CONGENITAL HYPOTHYRODISM

By Dr.Sally Zeinatie



At birth, clinical recognition of hypothyroidism is difficult and most infants appear normal.

The full-blown picture develops progressively over weeks and months.
Early suspicion in a neonate
Prolongation of physiological icterus
Feeding difficulties, chocking during feeds
Respiratory difficulties-apnea
Cry little,sleep much

Early symptoms:

Weakness,Fatigue,pale color
Cold intolerance
Constipation,Weight gain
Joint & muscle pain,brittle nails & hair


Late symptoms:

Slow speech
Dry flaky skin
Puffy face,hands & feet
Broad flat nose
Widely set eyes
Decreased taste & smell
Thinning of eyebrows
Hoarseness

Impaired mental development
Retarded bone age

Additional symptoms:

Muscle spasm
Muscle atrophy
Uncoordinated movements
Joint stiffness
Hair loss
Drowsiness
Appetite loss

Neurological manifestations:

Infantile hypotonia,psychomotor delay
Lack of cry “good baby”,
somnolence
Sluggish/
disinterested

Respiratory manifestations:

Apnea
Choking spells with feeds
Nasal obstruction
Noisy respirations
Respiratory distress syndrome

Cardiovascular manifestations:

Cardiomegaly
Murmers
Slow heart rate
Electrocardiographic findings:

Sinus bradycardia(usual)
Sinus tachcardia(rare)
QT prolongation
Decreased amplitude of p wave
Ventricular tachycardia
Atrioventricular & interventricularblock
Incomplete or complete right bundle branch block
Atrial fibrillation



Gastrointestinal manifestations:

Delayed dentation
Feeding difficulties
High birth weight
Large abdomen
Macroglossia
Poor appetite
Prolonged jaundice
Umbilical hernia

Endocrinal manifestations:

goiter

Hematological manifestations:

Anemia
Iron deficiency
Or
Pernicious anemia
With vitB12 deficiency
Renal manifestations
Decreased glomerular filtration rate
Impaired ability to excrete water load
Musculoskeletal manifestations
Increased head size
Broad, short fingers
Pseudohypertrophy of calf muscles
Short limbs ,Short thick neck
Cutaneous manifestations
Carotenemia
Coarse, brittle, scanty hair
Cold & mottled skin
Dry, scaly skin
Edema of genitals & extremeties
Low hair line