Congenital hypothyroidism: causes, symptoms and treatments. Congenital hypothyroidism: causes, manifestations, treatment and possible consequences The most common cause of congenital hypothyroidism is

Congenital hypothyroidism is an increasingly common occurrence in newborn babies. With such a disease thyroid does not produce enough thyroid hormones, which greatly inhibits normal development all organs and systems. In the absence of proper treatment, the nervous system suffers first of all, which negatively affects mental development. Favorable forecasts regarding this issue can begin to be built only after a month has passed since the beginning of therapy. This is why the problem early detection the disease is especially acute. In the first months of life, an infant develops rapidly, while hypothyroidism in a child significantly inhibits this process.

Congenital hypothyroidism in Europeans occurs in about one newborn in four or five thousand children, in Asians - less often, one person in six to seven thousand suffers from the disease. For representatives negroid race such a disease is practically not typical.

By gender, the disease is more common in girls than in boys; for every male with hypothyroidism, there are two female representatives.

Causes of the disease

Since the function thyroid gland cannot go down on its own, stand out different reasons hypothyroidism in children:

If the child was still in the womb at the time of the appearance of disorders in the development and subsequent work of the thyroid gland, then we can say that the disease is hereditary. This condition is quite dangerous, since the mother's body produces thyroid hormones only in the first weeks of pregnancy, after this period, the developing thyroid gland in the fetus begins to work independently, helping the organs and their systems to develop properly. Strong deficit hormones can cause severe physical and mental disabilities, and in newborns, congenital hypothyroidism is guaranteed in this case.
With the immunity of the thyroid gland itself to iodine obtained from food, the substances necessary for the production of thyroid hormones cease to enter the organ, which inevitably leads to the onset of the disease.
In the presence of endocrine diseases, affecting the pituitary gland and, the normal regulation of hormone secretion in the body is disrupted, which causes a disruption in the production of thyroid hormones.
If the mother took drugs that lower the concentration of thyroid hormones during pregnancy, this can lead to the body's immunity to thyroid hormones.

Classification

Childhood hypothyroidism is classified into two main groups:

Congenital hypothyroidism, which appeared in the womb - after birth, the baby has a serious lack of thyroid hormones, as a result of which the child is behind in development and requires immediate treatment.
Acquired hypothyroidism in children can develop due to a lack of iodine, previous operations on the thyroid gland, with thyroiditis, exposure to certain medications.

In terms of severity, the disease is subdivided into:

Transient, which is detected during the first examination - level thyroid-stimulating hormone at the same time, it is increased, and the concentration of thyroid hormones is reduced. Usually at the start timely treatment this condition passes rather quickly.
Subclinical, in which the thyroid gland is already affected, but no obvious symptoms are yet observed. The disease can only be diagnosed with a blood test.
When manifest, there is a deficiency of thyroid hormones against the background of an increase in the level of thyroid-stimulating hormone. The disease is accompanied by all the symptoms that are quite pronounced.

If we consider the disease in terms of the level of hormone secretion disturbance, then we can distinguish:

Primary, or thyrogenic, which is caused by the pathology of the thyroid gland, in which it begins to secrete much less hormones than is necessary. This is the most common type of hypothyroidism in children.
Secondary, or pituitary. The pituitary gland and the thyroid gland are inextricably linked, therefore, pituitary pathologies will inevitably lead to disturbances in the production of thyroid hormones. This type of disease is rare.
Tertiary, or hypothalamic. In this case, the cause of the disease is a violation of the activity of the hypothalamus.

Pathogenesis

During development inside the mother's womb, the fetus receives the necessary amount of hormones from the mother, there are enough of them for the normal growth of all tissues and organs. If, for some reason, at the moment when the mother's body stops supplying thyroid hormones to the fetus, his thyroid gland is unable to provide the body with vital essential substance, the cerebral cortex does not fully develop, for which reason it may appear mental retardation and .

At birth, the level of thyroid hormones in the body drops sharply, which only exacerbates the situation. Often, underdevelopment and congenital hypothyroidism become the reason that parents decide to send him to an orphanage or a specialized boarding school, but in fact, the treatment started on time helps to cope with the problem.

