay attention to the immune system of children with hypothyroidism - due to the constant use of drugs, the body becomes easily susceptible to viral diseases. In the season of ARVI, antiviral drugs should be used in accordance with the recommendations of the attending physician.

A curative diet is important for patients with hypothyroidism, which is also observed throughout life. First of all, light carbohydrates are completely excluded from the daily diet - all kinds of buns, cakes, refined flakes, pads, etc.

High fat foods (butter, animal fats, pork, fatty fish, etc.) are also unacceptable. Also, the sick can not be abused salt and consume large amounts of water.

Young patients should be examined annually by an endocrinologist and tested for hormone levels. It is not uncommon when, after therapy and proper use of the diet, the hormones of the child reach the desired level. Doctors in this case reduce the dosage of hormone replacement drugs, and sometimes exclude them temporarily, while at the same time observing the patient. However, even in the case of a long absence of treatment and well-being, you still need to regularly monitor your baby’s blood and condition, as at any time the situation can return to its beginning.

Let's sum up

The causes of hypothyroidism are clear, the signs of it are also difficult not to notice, and this is a big plus - the sooner doctors diagnose and start treatment, the less the child will suffer. The disease is not fatal, taking control of its development and dynamics, you can perfectly live all your life, almost without prejudice to anything. Delay and carelessness are much more dangerous - the baby will live, but it will be difficult for him to develop and learn.

If at least some of the signs are found in a baby, it is necessary to seek advice from an endocrinologist and undergo an appropriate examination. In the future and in adult children, hypothyroidism may be observed, this is an acquired disease that occurs in most cases due to a lack of iodine intake.

The causes of the pathology

As mentioned above, the substances produced by the thyroid gland, play a huge role in the body.

And if we talk about a person who has just been born, thyroid hormones take part in such important processes as the formation of the central nervous system and musculoskeletal complex, the development of children's mental abilities, as well as in regulating the body temperature and participation in almost all metabolic processes.

Congenital hypothyroidism in children can be caused by a number of reasons.

The main ones are listed below:

  1. Hypothalamic-pituitary complex dysfunction. The main function of the hypothalamus is to control the work of all other organs of the endocrine system. Violation of its functions entails disruptions in the functioning of hormone-synthesizing objects, including the thyroid gland. Dysfunction of the pituitary gland leads to a slowdown of the metabolic processes in the body of a baby, which, in turn, leads to inhibition of its development. This type of hypothyroidism is called secondary, as the thyroid disease is a consequence of other pathological processes.
  2. Violation of the hormone-synthesizing function of the thyroid gland. It may occur when there is a lack of iodine in the body or when its digestibility is low with thyroid tissue.
  3. High resistance of body tissues to thyroid hormones. Such a state of immunity to thyroid hormones may appear as a result of a woman taking medications that inhibit thyroid function during the child's pregnancy.
  4. Heredity. Genetic predisposition to conditions that cause thyroid dysfunction may, even in the prenatal period, lead to its incorrect formation, which will cause the appearance of hypothyroidism.

Congenital hypothyroidism, symptoms

Congenital hypothyroidism in newborns is caused by a decrease in the production of thyroid hormones. Thyroid, is the generic name for iodine-containing hormones synthesized by the thyroid gland. These include tetraiodothyronine (T4), better known as thyroxin, and triiodothyronine (T3). With their lack of a baby there is a lag in both physical and mental development. For the most part, such negative changes in the condition of the infant become visible several months after birth. Although sometimes they may occur after only a few weeks. This can be seen in the photo, which depicts the sick children.

The most pronounced symptoms of congenital hypothyroidism in newborns include:

  • heavy weight (over 3.5 kg),
  • the bluish tint of the skin of the space above the upper lip,
  • appearance of edema on the face, hands, feet and upper back,
  • constantly open mouth
  • low and hoarse voice when crying
  • yellowish skin, not passing for 10 days or more.

If hypothyroidism occurs after the first trimester of life, its symptoms will include the following conditions:

  • dry and scaly skin,
  • brittle hair,
  • problems with the chair,
  • lack of appetite,
  • reduced temperature for a long time
  • late hardening of the crown.

One of the signs of congenital hypothyroidism in babies older than 4 months is rather late dentition, which is caused by a general lag in physical development.

As in the case of any disease, timely diagnosis and treatment, which is to compensate for the lack of thyroid hormones, significantly increase the chances for the further full development of the baby. Otherwise, the development of the hypothyroid state of the thyroid may cause the development of cretinism.

The main features of this extreme stage of congenital hypothyroidism are:

  • short stature
  • serious mental retardation
  • puffy face shape,
  • curvature of the bones of the head and limbs,
  • susceptibility to various chronic pathologies, as a result of reduced immunity.

Congenital hypothyroidism: diagnosis and treatment

Diagnostic procedures for the presence of HS in a newborn baby are mandatory in any hospital.

These include:

  1. Neonatal screening. It may also be called “screening of newborns” and consists in the study of the content of thyroid-stimulating hormone (TSH) in the blood of infants. Blood is taken from the baby’s heel on the 4th day from birth.
  2. Apgar Scale. This diagnostic procedure consists in assessing the health status of the baby according to several criteria, each of which is assigned a certain score. If you exceed the total number of points mark "5" we can talk about the possible development of congenital hypothyroidism. These criteria include heart rate, respiration rate, muscle state (tone), state of reflexes, and skin condition.

As mentioned above, the earlier the disease was detected, the greater the chance of successful treatment. It is desirable that this happens in the first month after birth.

The dosage of the drug is calculated, taking into account the individual parameters of the infant: its weight, height, age, hormones, and so on. This type of treatment is aimed at bringing the state of thyroid hormones back to normal, which, in turn, is the key to the normalization of metabolic processes in the body.

The most common drug, which also has the greatest efficiency, is "L-thyroxin." It is based on a synthetic analogue of thyroid hormone thyroxine (T4), Levothyroxine sodium, which is closest to the “original”. It is perfectly absorbed by the body and, if necessary, is converted into triiodothyronine (T3), which participates in metabolic processes. Properly chosen treatment leads to the restoration of hormonal balance and will allow to keep the concentration of hormones at an optimal level afterwards.

Prevention of congenital hypothyroidism

All preventive measures relate to future parents of an unborn baby. The first concerns the future mom while carrying the child. It consists in taking drugs on the basis of iodine, since it is the lack of this trace element in the mother's body that becomes the most frequent cause of hypothyroidism in the newborn. The second applies to both parents. Within its framework, you need to consult a specialist genetics. This is especially true if there are people with thyroid disease in their families.

But even if it takes place, do not despair and put an end to the normal life of the baby. Timely diagnosis and treatment will be able to give him the opportunity to fully develop, in nothing, practically, not yielding to his peers. Therefore, at the first signs of this pathology, you should immediately consult with a specialist endocrinologist.

Hypothyroidism in children

Hypothyroidism in children is a pathological condition characterized by complete or partial insufficiency of thyroid hormones: thyroxine (T4), triiodothyronine (T3) and thyrocalcitonin. In the first weeks of intrauterine development, maternal thyroid hormones act on the embryo, but by 10-12 weeks, the own thyroid gland begins to function in the fetus. The production of thyroid hormones occurs in the cells of the gland - thyrocytes, which are able to actively capture and accumulate free iodine from the blood plasma. Thyroid hormones play an extremely important role for the normal harmonious development of the child, especially in the antenatal and first weeks of the postnatal period. Thyroid hormones regulate the processes of embryogenesis: the differentiation of bone tissue, the formation and functioning of the hematopoietic, respiratory and immune systems, the maturation of brain structures, including the cerebral cortex.

Deficiency of thyroid hormones in children causes more severe consequences than in adults, and the younger the child, the more dangerous is hypothyroidism for his health and life. Hypothyroidism in children leads to a delay in physical and mental development (growth, puberty, intelligence), disruption of all types of basic metabolism (proteins, fats, carbohydrates, calcium) and thermoregulation processes.

