Pediatrics · MU Sofia

16. Diseases of thyroid and adrenal gland.

Covers thyroid and adrenal disorders in children, starting with congenital hypothyroidism and its newborn screening, then acquired hypothyroidism and Graves hyperthyroidism with their treatments. It goes on to congenital adrenal hyperplasia, presented as a table of forms, then adrenal insufficiency in a primary versus secondary table, adrenal crisis management and Cushing syndrome. It closes with dental and oral signs linked to thyroid and adrenal disease.

Inside: 7 sections · 2 tables · 16 flashcards · 4 min

Topic 16 of 30 in the MU Sofia syllabus for Pediatrics (Medicine, Year 5). The free AceMed note covers it in 7 sections, about 508 words (4 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Congenital hypothyroidism
  3. Acquired hypothyroidism
  4. Hyperthyroidism
  5. Congenital adrenal hyperplasia (CAH)
  6. Adrenal insufficiency
  7. Too much cortisol (Cushing syndrome)

Introduction

Thyroid hormone drives growth and brain development; adrenal hormones keep blood pressure, salt and sugar steady under stress. In children, missing these hormones harms the brain (thyroid) or can kill within days (adrenal crisis), so both are screened for or looked for actively.

Congenital hypothyroidism

About 1 in 2000–3000 births; the commonest preventable cause of intellectual disability. Causes: thyroid dysgenesis (absent, small or ectopic gland, about 85%), dyshormonogenesis (enzyme defects, often with goitre), central (pituitary), transient (maternal antibodies or drugs, iodine excess or lack).

  • At birth most babies look normal (maternal T4 crosses the placenta), which is why newborn screening (TSH on the heel-prick sample) matters.
  • Signs if missed: prolonged jaundice, poor feeding, constipation, sleepiness, hoarse cry, large tongue, umbilical hernia, dry skin, large posterior fontanelle, low tone; later delay and short stature.
  • Treatment: levothyroxine 10–15 µg/kg a day, started within the first 2 weeks; children treated early have normal intelligence.

Acquired hypothyroidism

Usually autoimmune (Hashimoto) thyroiditis, girls, often with goitre, anti-TPO antibodies; more common in Down and Turner syndromes and type 1 diabetes. Clue in children: slowing growth with weight gain and delayed bone age; tiredness, constipation, cold intolerance, poor school work, delayed (or sometimes early) puberty. Treat with levothyroxine.

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