Symptoms

Parents of children under one year old need to be competent in matters of hypothyroidism in children, the symptoms of which at this age differ from the manifestations of the disease in adults. Signs of hypothyroidism in children are as follows:

At birth, the child has a rather large weight, more than four kilograms, there is swelling of the face and eyelids, crying is hoarse and rough, breathing is heavy. These are the main signs that allow suspecting hypothyroidism in newborns even before the first screening.
Jaundice does not stop for a long time, the sucking reflex is very weak. The umbilical wound does not heal.
The child does not gain weight for a long time, the growth is much less than necessary.
For a long time, the baby does not hold his head, cannot sit, the basic skills remain unformed.
The patient does not show interest in the world, does not want to communicate, does not make sounds typical for babies, does not play and does not contact other people, characterized by abrupt mood swings and capriciousness.
Immunity is not developed, the body is prone to frequent infectious diseases.

Timely diagnosis congenital hypothyroidism, the symptoms of which are quite clearly visible in the first months of a child's life, helps to prescribe the correct treatment that will save the little man.

Diagnostics

On the fourth to fifth day of life, the newborn is necessarily sent for screening, in which the amount of thyroid-stimulating hormone in the blood is determined, even if there is no suspicion of the presence of congenital hypothyroidism in children.

With an increased concentration of this substance, the child is sent for further examinations in order to exclude the possibility of congenital hypothyroidism. This produces ultrasound procedure and that detect pathologies in the shape, size and location of the organ.

Differential diagnosis of hypothyroidism in children is based on laboratory indications, according to the results obtained, the type of hypothyroidism a person suffers from is determined:

Primary form: TSH level above normal, the concentration of thyroid hormones is below normal;
Secondary and tertiary form: TSH is lowered or normal, thyroid hormones are lowered.

Treatment

Treatment of hypothyroidism in children should be started in the first weeks of life, immediately after the diagnosis is made, since delay in this matter can cause irreversible changes in the child's body. With hypothyroidism in children, treatment consists of taking synthetic analogues of substances produced by the thyroid gland. In addition, additionally assigned vitamin preparations, nootropics, a must proper nutrition and sessions of massage and physiotherapy exercises. Often with congenital hypothyroidism, mental retardation develops, if it is present, cure is no longer possible, taking hormonal drugs can only slightly improve the patient's condition.

Forecasts

An endocrinologist is one who knows everything about the symptoms and treatment, it is he who must carefully monitor the children and immediately prescribe medical examinations if congenital hypothyroidism is suspected. If treatment is started in a timely manner, the symptoms of the disease will quickly subside, and the child will begin to grow normally without mental and physical retardation. With hypothyroidism, a favorable outcome is possible only with constant observation, when each manifestation of the disease is recorded and treated. The child should eat well, exercise physiotherapy exercises, and spend the summer away from the hot sun, which can provoke an exacerbation of the disease.

Bibliography

TESTOSTERONE AND WOMAN'S QUALITY OF LIFE FA HAYDAROVA, SS NIGMATOVA
Whitehead H.M., Boreham C., McIlrath E.M. et al. Growth hormone treatment of adults with growth hormone deficiency: results of a 13-month placebo controlled cross-over study // Clin Endocrinol (Oxf) 1992; 36: 45-52.
Rosen T., Bengtsson B.A. Premature mortality due to cardiovascular disease in hypopituitarism // Lancet 1990; 336: 285-288.
Rosen V.B. Fundamentals of Endocrinology.
The role of vasomotor and no producing function of the endothelium in the development of climacteric disorders in postmenopausal women 2012 / Kolbasova E.A.

Roman is a bodybuilding coach with over 8 years of experience. He is also a nutritionist; there are a lot of famous athletes among his clients. Roman is with the author of the book "Sports and nothing but ..