Classification of hypothyroidism in children

Hypothyroidism in children can be congenital or acquired. In congenital hypothyroidism, children are born with thyroid insufficiency. The frequency of congenital hypothyroidism, according to pediatric endocrinology, is approximately 1 case per 4–5 thousand newborns (among girls 2 times higher than among boys).

According to the severity of manifestations of hypothyroidism in children can be transient (transient), subclinical, manifest. Depending on the level of thyroid hormone disruption, primary (thyrogenic), secondary (pituitary) and tertiary (hypothalamic) hypothyroidism in children is isolated.

Causes of hypothyroidism in children

Hypothyroidism in children develops with various disorders in the work of the hypothalamic-pituitary-thyroid system. In 10–20% of cases, genetic abnormalities may occur when children are inherited from parents by mutant genes, but in most cases the disease is random.

Primarily, children experience primary hypothyroidism associated with the pathology of the thyroid gland itself.A common cause of hypothyroidism in children are thyroid gland malformations, manifested by aplasia (absence), hypoplasia (hypoplasia), or dystopia (displacement) of the organ. Adverse environmental factors (radiation, iodine deficiency in food), intrauterine infections, pregnant women taking certain medications (thyrostatics, tranquilizers, bromides, lithium salts), the presence of autoimmune thyroiditis, endemic goiter can provoke damage to the fetal thyroid gland. In 10-15% of cases, hypothyroidism in children is associated with impaired synthesis of thyroid hormones, their metabolism, or damage to the tissue receptors responsible for the sensitivity of tissues to their action.

Secondary and tertiary hypothyroidism in children may be due to a congenital anomaly of the pituitary and / or hypothalamus or a genetic defect in the synthesis of TSH and thyroliberin, which regulate the secretion of thyroid hormones. Acquired hypothyroidism in children can occur if the pituitary or thyroid gland is damaged due to a tumor or inflammatory process, trauma or surgery, or with endemic iodine deficiency.

Symptoms of hypothyroidism in children

Hypothyroidism in newborns has minor clinical manifestations, which include late delivery (40–42 weeks), large weight of the child (over 3.5–4 kg), swelling of the face, eyelids, tongue (macroglossia), fingers and toes , intermittent and heavy breathing, low, rough crying. Newborns with hypothyroidism may experience prolonged jaundice, late healing of the umbilical wound, umbilical hernia, weak sucking reflex.

Symptoms of hypothyroidism increase gradually and become apparent as the child develops, they are less noticeable during breastfeeding due to compensation by maternal thyroid hormones. Already in infancy in children with hypothyroidism, signs of delayed somatic and psychomotor development are observed: general lethargy, drowsiness, muscular hypotonia, lethargy and hypodynamia, height and weight retardation, increase in size and late closing of the fontanel, delay in teething, lack of shape of skills (hold head, roll , sit, stand).

In hypothyroidism, children develop bradypsychia - indifference to the world around them with scant emotional and vocal reactions: the child does not walk, does not pronounce individual syllables, does not play independently, does not make contact well. There are signs of damage to the heart muscle, reduced immunity, pallor and dry skin, brittle hair, low body temperature, anemia, and constipation.

The severity of symptoms of congenital hypothyroidism in children depends on the etiology and severity of the disease. The danger of a pronounced lack of thyroid hormones in the early stages of intrauterine development consists in an irreversible disruption of the development of the child's CNS, leading to dementia and cretinism with severe mental retardation, skeletal deformity, dwarfism, mental impairment, hearing and speech (up to deafness), insufficient development.

In mild form, the signs of hypothyroidism in children in the neonatal period can be erased and manifest later, at the age of 2-6 years, sometimes in puberty. If hypothyroidism occurs in children over the age of 2 years, it does not cause serious impairment of mental development. In older children and adolescents, hypothyroidism can be accompanied by weight gain, obesity, stunted growth and puberty, deterioration of mood, delayed thinking, decrease in school performance.

Diagnosis of hypothyroidism in children

In order to detect primary congenital hypothyroidism in pediatrics, a compulsory screening of newborns is carried out (4-5 days after birth) with the determination of the level of TSH in serum as an indicator of the hormone-producing function of the thyroid gland. The diagnosis of hypothyroidism is confirmed at elevated levels of TSH in children.

For the differential diagnosis of types of congenital hypothyroidism in children, the levels of total and free T4, T3, thyroglobulin and antithyroid antibodies, the index of thyroid hormone binding are additionally determined, the test with thyroliberin is performed.

Further examination of hypothyroidism in children may include ultrasound and review of the thyroid gland scintigraphy, which allows to detect anatomical disorders of the organ (underdevelopment, deformation or displacement), reducing its functional activity. Determination of bone age using radiography of the knee joints and tubular bones of a child reveals impaired skeletal development in hypothyroidism.

Treatment of hypothyroidism in children

Treatment of congenital hypothyroidism in children should be started as soon as possible after the diagnosis has been established (no later than 1-2 weeks after birth) in order to prevent serious violations of the child’s psychosomatic development.

In most cases, congenital and acquired hypothyroidism in children requires lifelong replacement therapy with a synthetic analogue of the thyroid hormone, levothyroxine sodium. The drug is prescribed in the initial dose of 10-15 mg / kg of body weight per day under regular dynamic control of the child's condition and biochemical parameters for the selection of the optimal dose of the drug. Additionally shown are vitamins (A, B12), nootropic drugs (hopantenic acid, piracetam), good nutrition, massage, exercise therapy.

In subclinical hypothyroidism in children, treatment may not be necessary, in which case constant medical supervision is indicated. With the development of cretinism, complete cure is not possible, taking levothyroxine sodium somewhat improves the course of the disease.

Prognosis and prevention of hypothyroidism in children

The prognosis of hypothyroidism in children depends on the form of the disease, the age of the child, the time to start treatment, and the correct dose of levothyroxine. As a rule, with timely treatment of hypothyroidism in children, the condition is quickly compensated, and in the future normal indicators of physical and mental development are observed.

The absence or late initiation of treatment for hypothyroidism leads to profound and irreversible changes in the body and disability of children.

Children with hypothyroidism should always be under the supervision of a pediatrician, pediatric endocrinologist, pediatric neurologist with regular monitoring of thyroid status.

Prevention of hypothyroidism in children consists of sufficient iodine intake by the pregnant woman with food or in the form of medicines, especially in the regions of iodine deficiency, early detection of thyroid hormone deficiency in future mothers and newborns.

We treat hypothyroidism in infants: causes, symptoms, types and treatment of hypothyroidism in infants

Diseases of the thyroid gland, which manifested themselves in the neonatal period, require immediate medical intervention.

Such a dysfunction of the endocrine system, like hypothyroidism in infants, is explained by multiple factors, including hereditary ones.

Sometimes signs are not noticeable, however, an examination for the development of this pathology is necessarily performed on the 3-5th day after birth.

Clinical guidelines and hypothyroidism in children

During the development of the fetus in utero up to 10 weeks, the role of the thyroid gland in a child is played by the mother's body. After this time, the iron in the infant begins to work independently.

Often at this stage malformations appear, therefore hormonal dysfunction occurs, there is no release of the hormones thyroxine, tridothyronine, or they function poorly.

These components are responsible for the correct development of infants in the neonatal period.

The photo shows the obvious symptoms of hypothyroidism in infants.

Thanks to the correct functioning of the thyroid gland, the baby’s bone marrow stabilizes, the hematopoietic system improves, and the formation of internal organs ends.

If the symptoms of hypothyroidism did not manifest themselves in infancy, then the endocrine disease can manifest itself after two or three years or in adolescence, because of which sexual function is impaired.

Hypothyroidism in infants is often clearly visible by 3-6 months of life.

They say children! Grandma bring retirement home. The daughter approaches the postman and says:
- You would come to us more often and bring more money.

Disease classification: transient and subclinical hypothyroidism

Children's hypothyroidism can be distinguished in several ways: primary, secondary, congenital and acquired. Also, the disease is divided by severity: mild, moderate and severe.

