Dr. V. Kumaravel Dept of Endocrinology, AIMS, Kochi
Childhood hypothyroidism is one of the commonest endocrinological disease in pediatric age group. Causes of acquired primary childhood hypothyroidism include Hashimoto.s Thyroiditis, iodine deficiency, De Quervian.s thyrioditis, iodide Ingestion, infiltration, post-therapy and
late-onset congenital ectopic & enzymatic (NIS, TPO) defects. Hashimoto.s thyroiditis is the commonest cause with female predominance (2:1). It is rare under 4 years and 25% have familial incidence. The etiology being Antithyroid antibodies, defective T Cell suppression and viral damage: mumps, rubella. They present with diffuse firm goiter, delayed dentition, growth retardation, academic failure, calf-muscle hypertrophy, myopathy, pubertyrelated problems, galactorrhoea, hoarse speech and dry coarse skin. Biochemical investigations are low Free T4, high TSH and a positive Anti .Thyroid peroxisomal and anti-thyroglobulin antibodies. The treatment being LT4 3- 4 ug/kg in children and 1-2 ug /kg in adolescents. Even subclinical hypothyroidism has to be treated and TSH to be monitored after 6 weeks, then after 6 months, then annually. In case of children bone age to be done every 2 years and the goal of therapy is normal growth and puberty
with normal mental functions. We had to maintain a high normal FT4 with normal TSH
SHORT STATURE DUE TO GROWTH HORMONE DEFICIENCY
Dr. Tom Babu Dept of Endocrinology, AIMS, Kochi
Growth hormone deficiency (GHD) is the commonest pathological cause of short stature in children. It can be either in the form of isolated GHD (Idiopathic) or as a part of combined multiple hormone deficiencies (Acquired). In newborn infants, GHD should be considered if they present with a micropenis, cryptochidism or hypoglycemia. They could also present with midline defects like cleft palate/ lip, single central incisor, absence of nasal septum etc. In the case of acquired GHD, there would history incriminating a space-occupying lesion in the brain, which may have been operated, or history of trauma to the head. IGF .I or IGFBP .3 are good screening tests for GHD. The diagnosis can be confirmed by tests like the clonidine stimulation test. Once the diagnosis of GHD is made the child should be started on recombinant Growth Hormone (rGH) therapy. The cardinal rules of growth hormone therapy are 1) earlier started the better 2) optimal dose
should be used 3) should be given till growth ceases 4) It is very important to remember to correct thyroid hormone and cortisol deficiencies before starting therapy.