Hypothyroidism is a disease resulting from a prolonged, persistent lack 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 disorders in children. The development of this disease is based on 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 up to the onset of cretinism. Normal mental development observed only if hypothyroidism is recognized immediately, and replacement therapy with thyroid hormones (thyroid hormones) is prescribed in the first 30 days after the birth of the child. In 85-90% of all cases of the disease, congenital hypothyroidism develops as a result of iodine deficiency or with abnormal development of the thyroid gland in the prenatal period. In this case, most often there is a 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 a disruption in the formation of thyroid hormones, starting from a deficiency in the child's body of iodine and ending with the wrong course of all chemical processes the formation of thyroid hormones. Congenital hypothyroidism is transmitted in an autosomal recessive mode of inheritance and is often accompanied by an increase in the size of the thyroid gland. An extremely rare form of the disease in question is the syndrome of resistance of body tissues to the action of thyroid hormones. At the same time, the content of thyroid hormones in the child's blood serum remains within age norm... The so-called transient (temporary) hypothyroidism of newborns is considered separately. This condition occurs, for example, as a result of a woman taking thyreostatic drugs during pregnancy, such as propicil and thiamazole. In addition, transient hypothyroidism in newborns can be caused by the effect of maternal antibodies on the child's thyroid gland. After birth, after a certain period of time, maternal antibodies disappear from the child's blood, and all manifestations of the disease disappear. In most cases, transient hypothyroidism develops in premature and immature newborns, most of the cases of this disease occurs in areas with high iodine deficiency.

Allocate enough a large number of characteristic features congenital hypothyroidism. However, they are not always observed in a child in the first week of life. Typically, babies with congenital hypothyroidism are born more than 40 weeks of gestation and are heavier at birth. Also characteristic appearance children with this disease: the face, lips and eyelids are edematous, the mouth is constantly half-open, since the size of the tongue is enlarged, it is wide and “spread”, above the collarbones, as well as on the back surfaces of the hands and feet, there are limited swelling that looks like dense “pads ". At birth, although the pregnancy was full-term, the baby has all or most of the signs of immaturity. Such signs include the following: the child's skin has vellus hair, the nail plates do not completely cover the phalanx of the finger, in girls, the large labia do not cover the small ones, etc. When the child cries and screams, a low, rude voice can be noted. Passage of meconium occurs much later in comparison with healthy children, in the same way as fallout umbilical residue... The resulting umbilical wound heals also for a long time. Physiological jaundice, which develops in all children, with congenital hypothyroidism becomes protracted. Signs of congenital hypothyroidism at 3-4 months of a child's life are: poor appetite, the child gains little weight in comparison with the norm, there is a tendency to constipation, frequent bloating abdomen, the child's skin is dry, pale, peeling appears, hands and feet are cold to the touch, hair is brittle, dry, dull, muscle tone is reduced.

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

For early detection of congenital hypothyroidism in children, blood is taken and the level of hormones in it is determined. Blood is taken from the child's heel no earlier than on the fifth day of life. In the event that a study for thyroid hormones is carried out earlier than the specified period, then there is a possibility of obtaining false positive results... In the blood, both the hormones of the thyroid gland itself are determined, and the hormone of the pituitary gland, which affects the thyroid gland, increasing the production of its hormones. This pituitary hormone is called thyroid-stimulating hormone and is referred to as TSH. In the case of the birth of a premature baby, a blood test for thyroid hormones is carried out on the 7-14th day of life. This study produced using special blanks of filter paper. If a child is diagnosed with congenital hypothyroidism, the necessary treatment is immediately prescribed. 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 clinic. Such a study is carried out two weeks later, and then after 1 - 1.5 months after the start of the appropriate treatment. This multiple determination of thyroid hormones allows you to distinguish true congenital hypothyroidism from temporary. If the diagnosis of congenital hypothyroidism is confirmed, the diagnosis is clarified when the child reaches the age of one year. For this purpose, they cancel the hormonal drugs for two weeks, and then determine the levels of hormones in the blood. If normal values are obtained, hormonal drugs are no longer prescribed.

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

Congenital hypothyroidism is a group of diseases different etiology manifested congenital failure the production of thyroid hormones by the thyroid gland. The disease occurs with a frequency of 1 case per 5000 newborns, in boys - 2.5-3 times less often than in girls.

Lack of thyroid hormones has Negative influence on the development of a central nervous system... If congenital hypothyroidism is not detected in a timely manner and treatment is not started, the child develops mental impairment of varying severity. Therefore, in many countries, screening test newborns for hypothyroidism. In Russia, since 1997, screening has been carried out in all maternity hospitals.

Long-term physiological jaundice is one of the signs of congenital hypothyroidism

Causes and risk factors

In 80-90% of cases, congenital hypothyroidism is caused by malformations of the thyroid gland: for example, hypoplasia, dystopia (displacement) in the sublingual or retrosternal space.

The main risk factors for the formation of congenital hypothyroidism:

lack of iodine in the body of a pregnant woman;
exposure to ionizing radiation;
toxic effects on the developing fetus chemical substances, including some medicines;
infectious and autoimmune diseases pregnant.