  1. Primary hypothyroidism in infants can be congenital and acquired. It manifests itself due to a malformation of the thyroid gland in the 9th week of pregnancy. Also a negative factor is iodine deficiency for the normal formation of the fetus.
  2. Secondary hypothyroidism is accompanied by a decrease in the amount of hormones entering the blood. Begins to progress with injuries or tumors.
  3. The subclinical type of the disease is detected when thyroxin remains normal in the infant’s blood, however, an increase in TSH is noticeable.
  4. Transient hypothyroidism in a newborn is detected after conducting a diagnostic study in a maternity hospital, that is, based on the results of neonatal screening.

Congenital hypothyroidism (ICD code) 10 in children is of particular concern, since in this case several types of endocrine pathologies develop. Depending on the intensity of the symptoms, it is customary to divide these diseases according to their severity, and further treatment depends on this.

We recommend to watch the video, which tells about the features of the course of children's hypothyroidism. It also discusses topical treatments.

Hypothyroidism: symptoms in children under one year old with a photo

The malfunction of the endocrine system in a baby, namely hypothyroidism, is characterized by the following features:

If a newborn has a big belly - this is a reason to turn to an endocrinologist, since hypothyroidism may develop in infants

  • sullen face for several months of life
  • apathy, lack of interest in others,
  • long course of jaundice,
  • obesity in infants
  • later - the closing of the fontanelle and the absence of some acquired reflexes, weak innate reflexes,
  • after a year teething begins,
  • the neck increases, the belly becomes big,
  • obstruction of the stomach, puffy eyes.

In addition, the baby is not only lagging behind in growth, it is gaining weight incorrectly, in addition, it is physically and emotionally lagging behind in development. Look at the photo how babies with symptoms of congenital hypothyroidism look.

Moms note! Symptoms of hypothyroidism in infants may be poorly expressed or, conversely, increase. It depends on how abnormal the formation of the thyroid gland in a child is in the uterus. The more severe the form of the disease, the more difficult it is to study its cause.

Causes of endocrine disorders in infants

Hypothyroidism in infants is often acquired. It may be caused by gene mutation, incorrect production of thyroid hormones, iodine deficiency during breastfeeding.

The result of thyroid dysfunction in infants is often neck injuries obtained during childbirth, such as torticollis, infection, inflammation, autoimmune diseases, and concomitant endocrine pathologies in a child.

Hypothyroidism in infants is accompanied by swelling of the neck

Hypothyroidism treatment in infants with drugs and folk remedies

One of the methods that accurately determines the disease is considered to be a neonatal screening, which is a blood test taken from the baby’s heels on the 3-5th day of its life. The sooner such a procedure is carried out, the sooner with a positive result treatment will begin.

On a note! The first signs of thyroid dysfunction can be determined by a specialist. The younger the crumb, the higher the risk of complications on the body of the baby: developmental retardation, obesity, apathy.

During treatment, any stage of hypothyroidism in infants used hormonal agents. There is an opinion that it is possible to get rid of the symptoms without hormones, using only traditional medicine. However, the use of medication in therapy is considered an essential step in treatment.

For stopping the disease, babies are assigned thyroid of animal origin by injection, Tirecomb intramuscularly, Endonorm, analogues of the hormone thyroxine injections or through a catheter.

All preparations and dosage are indicated by a specialist, observing the condition of the baby during the whole treatment.

They say children! Finally, in November, a lot of snow fell. Tanya looks out the window:
- Oooh! How many winter s are!

Supplement drug therapy with a vitamin complex with iodine components.

Surgical intervention is performed in case of progression of the tumor process, otherwise this method is not effective in treatment.

In order to maintain the health of the baby during the treatment, it is important for the mother to exclude harmful foods when breastfeeding, and if the baby is fed artificially, it will be necessary to select a special adapted mixture.

Well help to cope with the symptoms of hypothyroidism in children under one year old folk remedies.

  1. Take 1 lemon and grate it with the zest. Add 1 tbsp. a spoonful of honey and mix the ingredients well. Give the mixture to the baby for several months once a day in a ¼ tsp. Remember that honey is an allergen, so before using this tool, consult a pediatrician.
  2. Take a red paprika 1 tsp, add 1 tsp. seaweed and 1 tbsp. l lungfish Ingredients are poured boiling water and left to cool. This means otpaivat baby 1/3 tsp. twice a day.
  3. You can treat with herbs, making decoctions of chamomile, succession, sage, St. John's wort in the standard way.

Do not forget to consult with your doctor about the use of traditional medicine recipes, a specialist must approve such treatment.

Complications of hypothyroidism in children

The consequences of childhood hypothyroidism are practically not encountered if therapy is started promptly and correctly. But delayed attention to the symptoms of thyroid problems leads to the backwardness of the baby in the overall development, as a result - life-threatening hormone preparations are possible.

Any type of hypothyroidism in infants brings unpleasant complications.

To prevent such developmental defects in infants, one should lead a correct lifestyle during pregnancy, especially in the initial periods. You have to balance your diet. And if the mother or father had this pathology before, the born baby is recorded at risk and put on record at the endocrinologist.

At the end of the article, watch the video that experts think about hypothyroidism of the thyroid gland in children and how to distinguish these manifestations from other endocrine pathologies.

Congenital hypothyroidism in children under one year old: symptoms in newborns and treatment

Congenital hypothyroidism is an endocrine disease that is increasingly common in newborns. With this disease, the thyroid gland does not produce sufficient thyroid hormones, which greatly inhibits the normal development of all organs and systems.

In the absence of proper treatment, the nervous system suffers first of all, which has a negative effect on mental development. Favorable predictions regarding this issue can be started only after a month has passed since the start of therapy. That is why the problem of early detection of the disease is particularly acute.

In the first months of life, the infant develops rapidly, while hypothyroidism in the child significantly inhibits this process.

Epidemiology of the disease

Congenital hypothyroidism in Europeans occurs in about one newborn for four or five thousand children, in Asians - less often, one person from six to seven thousand suffers from the disease. For representatives of the Negroid race, this disease is almost not typical.

By gender, the disease is more characteristic of girls than boys, for every male member suffering from hypothyroidism, there are two female representatives.

The causes of the disease

Since the function of the thyroid gland cannot decrease on its own, various causes of hypothyroidism in children are highlighted:

  • If the child was still in the womb at the time of the appearance of irregularities in the development and subsequent work of the thyroid gland, then we can say that the ailment is hereditary. This condition is quite dangerous, since the mother's body produces thyroid hormones only in the first weeks of pregnancy, after this period the developing thyroid gland in the fetus begins to work independently, helping organs and their systems to develop properly. Severe hormone deficiencies can lead to serious physical and mental abnormalities, and congenital hypothyroidism is guaranteed in newborns.
  • При невосприимчивости самой щитовидной железы к йоду, получаемому с пищей, вещества, необходимые для выработки тиреоидных гормонов, перестают поступать в орган, что неизбежно приводит к возникновению болезни.
  • При наличии эндокринных заболеваний, поражающих гипофиз и гипоталамус, нарушается нормальная регулировка секреции гормонов в организме, что становится причиной нарушения выработки гормонов щитовидной железы.
  • If the mother during pregnancy took drugs that reduce the concentration of thyroid hormones, it can lead to immunity of the body to thyroid hormones.

The concept of congenital hypothyroidism

Under congenital hypothyroidism means a disease associated with impaired functioning of the thyroid gland in newborns. It is two or two and a half times more often observed in girls than in boys. Statistics show that the disease is detected in 1-2 children out of 5,000 born.

Why is the thyroid gland so necessary for the proper, timely development of the baby? It is an organ of the endocrine system that performs the following functions in humans:

  • regulation of metabolism: fat, carbohydrates, proteins, and calcium,
  • body temperature control
  • contributes to the formation of intelligence in the child.

From birth, the thyroid gland has been directly involved, the main role in the growth and development of the baby’s body, especially of the bones and the formation of the nervous system.

One of the tasks performed by the thyroid gland is the production of two types of hormones: thyroxine, triiodothyronine.

Lack of these substances can significantly affect both physical and mental development of the person, inhibit mental processes, the growth of the child.

