A



SYNOPSIS OF DISSERTATION FOR SUBMISSION TO ETHICAL COMMITTEE OF AJ INSTITUTE OF MEDICAL SCIENCES MANGALORE

|1 |Name of the Candidate and Address |DR. NISHA CHACKO, |

| | |Department of Paediatrics, |

| | |A.J Institute of Medical Sciences, Kuntikana, Mangalore |

|2 |Name of the Institution |A.J Institute of Medical Sciences (Rajiv Gandhi University), |

| | |Kuntikana, Mangalore |

|3 |Course of Study and Subject |M.D. in Paediatrics |

| | |(3 Years Degree Course) |

|4 |Date of Admission to the Course |25 th May,2009 |

|5 |Title of the Topic: |“CLINICAL STUDY OF CONGENITAL HYPOTHYROIDISM AND ITS CORRELATION |

| | |WITH TECHNETIUM SCAN ”. |

|6. |BRIEF RESUME OF THE INTENDED WORK: |

| |6.1 Need for the study |

| |Congenital hypothyroidism (CH) can be defined as a lack of thyroid hormones present from birth which unless detected and |

| |treated early, is associated with irreversible neurological problems and poor growth. |

| |Congenital hypothyroidism is twice as common in girls as boys. The clinician is dependant on neonatal screening test for |

| |diagnosis of congenital hypothyroidism. Before neonatal screening programs, congenital hypothyroidism was rarely |

| |recognised in new born because the signs and symptoms are not sufficiently developed. It can be suspected and the |

| |diagnosis established during the early weeks of life if the initial, but less characteristics manifestations are |

| |recognised. Prolongation of physiological jaundice, feeding difficulties, especially sluggishness, lack of interest and |

| |choking spells during nursing are often present during the first months of life. Typical respiratory distress syndrome |

| |may occur. Affected infants cry little, sleep much, have poor appetite. There may be constipation that usually does not |

| |respond to treatment. 8 |

| |Hypothyroidism is one of the most common and treatable endocrine disease in which there is insufficient amount of thyroid|

| |hormones.Its absence causes mental and physical slowing, poor resistance to cold and in children, mental retardation and |

| |dwarfism. The overall prevalence of Congenital Hypothyroidism (CH) is 1 per 4000 while that of acquired hypothyroidism is|

| |1:500-1000. |

| |The most serious ill effect of congenital hypothyroidism is permanent brain damage and the ensuing mental |

| |retardation.Early diagnosis is essential,but diagnosis on clinical ground alone in the neonatal period is difficult |

| |because of the paucity of signs and symptoms which are often subtle and non specific. |

| |6.2 Review of Literature |

| |A study was done in Japan and published in Endocrinology Journal 2002 June;49(30):293-7.According to this study, |

| |ultrasonographic images of the thyroid gland with a high-resolution transducer were obtained in 204 healthy infants aged |

| |from newborn to 12 months (Group A), and 174 infants suspected of having CH detected by neonatal mass screening (Group |

| |B). The thyroid gland was imaged by transverse scanning at the anatomic site of the thyroid gland. By comparing with the |

| |normal thyroid gland size and location obtained from Group A, 174 infants of Group B were divided into four subgroups: 1)|

| |Normal in size (n = 117), 2) Enlarged (n = 33), 3) Small (n = 1) and 4) Invisible in the normal location (n = 23). They |

| |were compared with the final diagnoses based on the results of chemical laboratory data and scintigraphic findings.It was|

| |concluded that, ultrasonography is useful for determining the presence or absence of the thyroid gland in the normal |

| |location, whereas normal and enlarged sized glands require further examination to complete the diagnosis.1 |

| |A study was done in Oakland,USA and published in NJEP Pediatrics. 2004 Dec;114(6):e683-8 .This study was done to define |

| |the role of thyroid scintigraphy in diagnosing and managing newborn CH.It was concluded that,Initial laboratory diagnosis|

| |is simple and sufficiently accurate; treatment is simple, inexpensive, and effective. Severe mental retardation and |

| |growth failure can be prevented. Considering today's rapid advances in understanding the basic mechanisms of thyroid |