In about 2% of cases, thyroid abnormalities are caused by mutations in the PAX8, FOXE1, TITF2, TITF1 genes. With congenital hypothyroidism caused by genetic factors, other developmental anomalies are often observed in a child:

non-closure of the hard palate (cleft palate);
non-closure upper lip(cleft lip);
congenital heart defects.

In 5% of cases, the cause of congenital hypothyroidism is hereditary diseases that lead to a violation of the secretion of thyroid hormones or disrupt their interaction with each other. Such diseases include Pendred's syndrome, defects in thyroid hormones and iodine organification. Their inheritance is carried out in an autosomal recessive manner (both parents must be carriers of the defective genes).

In other cases, congenital hypothyroidism develops as a result of lesions of the hypothalamic-pituitary system due to:

aplasia of the pituitary gland;
asphyxia of the newborn;
birth trauma;
tumor processes;
developmental anomalies of the brain.

The clinical picture of congenital hypothyroidism can be caused by a syndrome of resistance: in some hereditary diseases thyroid gland secretes enough thyroid hormones, but target organs lose their sensitivity to them.

Forms of the disease

Depending on the reasons underlying the development of the disease, the following forms of congenital hypothyroidism are distinguished:

thyrogenic, or primary - arises as a result pathological changes thyroid gland;
secondary - the basis of its development is a deficiency of TSH (thyroid-stimulating hormone), associated with impaired functions of the adenohypophysis;
tertiary - the reason is a deficiency of thyroliberin (hypothalamic hormone);
peripheral. The mechanism of its development is associated with the absence of receptors for thyroid hormones in the tropic tissues or their defect. Also, the cause of this form of congenital hypothyroidism can be a violation of the process of converting T4 (thyroxine) to T3 (triiodothyronine).

Most dangerous complication hypothyroidism is myxedema (hypothyroid) coma. It can be triggered by hypothermia, trauma, infectious diseases.

Depending on the effectiveness of the treatment, congenital hypothyroidism is divided into:

on compensated - clinical symptoms there are no diseases, the concentration in blood plasma of T4, T3, TSH corresponds to the norm;
decompensated - laboratory and clinical manifestations hypothyroidism persists despite ongoing therapy.

According to the duration of the flow, two forms are distinguished:

Transient. Lack of thyroid function in a child develops under the influence of maternal antibodies to TSH circulating in his blood. This form of the disease lasts from 7 to 30 days.
Permanent. Hormone replacement therapy should be carried out for life.

latent (subclinical);
manifest;
complicated.

Clinical manifestations in latent hypothyroidism are usually absent or nonspecific. Blood tests reveal elevated level TSH with normal T4 content.

Complicated hypothyroidism is accompanied by the addition of other diseases (cretinism, polyserositis, heart failure). This form proceeds with a sharp deficiency of thyroxine with a very high level thyroid-stimulating hormone.

Symptoms

Congenital hypothyroidism manifests itself in different ages- depending on the severity of the disease and its form. So, with aplasia of the thyroid gland or pronounced hypoplasia, the symptoms of hypothyroidism become clearly visible already in the first week of a child's life. Minor hypoplasia and dystopia manifest clinically after one year of age.

Congenital hypothyroidism occurs with a frequency of 1 case per 5000 newborns, in boys - 2.5-3 times less often than in girls.

The main signs of congenital hypothyroidism:

immaturity of a newborn born after the 38th week of gestation;
delay in the passage of meconium;
large fetus (birth weight exceeds 4 kg);
long-term physiological jaundice;
muscle atony;
episodes of apnea (respiratory arrest) during feeding;
hyporeflexia;
flatulence;
frequent regurgitation;
a tendency to constipation;
an increase in the size of the tongue (macroglossia);
lethargy;
slow weight gain;
swelling of the genitals and extremities;
coldness of the skin to the touch;
dysplasia of the hip joints;
enlarged fontanelles.

At primary form congenital hypothyroidism and the absence of treatment, the severity of the symptoms of the disease increases. The skin becomes dry and hardened, becoming an icteric gray. Myxedema develops (edema subcutaneous tissue and skin). Sweat separation is reduced. Hair and nail plates atrophy. Voice changes (becomes rough, hoarse and low). There are signs of delayed psychomotor development. If treatment is not started, then mental deficiency (oligophrenia) is formed.