Congenital hypothyroidism in children occurs for a variety of reasons, the main of which are:

  • Heredity. Mainly due to genetic mutations, even when the child is in utero, the formation and functioning of the thyroid gland are disrupted.
  • Incorrect formation, production of thyroid hormones, for example, due to deterioration, slowing down of iodine metabolism.
  • Affection of the center of the nervous system, which is responsible for the functioning of the thyroid gland, which can cause serious disturbances in the endocrine system.
  • The susceptibility to thyroid hormones worsens.

Congenital hypothyroidism mainly manifests itself in infants not immediately, but several months later. Only in a countable number of children can the disease be detected in the first days, weeks of life.

The most vivid symptoms of the disease are: swelling of the face, heavy weight (more than three and a half kilograms), cyanosis in the nose, lips (cyanosis), puffiness in the supraclavicular fossae, half-open mouth, coarseness of voice, jaundice, prolonged for several weeks.

Later, at three, four months of age, congenital hypothyroidism is expressed as a deterioration in appetite, hair breakage, constipation, a decrease in body temperature, dryness, and peeling of the skin. Then, as a child grows up, physical, mental retardation in development is added to them.

Thanks to modern medicine, a comprehensive examination of infants, the detection of congenital hypothyroidism allows you to immediately take up his treatment, at first help the baby to develop along with other children, his peers.

Ignoring the disease subsequently negatively affects children, leads to cretinism, when they have face deformation, curvature of the legs, arms, much lower growth, susceptibility to chronic diseases, they stop developing intellectually.

Levothyroxine Dosing

An infant in the first few weeks after birth, as a rule, is prescribed an initial dose in an amount of from 12.5 to 50 µg / day per one square meter of body surface, and a supporting dose - from 100 to 150 µg / day.

Until six months, newborns give from 8 to 10 mg / day. counting on one kilogram of weight, from six months to a year - from 6 to 8 mg / day. per 1 kg of weight, from year to five years - 5-6 µg / day. per 1 kg of weight, children from 6 to 12 years old are prescribed, as a rule, 4-5 mcg / day. per 1 kg of weight.

Prescribe treatment to newborns with congenital hypothyroidism can only the appropriate specialist - a doctor endocrinologist. Together with the endocrinologist, pediatricians and neuropathologists should also monitor the course of treatment, changes in the condition of children.

With timely detection of problems, detection of congenital hypothyroidism, the implementation of the recommendations of doctors, proper treatment, the child will not differ from his peers in development, growth, and intellectual abilities.

Congenital hypothyroidism - symptoms in children and methods of treatment

Congenital hypothyroidism is one of the common pathologies of the thyroid gland in children.

It represents the consequences of intrauterinely formed functional insufficiency of this organ, the manifestations of which appear after the birth of a child.

The disease occurs with a frequency of 1 case per 4500 babies and is characterized by a partial or absolute deficiency of thyroid hormones.

As a result, all organs and systems suffer, mainly the central nervous system, which is manifested by a delay in intellectual development. Early diagnosis and timely hormone replacement therapy VG provide a favorable prognosis for the mental development of the baby.

The dependence of the prevalence of HS on the sex and race of children was revealed.

Pathology is almost three times more common in newborn girls than in male infants.

In Latin American countries, VH is recorded much more frequently (1 case per 2000 births) than in European countries.

Much less often, the disease is recorded in Japanese babies (in 1 newborn out of 7,000), and it is extremely rare in infants of the negroid group (in 1 case out of 30,000 observations).

What is congenital hypothyroidism?

Pathology is a complex of laboratory and objective symptoms of thyroid insufficiency that is present after the birth of a child.

Typical signs of VH are slower metabolism, delayed psychophysical development and myxedema.

Congenital hypothyroidism refers to diseases detected by mass screening of newborns.

This allows you to timely identify the pathology in 100% of cases and immediately begin treatment, preventing the development of the child’s intellectual inferiority. For the first time the mass diagnosis of VH started in 1971 in Canada. Currently, the technique of neonatal screening of VG is a routine type of screening in developed countries, including Russia.

The essence of the diagnosis of VG is to determine the level of thyroid hormones of the thyroid gland and thyroid-stimulating hormone produced by the pituitary gland. Since the screening of both parameters is quite costly, in most countries only the level of TSH (thyroid stimulating hormone) is determined, which rises in 90% of the most common varieties of SH.

All newborns with a high level of TSH are subsequently subject to a detailed in-depth examination in order to make a more accurate diagnosis. This algorithm allows you to begin an effective treatment of congenital hypothyroidism in the first three weeks after birth.

Causes of the problem

The views of medicine on the etiology of VG have undergone significant changes due to the emergence of modern genetic engineering methods.

Today, the heterogeneous nature of this disease is generally recognized, which can be based on the immaturity of the brain and thyroid structures, as well as their damage during fetal development.

Most cases of VH are caused by intrauterine development and formation of the thyroid gland, of which 15% of observations are associated with a genetic predisposition, and in 85% of the pathology is of a primary (sporadic) nature.

Thyroid dysgenesis options can be different - from the complete absence of an organ to hypoplasia (underdevelopment) or, most often, ectopia (unnatural location of the gland tissues).

In addition, violations of the hormone synthesis process in the fetal thyroid gland associated with defects in receptors, transport systems, or enzymes often become the cause of primary VG.

As you know, the endocrine system of the unborn child is formed regardless of the mother’s body, and normally by the 12th week a small amount of thyroid-stimulating hormone of the pituitary gland (TSH) is produced - a regulator of thyroid function.

In the case of enzymatic disorders, the level of TSH is substantially exceeded.

Some cases of VH are secondary. This condition occurs against the background of the pathology of the pituitary and hypothalamus, leading to a deficiency in the production of one or all hormones (panhypopituitarism).

The cause of transient (transient) hypothyroidism in newborns in some cases is the use of antithyroid drugs by a pregnant woman.

Congenital hypothyroidism - symptoms in newborns

A typical complex of clinical manifestations is observed only in 10-15% of newborns and infants. It includes the following criteria, noted in the early neonatal period:

  • giving birth in a gestation period over 40 weeks
  • signs of immaturity of the newborn,
  • prolonged jaundice
  • low tone of voice
  • overweight (4000 g or more)
  • later discharge of meconium masses,
  • swelling of facial tissues
  • wide tongue
  • swelling of hands and feet,
  • delayed epithelialization of the navel.

In cases where the child reaches 3-4 months of age without treatment, other characteristic symptoms of SH occur:

  • dry skin
  • dull color, brittle hair,
  • regular constipation
  • flatulence,
  • reduced appetite
  • lag of weight gain,
  • difficulty swallowing,
  • reduced temperature
  • decreased muscle tone
  • hyporeflexia.

In the second half of the year, the child develops a psychomotor retardation syndrome, growth rates slow down, and body proportions become pathological.

Typical signs of VH at this age are lagging development of the facial skull, wide sunken nose, delay in closing the fontanel, and also wide-set eyes.

The terms of teething in such babies are shifted to a later period, the same happens when changing milk teeth to permanent ones.

When examining young patients with HB, attention is drawn to:

  • rough, hoarse oh timbre,
  • signs of chondrodystrophy,
  • dysplasia in the hip joints,
  • increase in heart size,
  • hypotension,
  • heart rate reduction,
  • cyanosis of the nasolabial region,
  • stridorosis (difficulty) breathing.

In adverse cases, in the absence of adequate treatment, signs of oligophrenia develop.

Diagnosis of congenital hypothyroidism in newborns

A great deal of help in the diagnosis of VH is provided by the collection of anamnesis from the mother, which reveals the burdened heredity and harmful factors accompanying pregnancy or childbirth (past diseases, eating disorders, birth injuries, asphyxia). Early screening for VH is based on the Apgar scale for typical symptoms (skin condition, muscle tone, gender, jaundice duration, etc.). An Apgar score of over 5 points suggests VG.

In general laboratory tests, there are signs of anemia, increased cholesterol and lipoproteins.

With the help of specific tests determine the content of thyroid hormones, the level of which may be reduced or increased depending on the form of VG.

These analyzes act as neonatal screening.

