Congenital hypothyroidism

Hypothyroidism is a disease that occurs as a result of a prolonged, persistent deficiency of thyroid hormones or a decrease in their biological effect at the level of the tissues of the human body. Congenital hypothyroidism is one of the most common thyroid diseases in children. At the heart of the development of this disease is a deficiency of thyroid hormones, which can be either complete or partial. In most cases, children with this disease suffer in terms of mental development until the appearance of cretinism. Normal mental development is observed only if hypothyroidism is recognized immediately, and thyroid hormone replacement therapy( thyroid hormones) is prescribed in the first 30 days after the birth of the child. In 85-90% of all cases of congenital hypothyroidism develops as a result of iodine deficiency or with abnormal development of the thyroid gland during the intrauterine period. In this case, most often noted congenital absence of the gland( aplasia), its underdevelopment( hypoplasia), or it can be located in an uncharacteristic place for it( dystopia).In the remaining 5-10% of cases, congenital hypothyroidism occurs as a result of disruption of the formation of thyroid hormones, starting from a deficiency in the iodine child's body and ending with the abnormal course of all the chemical processes of the formation of thyroid hormones. Congenital hypothyroidism is transmitted according to the autosomal recessive type of inheritance and is often accompanied by an increase in the size of the thyroid gland. An extremely rare form of the disease under consideration is the syndrome of resistance of the body tissues to the action of thyroid hormones. Simultaneously, the content of thyroid hormones in the blood serum of the child remains within the age limit. The so-called transient( temporary) hypothyroidism of newborns is considered separately. This condition occurs, for example, as a result of taking a woman during pregnancy, thyreostatic drugs, such as propicil and thiamazole. In addition, transient hypothyroidism in newborns can be caused by the influence of maternal antibodies on the thyroid gland of a child. After birth, after a certain period of time, the maternal antibodies disappear from the blood of the child, and all manifestations of the disease pass. In most cases, transient hypothyroidism develops in premature and immature neonates, most cases of this disease occur in areas with large iodine deficiency.

A large number of characteristic signs of congenital hypothyroidism are distinguished. However, they are not always observed in a child in the first week of life. As a rule, children with congenital hypothyroidism are born with a gestation period of more than 40 weeks, and at birth have a large body weight. The appearance of children with this disease is also characteristic: the face, lips and eyelids are edematic, the mouth is always half open, as the size of the tongue is enlarged, it is wide and "spread out," over the clavicles, and also on the rear surfaces of the hands and feet, there are limited swelling that havekind of dense "pads".At birth, despite the fact that the pregnancy was full, the child has all or most of the signs of immaturity. Such signs include the following: on the skin of the child there are pushrod hair, the nail plates do not completely cover the phalanx of the finger, the girls do not cover the large labia lips with small ones, etc. When crying and crying, a low, rough voice can be noted. Departure of meconium occurs much later in comparison with healthy children, in the same way as the fallout of the umbilical remnant. The resulting umbilical wound heals also long enough. Physiological jaundice, which develops in all children, with congenital hypothyroidism takes a protracted character. Signs of congenital hypothyroidism at 3-4 months of the child's life are: a poor appetite, the child has little weight gain compared to the norm, there is a tendency to constipation, frequent bloating, the skin of the child is dry, pale, flaking occurs, the hands and feet are cold to the touch,hair is brittle, dry, dull, muscle tone is reduced.

When the child's age reaches 5-6 months, a lag in psychomotor and physical development becomes noticeable.

For early detection of congenital hypothyroidism, children take blood and determine the level of hormones in it. Blood is taken from the child's heel not earlier than on the fifth day of life. In the event that a study on thyroid hormones is carried out before the specified time, then there is a possibility of obtaining false positive results. In the blood, both the hormones of the thyroid gland and the pituitary hormone that affects the thyroid gland are determined, increasing the production of its hormones. This hormone of the pituitary gland is called thyrotropic and is designated as TTG.In the case of the birth of a premature baby, a study of his blood on the thyroid hormones is carried out on the 7-14th day of life. This study is carried out using special forms of filter paper. If a congenital hypothyroidism is detected in the child, the necessary treatment is immediately given. After the child is discharged from the maternity hospital, it is necessary to conduct a repeated control study of blood hormones in the children's polyclinic. Such a study is carried out two weeks later, and then 1 to 1.5 months after the start of the appropriate treatment. Such a multiple definition of thyroid hormones makes it possible to distinguish true congenital hypothyroidism from temporary congenital hypothyroidism. In the case of confirmation of the diagnosis of congenital hypothyroidism, the child, upon reaching the age of one year, shall refine this diagnosis. To this end, they cancel the hormonal preparations they receive for two weeks, and then determine the levels of hormones in the blood. In the case of obtaining normal parameters, hormonal drugs are no longer prescribed.

Treatment. Treatment of congenital hypothyroidism is the administration of thyroid hormones. These drugs include L-thyroxine. The dosage of the drug is selected individually by the attending physician.