Clinical picture central forms(secondary, tertiary) congenital hypothyroidism is usually indistinct. The disease is often combined with a deficiency of other homones (follicle-stimulating, luteinizing, somatotropic), anomalies in the structure of the facial skull.

In 80-90% of cases, congenital hypothyroidism is caused by malformations of the thyroid gland: for example, hypoplasia, dystopia (displacement) in the sublingual or retrosternal space.

Diagnostics

Currently, the diagnosis of congenital hypothyroidism is based primarily on the results of neonatal screening. A few drops of blood are taken from a child on the 4-5th day of life and applied to filter paper, which is transferred to the laboratory to determine the concentration of TSH. The diagnosis of congenital hypothyroidism is considered confirmed when the concentration of TSH in the test sample exceeds 100 mU / L.

If in a dry blood spot the TSH content is higher than 20 mU / l, then the result is regarded as doubtful and the analysis is repeated. When a similar result is repeated, the determination of free T4 and TSH in the blood serum is shown.

Treatment

Treatment for congenital hypothyroidism should begin immediately after diagnosis. Hormone replacement therapy is carried out for life with synthetic analogues of thyroid hormones. The dosage is selected individually in each case. If necessary, the doctor may additionally prescribe a sick child symptomatic remedies, multivitamin preparations. To assess the effectiveness of the treatment, the concentration in serum of T4 and TSH is determined.

If therapy is started in the first months of life, then psycho physical development the child and his intellect are not affected.

Possible complications and consequences

If untreated, congenital hypothyroidism is complicated by damage to the central nervous system with the formation of oligophrenia.

If the thyroid gland is insufficient, it suffers the immune system, therefore, children with congenital hypothyroidism are prone to colds and other infectious diseases, often taking a protracted, chronic nature.

The most dangerous complication of hypothyroidism is myxedema (hypothyroid) coma. It can be triggered by hypothermia, trauma, infectious diseases.

Forecast

In congenital hypothyroidism, the prognosis largely depends on the time of the onset of replacement hormone therapy... If it started in the first months of life, then psychophysical development the child and his intellect are not affected. At the beginning of therapy at the age of over 3-6 months, it is possible to stop further lag in psychomotor development. However, the already existing intellectual disabilities will remain for life.

Prophylaxis

Prevention of congenital hypothyroidism includes:

prevention of iodine deficiency in a pregnant woman;
medical and genetic counseling for married couples at the stage of pregnancy planning, especially if one of the parents or one of the close relatives suffers from thyroid pathology;
antenatal protection of the fetus.

YouTube video related to the article:

Congenital hypothyroidism is a complex chronic diseases... It occurs when the thyroid gland is not working properly in babies. Because of this, a decrease in the hormone triiodothyronine, produced by the thyroid gland, occurs in the blood. The causes of this disease can be varied.

The development of hypothyroidism is influenced by:

presence of infection;
hereditary disposition;
individual pathologies in development.

The main outward signs the child has:

mental retardation;
the appearance of teeth;
closing the fontanelle after the due date.

And also there will be a lag in physical development, the baby's skin will be very dry.

But it is not worth it because of illness to give the child to children's institution and give it up. Usually, the diagnosis of congenital hypothyroidism occurs in the first days after birth, even in maternity ward... In this case, it is necessary to carry out a special course of treatment. To do this, use hormones that are not enough. If the diagnosis is correct and timely, treatment can be effective. Delayed medical care leads to developmental disorders of the child's body, which cannot be restored. How is congenital hypothyroidism in newborns treated and diagnosed?

Congenital hypothyroidism in children manifests itself as early as 3-4 days after birth. It is expressed in the deterioration of the thyroid gland. According to medical data, such phenomena are observed only in 2 babies out of 5 thousand newborns, more often girls are exposed to this.

It is important that the thyroid gland works correctly, because its work is aimed at performing certain functions:

control over metabolism;
maintaining normal temperature body;
control over fat metabolism;
regulation of carbohydrate and protein metabolism;
maintaining calcium metabolism in the body;
impact on development mental abilities baby.

The normal functioning of the thyroid gland contributes to correct development child's body... The bones of the skeleton and the central nervous system are formed. In this case, the body will receive the right amount of hormones that gland produces. Lack of them in the body provokes a slow development of the child's mental abilities. And also there will be a lag in physical development. These phenomena are called pathologies and require specific treatment.