Blood sampling during diagnostic screening for VG is performed by percutaneous puncture (in the heel area) in the period of 4-5 days after birth in full-term and 10-14 days in premature babies. During the study, a special filter paper is soaked with blood in a volume of 5-8 ml.

Additional diagnostic methods include:

  • X-ray of the extremities (to assess zones of ossification, epiphyseal dysgenesis),
  • electrocardiography (detecting extended QRS interval and reduced amplitude of teeth),
  • Thyroid ultrasound (to determine the degree of underdevelopment or ectopic organ)
  • CT scan (MRI) of the pituitary gland,
  • molecular genetic studies.

Treatment of the disease

Treatment starts immediately after the diagnosis of congenital hypothyroidism.

In addition, replacement therapy is indicated in doubtful cases to prevent possible complications.

The drug of choice is levothyroxine sodium identical to the natural human hormones.

He has the ability to potentiate in the body in the form of "depot" with the subsequent expenditure in accordance with the needs of the body. This helps to maintain normal levels of hormones in the blood and to prevent fluctuations and peak concentrations.

Replacement therapy for SH continues throughout the life of the patient. The daily dose of the drug is taken once before breakfast, and in young children it is dissolved in portions of the morning feeding.

Congenital hypothyroidism | Please

in children under one year: symptoms in newborns and treatment

Congenital hypothyroidism is an endocrine disease that is increasingly common in newborns. With this disease, the thyroid gland does not produce sufficient thyroid hormones, which greatly inhibits the normal development of all organs and systems.

In the absence of proper treatment, the nervous system suffers first of all, which has a negative effect on mental development. Favorable predictions regarding this issue can be started only after a month has passed since the start of therapy. That is why the problem of early detection of the disease is particularly acute.

In the first months of life, the infant develops rapidly, while hypothyroidism in the child significantly inhibits this process.

Epidemiology of the disease

Congenital hypothyroidism in Europeans occurs in about one newborn for four or five thousand children, in Asians - less often, one person from six to seven thousand suffers from the disease. For representatives of the Negroid race, this disease is almost not typical.

By gender, the disease is more characteristic of girls than boys, for every hypothyroid male representative there are two female representatives.

The causes of the disease

Since the function of the thyroid gland cannot decrease on its own, various causes of hypothyroidism in children are highlighted:

  • If the child was still in the womb at the time of the appearance of irregularities in the development and subsequent work of the thyroid gland, then we can say that the disease is hereditary. This condition is quite dangerous, since the mother's body produces thyroid hormones only in the first weeks of pregnancy, after this period the developing thyroid gland in the fetus begins to work independently, helping the organs and their systems to develop properly. Severe hormone deficiencies can lead to serious physical and mental abnormalities, and congenital hypothyroidism is guaranteed in newborns.
  • With the immunity of the thyroid gland itself to iodine, obtained from food, the substances necessary for the production of thyroid hormones cease to enter the body, which inevitably leads to the occurrence of the disease.
  • In the presence of endocrine diseases affecting the pituitary and hypothalamus, the normal regulation of the secretion of hormones in the body is disrupted, which causes a violation of thyroid hormone production.
  • If the mother during pregnancy took drugs that reduce the concentration of thyroid hormones, it can lead to immunity of the body to thyroid hormones.

Classification

Children's hypothyroidism is divided into two main groups:

  • Congenital hypothyroidism, which appeared in the womb - after birth, the baby has a serious lack of thyroid hormones, as a result of which the child lags behind in development and requires immediate treatment.
  • Acquired hypothyroidism in children may develop due to a lack of iodine, previous operations on the thyroid gland, thyroiditis, exposure to certain medications.

By severity of the disease is divided into:

  • The transient, which is detected during the first examination - the level of thyroid-stimulating hormone is increased, and the concentration of thyroid hormones is lowered. Usually, at the beginning of timely treatment, this condition quickly passes.
  • Subclinical, in which the thyroid gland is already affected, but no obvious symptoms have yet been observed. The disease can only be diagnosed with a blood test.
  • When manifest there is a deficiency of thyroid hormones on the background of increasing levels of thyroid-stimulating hormone. The disease is accompanied by all the symptoms, which are quite pronounced.

If we consider the disease in terms of the level of violation of the secretion of the hormone, we can distinguish:

  • Primary, or thyroid, the cause of which is a pathology of the thyroid gland, in which it begins to release much less hormones than necessary. This is the most common type of hypothyroidism found in children.
  • Secondary, or pituitary. The pituitary gland and the thyroid gland are inextricably linked, so the pathology of the pituitary gland will inevitably lead to impaired thyroid hormone production. This type of disease is quite rare.
  • Tertiary, or hypothalamic. In this case, the cause of the disease is a violation of the activity of the hypothalamus.

During development inside the womb of the mother, the fetus receives the necessary amount of hormones from the mother, they are sufficient for the normal growth of all tissues and organs.

If, for some reason, when the maternal body stops supplying thyroid hormones to the fetus, its thyroid gland is unable to provide the body with vital matter, the cerebral cortex does not fully develop, which can cause mental retardation and cretinism .

At birth, the level of thyroid hormones in the body drops sharply, which only aggravates the situation. Often, underdevelopment and congenital hypothyroidism are the reason why parents decide to take it to an orphanage or a specialized boarding school, but in fact the treatment started in time helps to cope with the problem.

Parents of children under the age of one year must be competent in issues of hypothyroidism in children, the symptoms of which at this age differ from the manifestations of the disease in adults. Symptoms of hypothyroidism in children are as follows:

  • At birth, the child has a rather large weight, more than four kilograms, there is swelling of the face and eyelids, crying hoarse and rough, heavy breathing. These are the main signs that allow to suspect hypothyroidism in newborns before the first screening.
  • Jaundice does not stop for a long time, the sucking reflex is very weakly expressed. Umbilical wound does not heal.
  • The child does not gain weight for a long time, growth is much less than necessary.
  • For a long time, the baby does not hold his head, cannot sit, the basic skills remain unformed.
  • The patient does not show interest in the world, does not want to communicate, does not make typical sounds for babies, does not play and does not contact with other people, characteristic of sudden mood swings and capriciousness.
  • Immunity is not developed, the body is prone to frequent infectious diseases.

Timely diagnosis of congenital hypothyroidism, whose symptoms are quite clearly visible in the first months of a child’s life, helps to prescribe the correct treatment that will save a little person.

Diagnostics

On the fourth or fifth day of life, the newborn is necessarily sent for screening, in which the amount of thyroid-stimulating hormone in the blood is determined, even if there is no suspicion of the presence of congenital hypothyroidism in children.

With an increased concentration of this substance, the child is sent for further examinations to rule out the possibility of congenital hypothyroidism. This produces ultrasound and scintigraphy of the thyroid gland, which detect pathology in the shape, size and location of the organ.

Differential diagnosis of hypothyroidism in children is based on laboratory indications, according to the results obtained, the type of hypothyroidism to which a person suffers is determined:

  • Primary form: the TSH level is above normal, the concentration of thyroid hormones is below normal,
  • Secondary and tertiary form: TSH decreased or normal, thyroid hormones lowered.

Treatment of hypothyroidism in children must begin in the first weeks of life, immediately after a diagnosis is made, since a delay in this matter may cause irreversible changes in the children's body. In hypothyroidism in children, treatment consists of taking synthetic analogues of substances produced by the thyroid gland.

In addition, vitamin supplements, nootropics are additionally prescribed, proper nutrition and massage and physical therapy sessions are required. Often, in case of congenital hypothyroidism, mental retardation develops, if it is present, a cure is no longer possible, hormone therapy can only slightly improve the patient's condition.

An endocrinologist is one who knows all about the symptoms and treatment, he should carefully monitor the children and immediately appoint medical examinations for suspected congenital hypothyroidism.

If we start treatment in time, the symptoms quickly disappear, and the child begins to grow normally without mental and physical retardation. In hypothyroidism, a favorable outcome is possible only with constant observation, when every manifestation of the disease is recorded and treated.

The child should eat well, exercise, exercise, and spend the summer away from the hot sun, which can provoke an exacerbation of the disease.

