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儿童获得性甲状腺功能减退症。

Acquired Hypothyroidism in Children.

机构信息

Department of Pediatric Endocrinology, Manipal Hospital, Bengaluru, Karnataka, 560008, India.

出版信息

Indian J Pediatr. 2023 Oct;90(10):1025-1029. doi: 10.1007/s12098-023-04578-w. Epub 2023 May 31.

Abstract

Acquired hypothyroidism is generally also referred to as juvenile hypothyroidism. Hypothyroidism is due to the deficient secretion of thyroid hormones causing metabolic and neurological sequelae at the cellular level. It can present as overt hypothyroidism wherein the thyroid hormones (T4 and T3) secretion fall and thyrotropin (TSH) rises. Acquired hypothyroidism frequently presents between 9 and 11 y of age and is rarely seen before 4 y of age. Approximately 80% of the children and adolescents are asymptomatic at the time of diagnosis. Children with moderate to severe hypothyroidism often present for evaluation of poor growth, constipation, lethargy and/or dry skin. A detailed history and examination will provide us with enough clues for diagnosing hypothyroidism. Primary hypothyroidism can be diagnosed with raised TSH with subnormal levels of T3 and T4. Titres of thyroid antibodies - Anti-thyroperoxidase (TPO) and anti-thyroglobulin (ATG) antibodies, will be high in autoimmune hypothyroidism. Subclinical hypothyroidism is diagnosed with mildly elevated or high normal levels of TSH with free T4 being in the normal range. Insufficient secretion of thyrotropin from the pituitary causes central hypothyroidism. Acquired hypothyroidism is treated by replacement with levothyroxine. Regular monitoring of thyroid profile is necessary for adjusting doses of levothyroxine. Close monitoring and individualization of levothyroxine therapy is essential for normal growth and development of the child.

摘要

获得性甲状腺功能减退症通常也称为青少年甲状腺功能减退症。甲状腺功能减退症是由于甲状腺激素分泌不足,导致细胞水平的代谢和神经后遗症。它可以表现为显性甲状腺功能减退症,其中甲状腺激素(T4 和 T3)分泌减少,促甲状腺激素(TSH)升高。获得性甲状腺功能减退症常在 9 至 11 岁时发生,很少在 4 岁之前出现。大约 80%的儿童和青少年在诊断时无症状。中重度甲状腺功能减退症的儿童常因生长不良、便秘、嗜睡和/或皮肤干燥而就诊。详细的病史和体格检查将为我们提供足够的线索来诊断甲状腺功能减退症。原发性甲状腺功能减退症可通过升高的 TSH 和 T3、T4 水平降低来诊断。甲状腺抗体——抗甲状腺过氧化物酶(TPO)和抗甲状腺球蛋白(ATG)抗体的滴度在自身免疫性甲状腺功能减退症中会升高。亚临床甲状腺功能减退症的诊断标准为 TSH 轻度升高或正常高值,游离 T4 处于正常范围。垂体促甲状腺激素分泌不足会导致中枢性甲状腺功能减退症。获得性甲状腺功能减退症用左甲状腺素替代治疗。定期监测甲状腺功能谱对于调整左甲状腺素剂量是必要的。密切监测和个体化左甲状腺素治疗对于儿童的正常生长和发育至关重要。

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