Causes and symptoms of the disease

Congenital hypothyroidism has symptoms and special causes in infants. The main reasons for the development of congenital hypothyroidism:

Hereditary predisposition to thyroid dysfunction. These changes take place even before the baby is born. They are provoked by mutations at the gene level.
The individual characteristics of the child's body, which are expressed in the violation of iodine metabolism and poor perception of hormones.
Disruption of the hypothalamus, which is responsible for the thyroid and glands internal secretion... In this regard, a malfunction occurs in the body of a newborn. endocrine system.
Loss of sensitivity to theroid hormones. It can be caused by chronic diseases of the expectant mother.

It is possible to determine the development of hypothyroidism by certain signs in the first months of life. At the same time, a significant lag in the development of the baby will already be noticed. Therefore, according to characteristic symptoms development can be assumed complex disease already in the first days of life:

the child's weight is more than 3 kilograms 500 grams;
the mouth is always open;
the face is quite swollen;
swelling will be noticeable in the area of the collarbones;
when a child cries, his voice is harsh;
generic jaundice proceeds more than usual;
blue skin tone in the area of the nasolabial triangle.

Upon reaching the age of 3-4 months, the child will manifest:

very poor appetite;
disruption of bowel function and persistent constipation;
the skin flakes off all over the body;
body temperature is lower than usual;
hair does not grow well and will be very fragile.

A little later, the baby will observe:

delayed appearance of teeth;
lag in the development of mental and physical abilities.

For the modern detection of a congenital disease, special research... By the manifestation of symptoms during this period, it is impossible to determine specific disease... Therefore, all newborns are tested for the development of congenital hypothyroidism.

Such measures will help prevent the progression of the pathology and help normalize the amount of thyroid hormones. Treatment that is carried out already at the age of one month will be effective. Hypothyroidism in children and its symptoms may appear in the first week of life.

Diagnosis of the disease

The detection of congenital hypothyroidism occurs according to certain criteria. Pediatricians use a special scale. The development of hypothyroidism can be assumed if total amount the accumulated points is more than 5:

bowel dysfunction, constipation - 2;
hernia on the navel - 2;
generic jaundice more than 21 days - 1;
pale color skin – 1;
big tongue - 1;
weak muscles - 1;
the weight of the child at birth is more than 3500 grams - 1;
the posterior fontanelle does not close for a long time;
during pregnancy more than 40 weeks - 1.

Therefore, during the period of bearing a child, studies are carried out that can identify various pathologies even before the baby is born. The development of hypothyroidism contributes to the deterioration of the thyroid gland. But at the same time, the amount of hormone TSH, which is aimed at stimulating the work of the gland.

In order to conduct a study, blood is taken, in babies this is done from the heel. At normal performance the level of the hormone should be no more than 50 units, if it is higher, the development of pathology can be assumed. Laboratory test results occur within a few weeks. If a pathology is detected, the doctor notifies the parents of this.

There is a severe form of the course of the disease, which proceeds without treatment. They call her. But this only happens if complete absence qualified medical care... The main signs of this disease are:

irregular face shape;
poor health;
poor mental development;
small stature;
improper formation of the bones of the arms and legs.

Modern medicine can improve the health of babies with this diagnosis.

Treatment of congenital hypothyroidism

With timely treatment, general state the child's health will return to normal. The only condition for such an effect is the beginning of the provision of medical care immediately after the detection of the pathology.

For this, drugs are used:

Levotroxin sodium;
L-thyroxine;
Tyro-4;
L-thyroxin-Farmak.

With the use of small doses of Levothyroxine, the formation of various substances and the growth of all organs are stimulated. And also the amount of oxygen needed to saturate tissues with it increases. The result will become noticeable within a week of taking this medication.

This drug contains the thyroid hormone - thyroxine. Therefore, we can call it one of the most effective.

Taking the drug, the patient has the necessary accumulation in the body, which he will use as needed. Take the child into morning time an hour before meals. This method will help to get rid of the increase in the amount of hormones in the blood. A newborn, in the first days of life, can be given the drug during feeding in the morning.

If the treatment was effective, normalize the level of the hormone in the blood.

The examination of the child must be carried out:

in the first year at least once every 2 months;
then every 3, maximum 4 months.