Congenital hypothyroidism

In the modern world, medicine pays close attention to childbirth. Doctors seek to identify all abnormalities and defects in a child at the earliest gestational age, immediately after birth.

Among the many congenital diseases observed in children, hypothyroidism is considered to be very dangerous and serious. It is characterized by impaired functioning of the thyroid gland, a decrease in the amount of its hormones in the blood. Hypothyroidism in newborns can occur due to many reasons.

His diagnosis is carried out while he and his mother are in the maternity hospital, on the third or fourth day after birth.

The main symptoms of the disease: slow development, both in physical and mental direction, teething much later than usual in children, increased dryness of the skin. Treatment in infants of congenital hypothyroidism is carried out with the help of drugs that replace thyroid hormones.

Timely intervention, identifying health problems and taking the necessary measures gives children a chance to grow and develop along with their peers, to be no worse, no more stupid, no less than others.

If you don’t attach importance to the disease, in the future there may be defects in the child’s skeleton, problems with the nervous system appear.

The concept of congenital hypothyroidism

Under congenital hypothyroidism means a disease associated with impaired functioning of the thyroid gland in newborns. It is two or two and a half times more often observed in girls than in boys. Statistics show that the disease is detected in 1-2 children out of 5,000 born.

Why is the thyroid gland so necessary for the proper, timely development of the baby? It is an organ of the endocrine system that performs the following functions in humans:

  • regulation of metabolism: fat, carbohydrates, proteins, and calcium,
  • body temperature control
  • contributes to the formation of intelligence in the child.

From birth, the thyroid gland has been directly involved, the main role in the growth and development of the baby’s body, especially of the bones and the formation of the nervous system.

One of the tasks performed by the thyroid gland is the production of two types of hormones: thyroxine, triiodothyronine.

Lack of these substances can significantly affect both physical and mental development of the person, inhibit mental processes, the growth of the child.

Congenital hypothyroidism in children occurs for a variety of reasons, the main of which are:

  • Heredity. Mainly due to genetic mutations, even when the child is in utero, the formation and functioning of the thyroid gland are disrupted.
  • Incorrect formation, production of thyroid hormones, for example, due to deterioration, slowing down of iodine metabolism.
  • Affection of the center of the nervous system, which is responsible for the functioning of the thyroid gland, which can cause serious disturbances in the endocrine system.
  • The susceptibility to thyroid hormones worsens.

Congenital hypothyroidism mainly manifests itself in infants not immediately, but several months later. Only in a countable number of children can the disease be detected in the first days, weeks of life.

The most vivid symptoms of the disease are: swelling of the face, heavy weight (more than three and a half kilograms), cyanosis in the nose, lips (cyanosis), puffiness in the supraclavicular fossae, half-open mouth, coarseness of voice, jaundice, prolonged for several weeks.

Later, at three, four months of age, congenital hypothyroidism is expressed as a deterioration in appetite, hair breakage, constipation, a decrease in body temperature, dryness, and peeling of the skin. Then, as a child grows up, physical, mental retardation in development is added to them.

Thanks to modern medicine, a comprehensive examination of infants, the detection of congenital hypothyroidism allows you to immediately take up his treatment, at first help the baby to develop along with other children, his peers.

Ignoring the disease subsequently negatively affects children, leads to cretinism, when they have face deformation, curvature of the legs, arms, much lower growth, susceptibility to chronic diseases, they stop developing intellectually.

Diagnostics

In newborns, the diagnosis of congenital hypothyroidism is performed using a specially developed Apgar scale, which indicates the most common symptoms, reflects their importance in points:

  • constipation - 2 points
  • umbilical hernia - 2 points,
  • swelling of the face - 2 points,
  • pallor - 1 point
  • a large weight (over 3.5 kg) - 1 point,
  • muscle weakness - 1 point,
  • prolonged jaundice (more than 3 weeks) - 1 point,
  • big language - 1 point
  • open rear fontanel - 1 point,
  • the duration of pregnancy is more than 40 weeks - 1 point.

It is possible to suspect congenital hypothyroidism, if during the examination it is gained more than five points.

In order to accurately determine whether the baby is sick or not, on the third or fourth day of stay in the hospital, blood is drawn from his heel. The result of the analysis becomes known several weeks later after blood collection.

The level of thyroid stimulating hormone reveals the presence or absence of congenital hypothyroidism. If the concentration of TSH is more than 50 mU / l - this is already a cause for concern.

Parents are informed about the disease if the suspicion is confirmed.

If the congenital hypothyroidism in the baby is confirmed, it is necessary to begin treatment without delay.

The slightest delay, ignoring can have the most dire consequences, have a negative impact on his mental and physical development.

Procedures carried out in a timely manner will have a beneficial effect on the child, he will not differ in anything from other children, will also be active, smart, and intelligent.

As a rule, the main form of treatment of newborns for this disease is replacement therapy with levothyroxine sodium.

It has a positive effect on the growth of the body and the formation of necessary substances, when used in small dosages, the average dose of the drug can improve metabolism, increase the tissue's need for oxygen, contribute to the rapid, timely development of the baby and the growth of his body. Improvements after the use of this drug become noticeable after a week and a half.

The main feature of levothyroxine, its advantage over other drugs is its chemical composition with thyroxin. Infants are often advised to give the medicine when they are fed in the morning, older children are advised by experts to use levothyroxine in the morning, one hour before meals, with a small amount of liquid washed down with it.

Positive dynamics in a child can be determined by the following indicators, criteria:

  • Normalization in the blood of the required level of thyroid stimulating hormone.
  • The concentration of thyroxine meets the standards. Before the child’s year, the level of the substance is determined every two to three months, and subsequently every three to four months.
  • Good bone growth, skeleton.
  • Positive, corresponding to the dynamics of intellectual development.
  • Positive, corresponding to the dynamics of physical development.

Normalization in the blood of children of thyroxine occurs within ten to fourteen days after the start of treatment, and thyroid-stimulating hormone within two to three weeks. The dosage is assigned to each newborn strictly individually, based on its condition, analyzes, clinical data, laboratory tests. Levothyroxine tablets are found in different dosages, 25.50 and 100 μg each.

Levothyroxine Dosing

An infant in the first few weeks after birth, as a rule, is prescribed an initial dose in an amount of from 12.5 to 50 µg / day per one square meter of body surface, and a supporting dose - from 100 to 150 µg / day.

Until six months, newborns give from 8 to 10 mg / day. counting on one kilogram of weight, from six months to a year - from 6 to 8 mg / day. per 1 kg of weight, from year to five years - 5-6 µg / day. per 1 kg of weight, children from 6 to 12 years old are prescribed, as a rule, 4-5 mcg / day. per 1 kg of weight.

Prescribe treatment to newborns with congenital hypothyroidism can only the appropriate specialist - a doctor endocrinologist. Together with the endocrinologist, pediatricians and neuropathologists should also monitor the course of treatment, changes in the condition of children.

With timely detection of problems, detection of congenital hypothyroidism, the implementation of the recommendations of doctors, proper treatment, the child will not differ from his peers in development, growth, and intellectual abilities.

Congenital hypothyroidism - symptoms in children and methods of treatment

Congenital hypothyroidism is one of the common pathologies of the thyroid gland in children.

It represents the consequences of intrauterinely formed functional insufficiency of this organ, the manifestations of which appear after the birth of a child.

The disease occurs with a frequency of 1 case per 4500 babies and is characterized by a partial or absolute deficiency of thyroid hormones.

As a result, all organs and systems suffer, mainly the central nervous system, which is manifested by a delay in intellectual development. Early diagnosis and timely hormone replacement therapy VG provide a favorable prognosis for the mental development of the baby.

The dependence of the prevalence of HS on the sex and race of children was revealed.

Pathology is almost three times more common in newborn girls than in male infants.

In Latin American countries, VH is recorded much more frequently (1 case per 2000 births) than in European countries.

Much less often, the disease is recorded in Japanese babies (in 1 newborn out of 7,000), and it is extremely rare in infants of the negroid group (in 1 case out of 30,000 observations).

What is congenital hypothyroidism?

