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Profile of thyroid disorders in a referral centre in north India
Insights
Thyroid disorders in children are common, with hypothyroidism being frequently diagnosed late. Evaluating thyroid status is crucial for children experiencing growth failure, even if proportionate.
Area of Science:
- Pediatric Endocrinology
- Thyroidology
- Clinical Investigation
Background:
- Thyroid disorders present a significant challenge in pediatric populations.
- A comprehensive understanding of the diverse etiologies and clinical presentations is essential for timely diagnosis and management.
Purpose of the Study:
- To investigate the spectrum of thyroid disorders in children presenting to a clinic.
- To analyze the causes, diagnostic findings, and clinical features of pediatric thyroid dysfunction, including hypothyroidism, hyperthyroidism, and euthyroid goiters.
- To emphasize the importance of thyroid evaluation in cases of unexplained growth failure.
Main Methods:
- Retrospective analysis of 157 pediatric patients diagnosed with thyroid disorders between 1983 and 1988.
- Categorization of patients based on thyroid status (hypothyroid, hyperthyroid, euthyroid goiter) and specific etiological factors.
- Utilized investigations such as radioactive iodine uptake (RAIU), thyrotropin measurement (TMA), perchlorate discharge test, and urinary iodine levels.
- Assessed clinical features including age of presentation, presence of goiter, and growth patterns (short stature).
Main Results:
- Hypothyroidism was the most prevalent disorder, affecting 75% of patients (n=117), with congenital cases presenting at an average age of 4.07 years.
- Various causes of hypothyroidism were identified, including thyroiditis, dyshormonogenesis, iodine deficiency, athyreosis, hypoplasia, and ectopia.
- Proportionate short stature was observed in 44.4% of children, with 72% of those presenting solely with growth failure having dysgenetic glands.
- Hyperthyroidism occurred in 6% (n=10) with early onset, and euthyroid goiters in 19% (n=30).
- The study highlighted a trend of late diagnosis for hypothyroidism.
Conclusions:
- Hypothyroidism remains a significant concern in pediatric endocrinology, often diagnosed late.
- Growth failure, particularly proportionate short stature, necessitates a thorough thyroid status evaluation in children.
- Early detection and intervention are critical for managing pediatric thyroid disorders and optimizing growth outcomes.
Abstract:
From 1983-88, 157 patients were investigated in our clinic for thyroid disorders: 117 (75%) were hypothyroid, 10 (6%)-hyperthyroid, and 30 had euthyroid goiters. Average age of presentation of congenital hypothyroids was 4.07 years. Children with goitrous hypothyroidism (n = 19) were divided into: (i) thyroiditis: RAIU low and patchy, TMA positive: 2 children; (ii) dyshormonogenesis: RAIU high, family history positive, perchlorate discharge test positive: 2 children; (iii) iodine deficiency: RAIU high, urinary iodine low: 2 children, and (iv) cause unknown: RAIU normal or high, other investigations normal: 13 children. Ninety eight hypothyroid children without goiter were divided into 6 groups: (i) athyreosis: RAIU low, no thyroid tissue identifiable (n = 39); (ii) hypoplasia: RAIU low, gland small, in normal position (n = 7); (iii) ectopia: RAIU low, gland in ectopic position (n = 24); (iv) thyroiditis: TMA positive (n = 2); (v) iodine deficiency: low urinary iodine (n = 1); and (vi) cause unknown: RAIU and scan normal, other investigations normal and not done (n = 8). Proportionate short stature was present in 44.4% children. Twenty two children presented only with growth failure; 72% of them had dysgenetic glands. Early onset marked the group with hyperthyroidism (n = 10). Euthyroid goiter was present in 30 (19%). Hypothyroidism is still being diagnosed very late. All children with growth failure, even if proportionate, must have thyroid status evaluated.