| |embryogenesis and gene abnormalities, thyroid scintigraphy may provide insight into clinical and genetic correlates in |

| |CH.2 |

| |A study was done in 2002 and published in J Trop Pediatr.J 2006 Dec;52(6):411-5. Epub 2006 Aug 30. The aim of this study|

| |was to evaluate thyroid scintigraphy (TS) findings in infants with CH and to determine the relationship of serum TSH and |

| |T4 values with thyroid agenesia, in an attempt to identify factors that may detect thyroid agenesia before treatment. It |

| |was concluded that Tc-99m TS is a useful diagnostic tool for the initial investigation of suspected CH and considering |

| |the correlation of TS results with blood TSH levels, proper management and close monitoring of hypothyroid infants with |

| |severe hormonal alterations is necessary for the detection of thyroid agenesia.3 |

| |A study was published in Journal of Paediatrics,volume 144,Issue 6 (June 2004)the year 2004.This study was done to know |

| |if congenital hypothyroidism had succeeded or not.It was concluded that early diagnosis and treatment would prevent the |

| |progressive brain damage typically seen in late treated cretinism.Mental retardation has been eradicated and affected |

| |individuals show normal development and achievements into adulthood.4 |

| |A study was done in Indiana University School of Medicine in the year 2004 and published Indiana Journal of |

| |Paediatrics.2004 May;144(5):643-7 .In this study children above 3 years of age without any identified permanent cause |

| |were asked to discontinue thyroxine for a period of 4 weeks and thyroid function tests and thyroid ultrasound were |

| |obtained.An abnormal ultrasound was followed by Technetium scan.The conclusion was that a significant percentage of |

| |children with congenital hypothyroidism have a transient requirement tor thyroid hormone and its safe to discontinue |

| |thyroxine for a period of 4 weeks in children above 3 years of age.5 |

| |A study was done and published in the year 2006 in the American Academy of Paediatrics. According to this study, if |

| |congenital hypothyroidism is detected early in infants and treatment begun,normal development of mental function can |

| |occur.If treatment is delayed spasticity,gait problems and dysarthria and profound mental disability may result.For |

| |reaching this conclusion,developmental quotient and ability asessment covering the 4 areas were considered 6 |

| |A study was conducted in the year 2008 and published in Acta Paediatrica,volume 79 Issue 12,pages 1194-1198.This study |

| |comprised of 54 neonates with congenital hypothyroidism identified by North East and North West Thames Regional |

| |hypothyroid screenig programme..In this study,comparison of radioisotope and ultrasound imaging in 54 cases of congenital|

| |hypothyroidism was pared to the radioisotope scans,ultrasound identified normally sited thyroid tissue in only 7 |

| |out of 10 cases and ectopic thyroid tissue in only 5 out of 26 cases.Three out of 18 cases with no isotope uptake in the|

| |neck appeared to have normally sited tissue on ultrasound.Therefore, it was concluded that ultrasound of the neck has |

| |only limited value in the assessment of young infants with congenital hypothyroidism.7 |

| | |

| |6.3 Objective of the Study |

| |Primary: |

| |To find out the common presenting features of congenital hypothyroidism. |

| |To correlate the clinical features and T3, T4,TSH values with ultrasound and Technitium scan findings. |

| |To identify the etiology of congenital hypothyroidism in children who were previously diagnosed to have |

| |congenital hypothyroidism |

| |Secondary: |

| |1. To find out the male:female ratio |

| |2. Outcome of the study by anthropometric assessment, assessment of developmental milestones and academic |

| |performance |

| |3.To compare the sensitivity of ultrasound neck and Technetium |

| |scan. |

|7. |Materials and Methods: |

| |7.1 Source of Data |

| |It is a hospital based study.Eligible subjects were children who were detected to have congenital hypothyroidism before 1|

| |year of age and presently above the age of 3 years,on thyroxine and all freshly detected cases of congenital |

| |hypothyroidism below 1 year of age. After thyroxine was discontinued for 4 weeks, thyroid function tests, ultrasound neck|