It is imperative to record in this case:

the degree of development of the child physically, according to certain parameters;
mental health status;
the correct formation of bones and the skeleton as a whole.

The amount of thyroxine in the body at necessary treatment will be returned to normal in 14 days. After a maximum of 3 weeks, the infant will recover the TSH level. It must be remembered that only a doctor should prescribe the drug and its dosage. He always takes into account any peculiarities of the patient.

Levothyroxine use

Levothyroxine is a drug that is sold in pill form and has different dosage... This can be the concentration of the main substance - 25, 50, 100 μg. When calculating the dose, the height and weight of the baby are taken into account.

The amount of the drug used:

the smallest patients are prescribed from 12.5 to 50 mcg during the day;
then they can slightly increase the dose to 100 or 150 mcg;

Changing the dose as the patient grows older:

at the age of 6 months - at the rate of 8 to 10 μg per 1 kg of body weight per day;
from 6 months to a year - at the rate of 6 to 8 μg per 1 kg of body weight per day;
from 5 years of age - at the rate of 5 to 6 μg per 1 kg of body weight per day;
after 6 years and up to 12 - at the rate of 4 to 5 mcg per 1 kg of body weight per day.

If the drug is taken correctly and on time, the child passes preventive examinations, normal development can be predicted. But in any case, you need to be under the supervision of a doctor. long time... And you may also need to consult a pediatrician, endocrinologist and neuropathologist.

Much of the success of treatment will depend on responsible parenting. They must follow all the doctor's recommendations, conduct research on time and monitor medication intake. At the same time, the newborn has real chances of getting rid of the disease and communicating with peers. Such a diagnosis cannot be a reason for an orphanage or abandonment of a baby.

V modern world medicine pays close attention to childbirth. Doctors strive to identify all deviations and defects in a child at the most early dates pregnancy, immediately after birth. Among the many congenital diseases observed in children, hypothyroidism is considered very dangerous and serious. It is characterized by dysfunction of the thyroid gland, a decrease in the amount of its hormones in the blood. Hypothyroidism in newborns can occur for many reasons. His diagnosis is carried out while he and his mother are in the hospital, on the third or fourth day after birth.

The main symptoms of the disease: delayed development, both in physical and mental directions, teething much later than usual in children, increased dryness of the skin. Treatment of congenital hypothyroidism in infants is carried out with drugs that replace thyroid hormones. Timely intervention, identification of health problem and acceptance necessary measures gives children a chance to grow and develop on a par with their peers, to be no worse, no more stupid, no less than others. If you do not attach importance to the disease, in the future defects in the child's skeleton may appear, and problems with the nervous system may appear.

The concept of congenital hypothyroidism

Congenital hypothyroidism refers to a disease associated with impaired functioning of the thyroid gland in newborns. It is two to two and a half times more common in girls than in boys. Statistics show that this disease is detected in 1-2 children out of 5000 born.

Why is the thyroid gland so necessary for the correct, timely development of the baby? It is an organ of the endocrine system that performs the following functions in the human body:

regulation of metabolism: fats, carbohydrates, proteins, as well as calcium;
body temperature control;
contributes to the formation of intelligence in a child.

From birth, the thyroid gland is directly involved, the main role in the growth, development of the baby's body, and especially the bones and the formation of the nervous system. One of the tasks performed by the thyroid gland is the production of two types of hormones: thyroxine, triiodothyronine. The lack of these substances can significantly affect both the physical and mental development personality, inhibit mental processes, child growth.

Causes

Congenital hypothyroidism in children occurs for a variety of reasons, the main ones of which are:

Heredity. Mainly due to genetic mutations, even when a child is found in utero, the formation and functioning of the thyroid gland are disturbed.
Improper formation, production of thyroid hormones, for example, due to deterioration, slowing down of iodine metabolism.
Damage to the center of the nervous system responsible for the functioning of the thyroid gland, which can cause serious violations in the work of the endocrine system.
Susceptibility to thyroid hormones is impaired.

Symptoms

Congenital hypothyroidism, mainly manifests itself in infants not immediately, but several months later. Only in a countable number of children can the disease be detected in the first days, weeks of life. The most striking symptoms that speak of the disease are: swelling of the face, heavy weight (more than three and a half kilograms), cyanosis in the area of the nose, lips (cyanosis), swelling in the area of the supraclavicular fossa, a half-open mouth, rudeness of the voice, jaundice, which lasts several weeks.

