Juvenile Hypothyroidism – Health of the children has been considered as the vital importance to all societies because children are the basic resource for the future of humankind. Nursing care of children is concerned for both the health of the children and for the illnesses that affect their growth and development. The increasing complexity of medical and nursing science has created a need for special area of child care, i.e. pediatric nursing.
Pediatric nursing is the specialized area of nursing practice concerning the care of children during wellness and illness. It includes preventive, promotive, curative and rehabilitative care of children. It emphasizes on all round development of body, mind and spirit of the growing individual. Thus, pediatric nursing involves in giving assistance, care and support to the growing and developing children to achieve their individual potential for functioning with fullest capacity.
Juvenile Hypothyroidism
Juvenile Hypothyroidism:
Deficiency or low circulating level of thyroid hormones results in hypothyroidism. It can be congenital which is known as cretinism and can be acquired as juvenile hypothyroidism.
(Ref: Paediatric Nursing, Parul Datta/34/393)
Causes of Hypothyroidism in Children:
A. Primary hypothyroidism;
a) Thyroid digenesis:
- Aplasia, hypoplasia
- Ectopic or lingual thyroid gland
b) Inborn errors of thyroid hormone synthesis, secretion or utilization
- Endemic iodine deficiency
- Autoimmune thyroiditis
c) latrogenic:
- Anti-thyroid drugs and goitrogens
- Irradiation
- Post-thyroidectomy
B. Secondary/tertiary hypothyroidism (pituitary/hypothalamic):
a) Congenital:
- Isolated or panhypopituitarism
b) Acquired:
- Trauma
- Infection
- Neoplastic/Postsurgical
- Irradiation
(Ref: IAP Text Book of Pediatrics/5th/805)
Clinical Features of Congenital Hypothyroidism:
A. During neonatal period;
a) Unusually large and heavy at birth
b) Marked open posterior fontanel
c) Wide sutures
d) The earliest clinical manifestations may be found as
- Lethargy,
- Sluggishness,
- Hoarse cry
- Feeding difficulties,
- Hypotonia and
- Oversleeping.
e) Other features are –
- Persistent constipation,
- Prolonged physiological jaundice,
- Abdominal distension and
- Cold, dry, rough thick skin
- Umbilical hernia and anemia are common
B. During 8-12 weeks:
The classical features of cretinism appear usually in 8 to 12 weeks. They are
- The characteristic coarse facial feature
- Large protruding tongue from large open mouth with thick lips
- Puffy eyelids,
- Depressed nasal bridge.
- Seemingly wide apart eyes (pseudohypertelorism) and
- Wrinkle forehead with sparse eyebrows and low level of hairline
- The scalp hair is scanty, rough, dry and brittle
- Anterior fontanel and coronal sutures are usually widely open
- The neck is short with a pad of supraclavicular fat.
- Voice is hoarse.
- Dentition is delayed.
- Hypotonia is commonly found.
- Abdomen is distended with presence of an umbilical hernia. S
- Hands are broad with short fingers.
- Poor feeding and constipation are commonly present.
- Sluggish behavior,
- Delayed physical growth with infantile skeletal proportion.
- Mental retardation,
(Ref: Paediatric Nursing, Parul Datta/34/393)
Clinical Features of Acquired Hypothyroidism:
- Child present with growth retardation
- Short stature
- Stocky appearance
- Large head
- Dull expression
- Puffy face
- Myxedematous skin (thick and pigmented)
- Lethargic
- Cold intolerance
- Hypotonia
- Delayed dentition
- Delayed puberty
- Delayed skeletal maturation
- Goiter
- Poor school performance
(Ref: Paediatric Nursing, Parul Datta/34/393)
Treatment of Juvenile Hypothyroidism;
1. Thyroxin: lifelong.
- Starting dose: 10 µg/kg/day & increased as the child grows
2. Rehabilitation of mentally retarded child –
- Physiotherapy.
- Speech therapy.
- Should be educated at special school.
- Employment.
3. Follow up:
- 2-3 monthly op to 2 years
(Ref: M.R Khan’s 228/4″)
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