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:thought_balloon:Hypothyroidism (Thy3) (:large_blue_diamond:Congenital…

- - - - Dyshormonogenesis
        
        10-15% of permanent congenital hypothroid
        
        usu. AR (but AD - พ่อและแม่ก็เป็น)
        
        M/C
        
        defect of TPO
        
        Pendred syndrome: Hypothyroidism, Deafness, Goiter
      - Thyroid gland dysgenesis
        
        Female:male ratio = 2:1
        
        :arrow_up:risk of congenital malformation
        
        :arrow_up: prevalence of thyroid abnormalities in 1st degree relative
        
        3 forms: thyroid agenesis, Thryoid hypogenesis, Thyroid ectopia
      - Resistance to TSH or signaling
    - - found in 5-10% of newborn screening
      - Maternal factors
        
        Antithyroid medication
        
        Transplacental thyrotropin receptor blocking Abs
        
        Exposure to Iodine def or Iodine excess
        
        Goitrogenic agents (eg กินกะหล่ำเยอะๆ)
      - Neonatal factors
        
        Neonatal iodine deficiency or excess
        
        Congenital liver hemangiomas
        
        Mutations in genes encoding for DUOX, DUOXA2
  - - - NB at home or sick
        ➯ screen within aged 7 days & before blood transfusion
      - GA < 36 wks or BW < 2.5 kg or Monozygotic twins
        ➯ screen at aged 48 - 96 hr then aged 2-3 wks
      - Sick preterm and receiving dopamine
        ➯ screen within aged 7 days ➯ then *after discontinued dopamine *≥ 24-48 hr
        Note: to let dopamine washout fr system
      - Maternal Graves' disease
        ➯ T4 or FT4, T3, TSH at aged 48-96 hr ➯ then aged 1 - 2 wks
    - - Capillary TSH > 25 mU/L ➯ Confirm serum FT4 and TSH ➯ Intepretation or Intervention :grapes:
  - - - To identify the presence and location of thyroid tissue
      - False positive: maternal TSH receptor blocking Ab
  - - - :warning: Careful
        
        Only tablet (50 µg, 100µg/tab)
        
        Avoid concomitant administration of soy, fiber, iron, Ca, aluminium hydroxide, cholestyramine, sucralfate
        as these :arrow_down: absorption of thyroxine
        
        Advice อาหาร & วิธีการป้อนยาดีๆ
    - - Normalize T4 within 2 wks & TSH within 1 mo.
    - - FT4 in the upper half of reference range (> 1.4 ng/dL)
      - TSH in the reference range (0.5-5 mU/L)
    - - 2wks after intial Rx
      - age0-6mo. : q 1-2 mo
      - age6mo-3yr : q 2-3 mo
      - age>3yr : q 6-12 mo
      - 4 weeks after any change in dose (เปลี่ยนโดสยาทีจะนัด F/U 4 wks)
- - - - Goitrous autoimmune thyroiditis
      - Atrophic autoimmune thyroiditis
    - - Type 1 DM
      - Autoimmune polyglandular syndrome
    - - Hyperthyroidism (Hashitoxicosis)
        
        :warning:Difficult to differentiated from Graves' disease
        
        Transient
        
        found 5-10%
      - Euthyroidism
      - Hypothyroidism
        
        Compensated hypothyroidism
        
        Overt hypothyroidism
    - - TFTs depends on stage of ds
      - Presence of Thyroid autoantibodies (90%)
        
        Thyroid peroxidase ab (anti-TPO) :sparkles:
        
        Antithyroglobulin (antiTg) :sparkles:
        
        TSH receptor ab (TRab)
    - - Hypothyroidisim ➯ LT4 treatment
      - Euthyroidism ➯ F/U
        
        if progression to hypothyroidism (3-5% per year) ➯ F/U TFT yearly or symptomatic
      - Hyperthyroidism ➯ Beta blocker & Antithyroid drugs