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| Testimonials For Pediatric Oncall |
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Preeti
I am a final yr medical student and i just love ur website!!! I regularly use it to help me with my preparations. The topics are so lucidly written and easily understood with up to date information.. Even the HIV related web site ( www.hivinchildren.org) by Dr.Ira Shah is just fabulous!!! |
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Dr Parang N Mehta
Dear Dr Ira Shah, Congratulations on putting up an excellent website, which will be of great use to practicing pediatricians everywhere. You have achieved the near impossible in getting some of the biggest names in pediatrics in India to contribute content to your site. |
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| Sailala
An excellent website!! good and useful information! Many Thanks for to u all! |
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Sujatha
Very informative site, and queries are getting resolved immediately. Thanks |
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Uttam Laisram
I found the Vaccine Reminder feature on your Website very interesting. My request is that this useful facility may not be restricted to Registered Users, but may be made available to all Visitors, who may like to enter their child's details and take a print-out of the Vaccine schedule. Please consider. Keep up the excellent work in providing India-relevant information for child care. |
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| Congenital Hypothyroidism |
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Dr Ira Shah
M.D, DNB, DCH(Gold Medalist), FCPS
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Clinical Manifestations: Congenital hypothyroid child may present with slightly increased head size due to myxedema of the brain. There may be prolongation of physiological jaundice, lethargy, somnolence, large tongue and nasal obstruction. Affected infants cry little, sleep more and are very lethargic. There may be presence of umbilical hernia, hypothermia, constipation, edema of genitals and extremities, cardiomegaly, bradycardia and asymptomatic pericardial effusion.
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Symptoms appear gradually and if neonatal screening is not done, the diagnosis is often delayed. Ideally a neonatal screening (TSH screening) for CH should be routinely done in all children as treatment of affected infants within 45 days of birth leads to normal mental development. The TSH should be done 3 to 5 days after birth and patients with TSH levels more than 20-25 mU/L should be assessed further.
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When there is partial deficiency of thyroid hormone as in ectopic thyroid and thyroid dyshormonogenesis, the symptoms may be milder. As the child grows, infantile proportions are maintained and child may have disproportionate short stature. Both anterior and posterior fontanelles are wide-open and coarse facies such as hypertelorism, depressed nasal bridge, puffiness of eyes; open mouth and short neck develop. Skin may appear yellow due to carotenemia. Hairline reaches far down on forehead and development is retarded. Voice is hoarse and child has hypotonia. Goiter may be seen in patients with dyshormonogenesis, thyroid hormone resistance and transient hypothyroidism.
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Diagnosis: - Once clinically suspected or a positive neonatal screening test; the diagnosis is confirmed by serum T4 and TSH levels. The TSH will be elevated (>10 mcU/ml) and T4 will be low (<6.5 mcg/dl) in neonatal period in patients with CH. 20% of the infants may have normal T4 with modest TSH elevations. Such infants may require repeat examinations to establish a diagnosis of CH. Intrauterine deprivation of thyroid hormone may retard osseous centers and manifest as absent distal femoral epiphysis at birth.
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Treatment
Treatment should be started as soon as diagnosis is confirmed. The goal of therapy is early, adequate thyroid hormone replacement. It is desirable to maintain the serum T4 in the upper half of normal range in infants. An initial dose of thyroxine at 10-15 mcg/kg/day is recommended to minimize IQ loss. Infants with transient hypothyroidism should not be treated unless low T4 and elevated TSH persist beyond 2 weeks. Therapy in them should be discontinued after 8 to 12 weeks (in patients with maternal goitrogenic drugs) or by 5 months (in infants with maternal autoantibody).
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T4 and TSH should be monitored at regular intervals. Over treatment should be prevented and can be recognized by signs such as tachycardia, excessive nervousness, disturbed sleep pattern, advanced bone age and craniosynostosis.
Children may require a dose of 4 mcg/kg/day.
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References
- Pediatric Endocrinology – Sperling MA, 1 st ed. Philadelphia, W.B. Saunders Company, 1996, pg 57-64.
- Nelson’s Textbook of Pediatrics – Behrman RE et al, 16 th ed. Vol.2, Philadelphia, W.B. Saunders Company, 2000, pg 1698-1703
Last Updated on 11-08-2007
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