Profile of Euthyroid Goiters in Children and the Role of Levothyroxine

Mohamed, Sajjid (2007) Profile of Euthyroid Goiters in Children and the Role of Levothyroxine. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: ANATOMY OF THE THYROID GLAND: The Thyroid Gland (Glandula Thyreiodea; Thyroid Body) — the thyroid gland is a highly vascular organ, situated at the front and sides of the neck; it consists of right and left lobes connected across the middle line by a narrow portion, the isthmus. Its weight is somewhat variable, but is usually about 30 grams. It is slightly heavier in the female, in whom it becomes enlarged during menstruation and pregnancy The lobes (lobuli gl. thyreoideæ) are conical in shape, the apex of each being directed upward and lateralward as far as the junction of the middle with the lower third of the thyroid cartilage; the base looks downward, and is on a level with the fifth or sixth tracheal ring. Each lobe is about 5 cm. long; its greatest width is about 3 cm. and its thickness about 2 cm. The lateral or superficial surface is convex, and covered by the skin, the superficial and deep fasciæ, the Sternocleidomastoideus, the superior belly of the Omohyoideus, the Sternohyoideus and Sternothyreoideus, and beneath the last muscle by the pretracheal layer of the deep fascia, which forms a capsule for the gland. The deep or medial surface is moulded over the underlying structures, viz., the thyroid and cricoid cartilages, the trachea, the Constrictor pharyngis inferior and posterior part of the Cricothyreoideus, the esophagus (particularly on the left side of the neck), the superior and inferior thyroid arteries, and the recurrent nerves. The anterior border is thin, and inclines obliquely from above downward toward the middle line of the neck, while the posterior border is thick and overlaps the common carotid artery, and, as a rule, the parathyroids. AIMS AND OBJECTIVES OF THE STUDY: 1. To study the complete clinical and biochemical profile of the children with Euthyroid goiters. 2. To evaluate the effect of thyrotropin (TSH) suppressive therapy with levothyroxine on the size of diffuse, multinodular and solitary nodular Euthyroid goiters in the pediatric population. 3. To study the side-effect profile of levothroxine therapy, if any. 4. To ascertain the existence of iodine deficiency in our pediatric population as it is the most important cause of Euthyroid goiters. 5. To study different pathologies of euthyroid goiters as evidenced by FNAC. 6. To evaluate the incidence of euthyroid goiters at the pediatric endocrinology department of Institute of Child Health and Hospital for Children 7. To compare this study with other similar kinds of studies. DISCUSSION: The present study depicts that the incidence of grade II euthyroid goiters is 1.5% in the pediatric population aged 6 to 12 in the endocrinology department of Institute of Child Health and Hospital for Children. This could only be tip of the ice berg as this is hospital based and not community based study. The occurrence of euthyroid goiter depends on the endemicity of the area. The incidence is more in the endemic zones when compared to non endemic areas. This could be because of the difference in the iodine content of the soil in different places. Generally higher altitude areas which are above the sea level are endemic zones of euthyroid goiters as the iodine content of the soil and hence that of the vegetables and fruits grown in that soil is generally deficient. Also sea food is a rich source of iodine which is not available at high altitudes.4, 5 In the present study we found that the most common cause of euthyroid goiter in pediatric population aged 6 to 12 is probably iodine deficiency as 91.9% of the children studied had iodine deficiency with mild iodine deficiency being most common at 77%. World over the most common cause of euthyroid endemic goiters is iodine deficiency. This is again substantiated in our study. This shows that even in a non goiters in children observed significant decline of more than 20% in children with euthyroid goiter on levothyroxine suppressive therapy for 12 months. They found the goiter size to increase on discontinuation of therapy. Celani MF12 in his study with multinodular goiters found nodules behaving variably with a decrease by 50% or more or nil on levothyroxine suppressive therapy. Wilders-Truschnig MM, et al13 in their study on 37 euthyroid patients concluded that levothyroxine as well as iodine was effective in reducing the thyroid size. Einenkel D, et al14 in there study on treatment of juvenile goiter with three groups of 30 each with levothyroxine, iodide or a combination of both found a decrement of 41%, 52% and 52% respectively. When the treatment was discontinued for three months, thyroid volume increased again in the levothyroxine group but not in the iodide group. CONCLUSION: 1. The cosmetic misery of Euthyroid goiters in children was focused in the present study. 2. Deficiency of iodine necessary for hormonogenesis and prevention of goiters is the most common cause resulting in Euthyroid goiters which is well substantiated in our study. 3. Suppressive levothyroxine therapy for a destined period of 6 months resulted in appreciable decline in the size of the goiter both clinically and when viewed through sonologically, thus comforting the patients. 4. This study thus proves the usefulness of levothyroxine therapy in these subjects. The usage of iodine will further prove to be helpful in reducing the goiter size, more so with Hashimoto’s thyroiditis along with levothyroxine therapy. 5. Reversible iatrogenic sub clinical hyperthyroidism is observed in quite a number of patients in this study. 6. This study is the first institution based amongst South Indian children which unravels the usefulness of measuring urinary iodine in all Euthyroid goiters which will give an insight into management protocol and highlights the usefulness of levothyroxine suppressive therapy. 7. Though the study is done in fewer sample size, future studies in larger numbers will be more useful and meaningful to substantiate our findings.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Profile ; Euthyroid Goiters ; Children ; Role ; Levothyroxine
Subjects: MEDICAL > Paediatrics
Depositing User: Ravindran C
Date Deposited: 20 Apr 2018 07:20
Last Modified: 20 Apr 2018 07:20

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