Pathology is a complex of laboratory and objective symptoms of thyroid insufficiency that is present after the birth of a child.

Typical signs of VH are slower metabolism, delayed psychophysical development and myxedema.

Congenital hypothyroidism refers to diseases detected by mass screening of newborns.

This allows you to timely identify the pathology in 100% of cases and immediately begin treatment, preventing the development of the child’s intellectual inferiority. For the first time the mass diagnosis of VH started in 1971 in Canada. Currently, the technique of neonatal screening of VG is a routine type of screening in developed countries, including Russia.

The essence of the diagnosis of VG is to determine the level of thyroid hormones of the thyroid gland and thyroid-stimulating hormone produced by the pituitary gland. Since the screening of both parameters is quite costly, in most countries only the level of TSH (thyroid stimulating hormone) is determined, which rises in 90% of the most common varieties of SH.

All newborns with a high level of TSH are subsequently subject to a detailed in-depth examination in order to make a more accurate diagnosis. This algorithm allows you to begin an effective treatment of congenital hypothyroidism in the first three weeks after birth.

Causes of the problem

The views of medicine on the etiology of VG have undergone significant changes due to the emergence of modern genetic engineering methods.

Today, the heterogeneous nature of this disease is generally recognized, which can be based on the immaturity of the brain and thyroid structures, as well as their damage during fetal development.

Most cases of VH are caused by intrauterine development and formation of the thyroid gland, of which 15% of observations are associated with a genetic predisposition, and in 85% of the pathology is of a primary (sporadic) nature.

Thyroid dysgenesis options can be different - from the complete absence of an organ to hypoplasia (underdevelopment) or, most often, ectopia (unnatural location of the gland tissues).

In addition, violations of the hormone synthesis process in the fetal thyroid gland associated with defects in receptors, transport systems, or enzymes often become the cause of primary VG.

As you know, the endocrine system of the unborn child is formed regardless of the mother’s body, and normally by the 12th week a small amount of thyroid-stimulating hormone of the pituitary gland (TSH) is produced - a regulator of thyroid function.

In the case of enzymatic disorders, the level of TSH is substantially exceeded.

Some cases of VH are secondary. This condition occurs against the background of the pathology of the pituitary and hypothalamus, leading to a deficiency in the production of one or all hormones (panhypopituitarism).

The cause of transient (transient) hypothyroidism in newborns in some cases is the use of antithyroid drugs by a pregnant woman.

Congenital hypothyroidism - symptoms in newborns

A typical complex of clinical manifestations is observed only in 10-15% of newborns and infants. It includes the following criteria, noted in the early neonatal period:

  • giving birth in a gestation period over 40 weeks
  • signs of immaturity of the newborn,
  • prolonged jaundice
  • low tone of voice
  • overweight (4000 g or more)
  • later discharge of meconium masses,
  • swelling of facial tissues
  • wide tongue
  • swelling of hands and feet,
  • delayed epithelialization of the navel.

In cases where the child reaches 3-4 months of age without treatment, other characteristic symptoms of SH occur:

  • dry skin
  • dull color, brittle hair,
  • regular constipation
  • flatulence,
  • reduced appetite
  • lag of weight gain,
  • difficulty swallowing,
  • reduced temperature
  • decreased muscle tone
  • hyporeflexia.

In the second half of the year, the child develops a psychomotor retardation syndrome, growth rates slow down, and body proportions become pathological.

Typical signs of VH at this age are lagging development of the facial skull, wide sunken nose, delay in closing the fontanel, and also wide-set eyes.

The terms of teething in such babies are shifted to a later period, the same happens when changing milk teeth to permanent ones.

When examining young patients with HB, attention is drawn to:

  • rough, hoarse oh timbre,
  • signs of chondrodystrophy,
  • dysplasia in the hip joints,
  • increase in heart size,
  • hypotension,
  • heart rate reduction,
  • cyanosis of the nasolabial region,
  • stridorosis (difficulty) breathing.

In adverse cases, in the absence of adequate treatment, signs of oligophrenia develop.

Diagnosis of congenital hypothyroidism in newborns

A great deal of help in the diagnosis of VH is provided by the collection of anamnesis from the mother, which reveals the burdened heredity and harmful factors accompanying pregnancy or childbirth (past diseases, eating disorders, birth injuries, asphyxia). Early screening for VH is based on the Apgar scale for typical symptoms (skin condition, muscle tone, gender, jaundice duration, etc.). An Apgar score of over 5 points suggests VG.

In general laboratory tests, there are signs of anemia, increased cholesterol and lipoproteins.

With the help of specific tests determine the content of thyroid hormones, the level of which may be reduced or increased depending on the form of VG.

These analyzes act as neonatal screening.

Blood sampling during diagnostic screening for VG is performed by percutaneous puncture (in the heel area) in the period of 4-5 days after birth in full-term and 10-14 days in premature babies. During the study, a special filter paper is soaked with blood in a volume of 5-8 ml.

Additional diagnostic methods include:

  • X-ray of the extremities (to assess zones of ossification, epiphyseal dysgenesis),
  • electrocardiography (detecting extended QRS interval and reduced amplitude of teeth),
  • Thyroid ultrasound (to determine the degree of underdevelopment or ectopic organ)
  • CT scan (MRI) of the pituitary gland,
  • molecular genetic studies.

Treatment of the disease

Treatment starts immediately after the diagnosis of congenital hypothyroidism.

In addition, replacement therapy is indicated in doubtful cases to prevent possible complications.

The drug of choice is levothyroxine sodium identical to the natural human hormones.

He has the ability to potentiate in the body in the form of "depot" with the subsequent expenditure in accordance with the needs of the body. This helps to maintain normal levels of hormones in the blood and to prevent fluctuations and peak concentrations.

Replacement therapy for SH continues throughout the life of the patient. The daily dose of the drug is taken once before breakfast, and in young children it is dissolved in portions of the morning feeding.

Prevention

Preventive measures for VH are reduced to the physiological management of pregnancy and childbirth and antenatal protection of the fetus.

A rational diet is needed, including enough iodine-containing foods.

In order to identify hidden risk factors for congenital thyroid pathology, when planning a future pregnancy, medical genetic counseling is used.

Congenital hypothyroidism | Please

Congenital hypothyroidism - a condition in which, for various reasons, the thyroid gland cannot perform its functions from birth.

It is noteworthy because with timely detection and proper treatment, instead of a severely disabled person, a perfectly healthy person will grow from a child with congenital hypothyroidism.

Thyroid function

  • Regulation of the rate of metabolic processes in the body.
  • Regulation of growth and development.
  • Participation in providing the body with energy.
  • Accelerating the oxidation of nutrients.
  • Strengthening of heat exchange processes.

  • Activation of the activity of certain endocrine glands (eg, sex glands, adrenal glands).
  • Stimulation of the nervous system.

    When violations at any of the stages of the synthesis of thyroid hormones, it ceases to perform these functions, and hypothyroidism develops.

    Causes of Congenital Hypothyroidism

    The causes leading to congenital hypothyroidism are very diverse, but in general they come down either to hereditary pathology, or to spontaneous genetic mutations, or to the effect on the mother of factors that cause a disruption in the development of the child during the prenatal period.

    These factors include:

    • toxic lesions (effects of alcohol, nicotine, toxic chemicals, etc.),
    • mother taking some medications
    • infections,
    • radiation exposure,
    • living in a dysfunctional iodine region.

    Can mother hypothyroidism cause congenital hypothyroidism in a child?

    First of all, it must be remembered that hypothyroidism is not a specific disease, but a condition that is caused by completely different causes.

    In older children, adolescents and adults, most often in girls and women, the main cause of hypothyroidism is autoimmune thyroiditis. This disease is caused by an autoimmune inflammation of the thyroid gland.

    It destroys the structure of its cells, and they can not perform their functions to produce hormones.

    Autoimmune thyroiditis itself is not transmitted to a newborn baby, but an uncompensated hypothyroid state in the mother slightly increases the likelihood of congenital hypothyroidism in the infant.

