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Thyroid gland disorders 

Thyroid gland disorders
Thyroid gland disorders

Gary Butler

and Jeremy Kirk

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date: 24 September 2021

The thyroid gland produces all of the T4 and 20% of T3.

Congenital hypothyroidism is caused by:

anatomical defects: agenesis/dysgenesis, ectopic, sublingual

inborn errors of thyroid hormone metabolism

secondary (pituitary thyroid-stimulating hormone (TSH)) or tertiary (hypothalamic thyrotropin-releasing hormone) deficiency

iodine deficiency (commonest cause worldwide of hypothyroidism, patients are usually euthyroid).

Genetic causes are rare.

In most countries worldwide, newborn TSH screening is performed at 0–5 days of age. Treatment with l-thyroxine is (usually) lifelong.

Neonatal thyrotoxicosis due to transplacental passage of thyroid-stimulating immunoglobulins (TSIs) from mothers with thyrotoxicosis/Graves’ disease and may require antithyroid drugs (ATDs).

Acquired autoimmune hypothyroidism in children and adolescents:

is caused by lymphocytic infiltration of the thyroid gland (Hashimoto’s disease/thyroiditis)

raised thyroid peroxidase antibodies are diagnostic

treatment is with l-thyroxine.

Hyperthyroidism (Graves’ disease, Hashimoto’s stimulatory phase (Hashitoxicosis)):

is caused by autoantibodies to the TSH receptor (TSI, or TRAbthyrotropin receptor antibody)

the first-line drug of choice is the ATD carbimazole

thyroidectomy or radioiodine treatment can be considered for drug-resistant cases or after relapse.

Thyroid cancer is rare in childhood and adolescence, usually presenting with a nodule, but can be part of the multiple endocrine neoplasia syndromes.

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