Later, at the age of three or four months, congenital hypothyroidism is expressed in the form of a deterioration in appetite, brittle hair, constipation, a decrease in body temperature, dryness, and peeling of the skin. Then, as the child grows up, physical, mental inhibition in development is added to them.

Thanks to modern medicine, a versatile examination of infants, the detection of congenital hypothyroidism allows you to immediately take up its treatment, at first to help the baby develop on a par with other children, his peers. Ignoring the disease subsequently negatively affects children, leads to cretinism, when they have deformation of the face, curvature of the legs, arms, much lower stature, susceptibility chronic diseases, they stop developing intellectually.

Diagnostics

In newborns, the diagnosis of congenital hypothyroidism is carried out using a specially developed Apgar scale, which indicates the most common symptoms, their significance is reflected in points:

constipation - 2 points;
umbilical hernia - 2 points;
swelling of the face - 2 points;
pallor - 1 point;
heavy weight (over 3.5 kg) - 1 point;
muscle weakness - 1 point;
prolonged jaundice (more than 3 weeks) - 1 point;
big tongue - 1 point;
open posterior fontanelle - 1 point;
duration of pregnancy more than 40 weeks - 1 point.

It is possible to suspect congenital hypothyroidism if the examination scores more than five points.

In order to accurately determine whether the baby is sick or not, on the third or fourth day of stay in the hospital, blood is taken from his heel. The test result becomes known a few weeks after blood collection. According to the level of thyroid-stimulating hormone, the presence or absence of congenital hypothyroidism is revealed. If the TSH concentration is more than 50 mU / L, this is already a cause for concern. Parents are informed about the disease if the suspicion is confirmed.

Treatment

If congenital hypothyroidism in a baby is confirmed, then treatment should be started without delay. The slightest delay, ignorance can have the most dire consequences, have a negative impact on his mental and physical development. Procedures carried out in a timely manner will have a beneficial effect on the child, he will not differ in anything from other children, he will also be active, smart, intellectual.

As a rule, the main form of treatment for newborns from this disease – replacement therapy with the help of medicines levothyroxine sodium. It has a positive effect on the growth of the body and education. essential substances, when used in small dosages, medium doses of the drug can improve metabolism, increase tissue oxygen demand, contribute to the rapid, timely development of the baby and the growth of his body. Improvements after using this medicinal product become noticeable after a week and a half.

The main feature of levothyroxine, its advantage over other drugs is the similarity in its chemical composition with thyroxine. For babies, it is most often recommended to give medicine during morning feeding; for older children, experts advise to use levothyroxine in the morning, an hour before meals, with a small amount of liquid.

Positive dynamics in a child can be determined by the following indicators, criteria:

Normalization of the required level of thyroid-stimulating hormone in the blood.
The concentration of thyroxine meets the standards. Until a child is one year old, the level of the substance is determined every two to three months, then every three to four months.
Good growth rates of bones, skeleton.
Positive dynamics of intellectual development corresponding to the norms.
Positive dynamics of physical development corresponding to the norms.

Normalization of thyroxine in the blood of children occurs within ten to fourteen days after the start of treatment, and thyroid-stimulating hormone - after two to three weeks. The dosage for each newborn is prescribed strictly individually, based on his condition, analyzes, clinical data, laboratory research... Levothyroxine tablets are found in different dosages, 25.50 and 100 mcg each.

Dosing of levothyroxine

In the first few weeks after birth, the baby is usually prescribed an initial dose of 12.5 to 50 mcg / day for one square meter body surface, and supporting - from 100 to 150 mcg / day.

Up to six months, newborns are given from 8 to 10 mcg / day. per one kilogram of weight, from six months to a year - from 6 to 8 mcg / day. per 1 kg of weight, from one to five years - 5-6 mcg / day. per 1 kg of weight, children from 6 to 12 years old are prescribed, as a rule, 4-5 mcg / day. per 1 kg of weight.

Only an appropriate specialist, an endocrinologist, can prescribe treatment for newborns with congenital hypothyroidism. Pediatricians and neuropathologists should also monitor the course of treatment, changes in the condition of children, together with an endocrinologist.

With the timely detection of problems, detection of congenital hypothyroidism, following the recommendations of doctors, correct treatment, the baby in terms of development, growth, intellectual abilities will not differ in any way from his peers.