| |and Technetium scan were obtained. |

| | |

| | |

| | |

| |7.2 Method of the Collection of the Data |

| |Study Design: Two year clinical study |

| |Sample size: 30 children |

| |Sample: It is a hospital based study. |

| |1.All babies that were diagnosed to have hypothyroidism at birth or fresh cases below 1 yr of age ,prior to the |

| |initiation of thyroxine . |

| |2.Those children who were detected to have hypothyroidism within the 1st year of life and presently above 3 yrs of age |

| |in A.J. Hospital, Mangalore. |

| |Place: A.J.Hospital, Kuntikana, Mangalore |

| |Duration: Two years from December 2009 to December 2011. |

| |Method: All those children above 3 yrs of age who were diagnosed to have congenital hypothyroidism on thyroxine, are |

| |advised to stop thyroxine for a period of 4 weeks and all newly detected cases of congenital hypothyroidism are subjected|

| |for thyroid function test.All children with abnormal thyroid function are subjected to an ultrasound neck and Technetium |

| |scan. |

| |Outcome of the study is detected by assessing the development, anthropometry, academic performance ,ultrasound neck and |

| |Technetium scan findings. |

| |Inclusion Criteria |

| |1.Children below 16 and above 3 years of age who were diagnosed to have hypothyroidism before 1 year of age on thyroxine.|

| |2.All freshly detected cases of congenital hypothyroidism below 1 year of age prior to starting thyroxine. |

| | |

| |Exclusion Criteria |

| | |

| |1.Babies who were diagnosed to have hypothyroidism after 1 year of age. |

| |2.Children presenting with clinical features of hypothyroidism after 1 year of age. |

| |3.Babies with metabolic or neurodegenerative diseases. |

| |4.Babies with chromosomal or genetic defects |

| | |

| |Data Analysis: |

| |7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If|

| |so, please describe briefly. |

| |Yes |

| |1.Stopping of thyroxine for a period of 4 weeks |

| |2.Ultrasound neck and Technitium scan for finding out the underlying etiology |

| | |

| | |

| | |

| | |

| | |

| |List of References |

| |1.Ohnishi H, Inomata H, Watanabe T, Wataki K, Sato H, Sanayama K, Noda H, Yasuda T, Niimi H |

| |Clinical utility of thyroid ultrasonography in the diagnosis of congenital hypothyroidismEndocr J. 2002 |

| |Jun;49(3):293-7 |

| |2. Schoen EJ, Clapp W, To TT, Fireman BH |

| |The key role of newborn thyroid scintigraphy with isotopic iodide (123I) in defining and managing congenital |

| |hypothyroidismPediatrics. 2004 Dec;114(6):e683-8 in NJEP |

| |3.Iranpour R, Hashemipour M, Amini M, Talaei SM, Kelishadi R, Hovsepian S, Haghighi S, Khatibi Kh |

| |[Tc]-99m thyroid scintigraphy in congenital hypothyroidism screening program: J Trop Pediatr. 2006 Dec;52(6):411-5. Epub |

| |2006 Aug 30 |

| |4.Mosby, Inc.  - In search of the optimal therapy for congenital hypothyroidism.. |

| |Journal of Pediatrics - Volume 144, Issue 6 (June 2004)   |

| |5.Eugster EA, LeMay D, Zerin JM, Pescovitz O, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. |

| |.Definitive diagnosis in children with congenital hypothyroidism. 1: J Pediatr. 2004 May;144(5):643-7. |

| |6.Guidelines of congenital hypothyroidism (American Academy of Paediatrics) Update of newborn screening and therapy for |

| |congenital hypothyroidism. Paed 2006 June, 117(6):2290-303(Pubmed) |

| |7. Acta Pædiatrica |

| |Volume 79 Issue 12, Pages 1194 - 1198 |

| |Published Online: 21 Jan 2008 |

| |Journal Compilation © 2009 Foundation Acta Pædiatrica |

| |Neonatal Hypothyroidism:Comparison of radioisotope and ultrasound imaging in 54 cases of congenital hypothyroidism |

| |8.Nelson Text book of Paediatrics(2008 edition)Topic:Hypothyroidism,page no.2319 |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

[pic]

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download