ACQUIRED SEVERE PRIMARY HYPOTHYROIDISM - FROM DIAGNOSIS TO TREATMENT
Keywords:
acquired hypothyroidism, autoimmune thyroiditisAbstract
Introduction: Hypothyroidism can occur at any age in previously healthy children. The most common cause of acquired hypothyroidism in children is a chronic autoimmune thyroiditis. The clinical presentation is dominated by obesity, dizziness, lethargy, cold and dry skin, bad hair, edema, abnormal heartbeat, slowed growth. The treatment was successful and is being implemented by substituting Na-l-thyroxine.
Aim: To describe an adolescent with late-recognized severe acquired, primary hypothyroidism due to autoimmune thyroiditis and emphasize the importance of adequate and timely treatment.
Material and methods: A retrospective analysis of data from the medical data of primary care, and medical data Pediatric Internal Medicine, Department of Endocrinology in UKC Nis. The work was written in the descriptive method.
Case outline: Adolescent age 17 years presented to Endocrinology department due to edema of the eyelids, face and chest, fatigue, lethargy as well as elevated liver enzimes and creatinine. The investigation revealed:growth retardation, miksoedema, ksantochromia, endocrine obesity, cardiac rhythm abormalnity. Laboratory tests registered elevated levels of hTSH:> 100.000 mlU/L and Anti-TPO: 304.0 IU/ml and low FT4<5.15 pmol/L. A diagnosis of hypothyroidism caused by autoimmune thyroiditis was made. Thyroid hormone deficiency in tissues has led to an increase level of creatinine, liver enzymes and cholesterol. Gradual substitution therapy with Na-l-thyroxine was carried out. He was released home in good general condition with normal thyroid status.
Conclusion: Delayed recognition and failure to treat hypothyroidism can seriously impair child's health and adversely affect the performance of normal life activities. Early diagnosis prevent serious complications of the disease.
References
Šaranac Lj. Poremećaji tiroidne žlezde.U:Pedijatrija. Tom 2, udžbenik za poslediplomsko usavršavanje lekara. Akademska misao, Beograd, Ed 2016, Str. 1249-1256.
Antonelli A, Ferrari SM, Corrado A, Di Domenicantonio A, Fallahi P. Autoimune thyroid disorderes. Autoimun Rev.2015; 14:174-180.
Eschler DC, Hasham A, Tomer Y.Cutting edge:the etiology of autoimmune thyroid diseases.Clin Rev,Allergy Immunol.2011;41:190-197.
Šaranac Lj, Zivanović S, Bjelaković B, et al. Why is the thyroid so prone to autoimmune disease? Horm Res Paediatr. 2011; 75:157-165.
Šaranac Lj, Stamenkovic H, Stankovic T, et al. Growth in Children with Thyroid Dysfunction. In Potlukova E, editor. Current Topics in Hypothyroidism with Focus on Development. Rijeka: in Tech 2013: 119-134.
Selerno M, Capalbo D, Cerbone M, De Luca F. Subclinical hypothyroidism in childhood-curent knowledge and open issues.Nat rev Endocrinol. 2016; 12:734-46.
Crisafulli G, Gallizzi R, Aversa T, Salzano G, Valenzise M, et al. Thyroid function test evolution in childrenwith Hashimotos thyroiditis is closely conditioned by the biochemical picture at diagnosis. Ital J, Pediatr. 2018; 7:22.
Balasubramanian R, Marks SD. Post-infectious glomerulonephritis. Paediatr Int Child Health. 2017.Nov;37(4):240-247.
Mullur R, Liu YY, Brent GA. Thyroid hormone regulation of metabolism. Physiol Rev. 2014; 94:355–382.
Chi, H-C, Tsai, C-Y, Tsai, M-M, Yeh, C-T, Lin, K-H. Molecular functions, and clinical impact of thyroid hormone-triggered autophagy in liver-related diseases. J Biomed Sci 2019; 26:24.
Madani, SH, Far, ZR, Jalilian, N, Zare, ME, Shaveisi, F. Evaluate the liver function in hyperthyroidism patients. J Paramed Sci 2014; 5:75–78.
Lin, TY, Shekar, AO, Li, N, Yeh, MW, Saab, S, Wilson, M, et al. Incidence of abnormal liver biochemical tests in hyperthyroidism. Clin Endocrinol 2017; 86:755–9
Xin Su, Hua Peng, Xiang Chen, Xijie Wu, Bin Wang. Hyperlipidemia and hypothyroidism. ClinicaChimicaActa.2022,527:61-70.
Xin Su, Xiang Chen, Hua Peng, Jingjin Song, Bin Wang, Xijie Wu. Novel insights into the pathological development of dyslipidemia in patients with hypothyrodism. Bosn J Basic Med Sci.2022,22(3):326-339.
Sindoni A, Rodolico C, Pappalardo MA, Portaro S, Benvenga S. Hypothyroid myopathy: A peculiar clinical presentation of thyroid failure. Review of the literature. Rev Endocr Metab Disord.2016Dec;17(4):499-519.
Eslamian F, Bahrami A, Aghamohammadzadeh N, Niafar M, Salekzamani Y, Behkamrad K. Electrophysiologic changes in patients with untreated primary hypothyroidism. J Clin Neurophysiol.2011Jun;28(3):323-8.
Vignesh G, Balachandran K, Kamalanathan S, Hamide A. Myoedema: A clinical pointer to hypothyroid myopathy. Indian J Endocrinol Metab. 2013 Mar;17(2):352
Savran Y., Mengi T., Keskinkilic M. A severe case of levothyroxine intoxication successfully treated in intensive care unit. J Acute Dis. 2018; 7:175–177. doi: 10.4103/2221-6189.241029.
Ioos V., Das V., Maury E., Baudel J.L., Guéchot J., Guidet B., Offenstadt G. A thyrotoxicosis outbreak due to dietary pills in Paris. Therapeut. Clin. Risk Manag. 2008;4(6):1375–1379. doi: 10.2147/tcrm. s4110.
Brandt F., Green A., Hegedüs L., Brix T.H. A critical review and meta-analysis of the association between overt hyperthyroidism and mortality. Eur. J. Endocrinol. 2011;165(4):491–497. doi: 10.1530/EJE-11-0299.
