Cretinism – Hypothyroidism

by Carlo Raj, MD

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    If Hashimoto is to a female, older adult, cretin… cretinism is to a child. This one we can walk through quickly. Iodine lacking in a pregnant woman resulting in decreased thyroid hormone nourishment to the foetus; enzymatic deficiency in the foetal thyroid gland resulting in lack of T3, T4. Failure of the thyroid gland to properly descend into the neck where it should belong or anti-thyroid antibodies from the mother attacking the foetal thyroid, therefore may result in cretin. What’s cretinism? Can’t miss this child, unfortunately, a new born, short stature; take a look at the face, puffy. I want you to specifically look at the mouth, see how large it is? Because the tongue inside is macroglossic. If you take a look at the stomach, it’s enlarged. If you were to take a look at the skin in colour, you’d probably expect them to be yellow, why? Not because of jaundice… do not confuse this with kernicterus… this is accumulation of keratin. Short stature, coarse facial features, large tongue, protuberant abdomen and umbilical hernia and IQ in this child unfortunately very, very low. Let’s talk about myxoedema and hypothyroidism and this would be for an adult. Take a look at the face in this patient on the left with hypothyroidism. The patient was then treated with synthroid. Upon administration, you’ll notice that months afterwards, on your right, the same patient, the puffiness on the face has now become diminished. The myxoedema subsides upon administration of synthroid in a patient with hypothyroidism. Would you expect such puffiness in a patient with Graves’ disease? Not at all, the myxoedema that you find in Graves’ disease will be located most likely pretibial. Remember I showed you and have shown you pretibial myxoedema along with dermopathy of Graves’? This however is myxoedema in...

    About the Lecture

    The lecture Cretinism – Hypothyroidism by Carlo Raj, MD is from the course Thyroid Gland Disorders.

    Included Quiz Questions

    1. Thyroidal aplasia
    2. Maternal iodine deficiency
    3. Fetal thyroid enzyme deficiency
    4. Failure of thyroid to descend in fetus
    5. Anti-thyroid hormone from mother
    1. Lack of philtrum
    2. Macroglossia
    3. Mental retardation
    4. Protuberant abdomen with umbilical hernia
    5. Short stature
    1. Glycosaminoglycans and hyaluronic acid
    2. Lymphocytes and eosinophils
    3. Albumin and plasma
    4. LDL and fatty acids
    5. Thyroid hormone bound to TBG
    1. Myxedema coma
    2. Hypoxic brain injury
    3. CVA
    4. Thyroid encephalopathy
    5. Locked in syndrome
    1. Elevated TSH with normal free T4
    2. Elevated bound T4 with normal free T4
    3. Normal TSH with low free T4
    4. Elevated TBG with normal TSH
    5. Low free T3 with normal free T4

    Author of lecture Cretinism – Hypothyroidism

     Carlo Raj, MD

    Carlo Raj, MD

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