    In regions deficient in iodine, women often have such a condition as latent hypothyroidism caused by a constant lack of iodine in food. This is reflected in the child’s condition in the same way - it slightly increases the likelihood of hypothyroidism in the child, but does not directly lead to it.

    There are single inherited diseases and mutations that can be transmitted from parents to children through genes. This happens extremely rarely, usually in parents with slightly pronounced hypothyroidism.

    In the overwhelming majority of cases (85-90%), the appearance of hypothyroidism in a newborn child is unpredictable and is due to random, newly emerged mutations.

    Congenital hypothyroidism: symptoms in newborns

    Only 10–20% of children with congenital hypothyroidism have at the time of birth any of its manifestations:

    • Prolonged pregnancy (birth after 41 weeks).
    • Large mass at birth (3500 grams or more).
    • Puffiness, puffiness first of all of face, lips and eyelids.
    • Swelling of the hands, stop.
    • Big tongue, half open mouth.
    • Rough voice, hoarseness when crying.
    • Protracted jaundice.

    Symptoms of congenital hypothyroidism in infants

    The remaining newborns, despite the hidden development of the disease, look perfectly healthy, until the gradual appearance of the following symptoms began:

    • Decreased appetite, low weight gain.
    • Constipation, flatulence (flatulence).
    • Dry and flaky skin.
    • Hypotension (decreased muscle tone).
    • Difficulty breathing.
    • The delay in teething, closing the fontan.
    • From about the fifth to the sixth month of life one can notice a lag in physical and mental development.

    Further, the developmental delay and changes in the work of the heart, which are seen during the examination of the doctor and on the ECG, are getting worse and are coming to the fore.

    There are children who have a congenital dysfunction of the thyroid gland is not complete, but partial. Then a certain amount of hormones needed by the body is still produced, and mental retardation and other symptoms will not be expressed.

    Definition and causes of hypothyroidism in children

    A disease in which thyroid function is reduced and an insufficient amount of hormones is produced to keep the body healthy is called hypothyroidism. Children of all ages are subject to it, starting with the period of intrauterine development. According to medical statistics, among newborn babies, one in 5,000 children has congenital hypothyroidism. In this case, girls are 2 times more likely to suffer from pathology.

    Congenital form

    Depending on the type of disease, the causes of its occurrence vary. Background of congenital hypothyroidism (VG):

    • genetics, heredity,
    • thyroid mutations - underdevelopment, unnatural location, complete absence of an organ,
    • failures of the thyroid gland, its resistance to iodine absorption,
    • mother’s residence in an environmentally unfriendly region with a high level of radiation contamination,
    • overdose and abuse of medications by a pregnant woman, if she has a thyroid disease,
    • serious disorders in the hypothalamic-pituitary system,
    • diseases of the infectious nature of the mother or fetus.

    Purchased form

    Causes of the acquired form of the disease, the risk of which exists for a child at any age:

    • neck injuries
    • the absence or lack of a diet of foods containing iodine,
    • effects of thyroid surgery,
    • tumors, inflammations or injuries anywhere on the hypothalamus-pituitary-thyroid gland,
    • autoimmune diseases that caused the body to malfunction.

    Classification of pathology in children

    The causes of hypothyroidism entail differences in the form, specificity and clinical manifestations of the disease. In addition to disorders of the thyroid gland, hypothyroidism develops with pathologies or diseases of the hypothalamus and pituitary, susceptibility of tissues to the effects of hormones.

    In medical practice, the following classification of pathology is adopted (see the table of hypothyroidism classification in children):

    Newborn babies

    From the moment the child is born, it is not always possible to suspect hypothyroidism in him. The most striking manifestations that give rise to an urgent blood test of a newborn will be:

    • weight exceeding 4 kg,
    • postmaturity of the baby, its appearance after 42 weeks,
    • cyanosis of the nose and lips,
    • coarseness of voice
    • the absence of the first cry,
    • open mouth
    • severe swelling of the face
    • seals in the form of mounds in the supraclavicular grooves,
    • lack of ability to maintain a stable body temperature in a comfortable environment,
    • preservation of the yellowness of the skin more than a month after birth.
    In congenital hypothyroidism, the thyroid gland cannot perform its functions to the full

    If such signs did not appear in the baby, then after 1 month of life they have the following picture:

    • problem with body heat regulation,
    • peeling of the skin and brittle hair,
    • teeth erupt later than in healthy peers (we recommend reading: how teeth erupt in infants: photo gums),
    • loss of appetite, including a complete rejection of food and water on the background of a decrease or increase in body weight,
    • the sucking reflex is mild,
    • the size of the tongue is too big due to edema,
    • eyelid swelling,
    • weak dynamics of weight gain, height,
    • digestive problems - bloating, constipation,
    • failures of the nervous system - whims, lack of reflexes by age, lethargy, fatigue,
    • pathologies in the work of the cardiovascular system - weak pulse, low blood pressure,
    • bad and long healing umbilical wound,
    • later closing the fontanel,
    • the timbre of the voice is rough,
    • weakness of muscle tissue - late development of the ability to hold the head, roll over, sit,
    • genitals are underdeveloped.
    It is extremely important in the presence of the disease in infants to keep breastfeeding, which will positively affect the dynamics of recovery

    Breastfeeding provides infants with less pronounced symptoms. This is explained by the intake of hormones with mother's milk.

    In children from 1 year to 3 years

    At the age of one to three years, subclinical hypothyroidism is most often diagnosed in children when there is no obvious clinic. The results of the blood test will show the rate of the hormone T4 and increased concentration of TSH. Go with the baby to the doctor if you notice most of the following phenomena:

    • constant apathy, drowsiness, laziness, lethargy, lack of interest in the world,
    • when in contact with children and adults, the child remains indifferent, silent, not humble,
    • muscle weakness
    • strong backlog in teething, weight gain, height, age skills,
    • swelling of facial muscles, overly large tongue,
    • dry skin, brittle hair,
    • violation of the proportions of the body when the body is long, the limbs are small,
    • problems with appetite and digestive system.

    In children over 3 years

    After three years, hypothyroidism in children is in the form of an acquired species, but it is also subclinical. It appears as a violation:

    • weight - obesity,
    • growth - dwarfism, body disproportion,
    • nervous development - flashes of arousal, mood swings, drowsiness, lethargy,
    • facial expressions - it is absent due to swelling of the face,
    • attention and thinking - slow down,
    • heart rhythm - weakness, low frequency,
    • water balance of the skin - dry, flakes,
    • hair structures - thin and break,
    • vocal cords - hoarseness and coarseness of voice,
    • reproductive system - late maturation,
    • the size of the internal organs increased.

    Treatment methods

    The earlier hypothyroidism was detected, the greater will be the effect of its complex treatment. Children with congenital hypothyroidism show positive results in the growth and development of all organs and systems after therapy. The optimal time to start it is 7-14 days after birth.

    Endocrinologists use a number of treatments:

    • medication - with the use of drugs Levothyroxine Sodium, which are shown to receive for life,
    • diet and dietary adjustment,
    • vitamin and mineral complexes,
    • surgery in the presence of tumors in the area of ​​the thyroid gland,
    • herbal therapy - decoctions of chamomile, train, sage, St. John's wort.

    After connecting a neurologist to the treatment of the disease in the list of mandatory procedures appear massages, exercise therapy, nootropic drugs. The criteria for the effectiveness of a combination of methods are the disappearance of all the symptoms of hypothyroidism, the normal level of TSH in the blood, the physical and mental development of children is age appropriate.

    Forecasts and Prevention

    Children with a congenital form of hypothyroidism diagnosed in the first month of life have a positive prognosis for treatment. If this happened at 3 months and later, then there is a high probability of deviations in further development. A longer delay in the diagnosis and prescription of treatment is fraught with obvious pathologies of skeletal growth and neuropsychic development. Entering hormonal drugs will not improve the condition of the child.

    The best prevention is a conscious approach of parents to planning pregnancy. The future mother should check the thyroid gland, the level of hormones in the blood, enrich the diet with iodine-containing foods, perhaps even change the region of residence to a more favorable one. Consult an endocrinologist if you have had thyroid disease in the family or you have goiter.

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