Paeds Vivas · endocrinology-diabetes-and-growth
Acquired hypothyroidism and Hashimoto thyroiditis — viva
Branching structured oral on acquired hypothyroidism and Hashimoto thyroiditis.
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Prompt
A growth chart shows a 13-year-old girl whose height has crossed from the 50th to the 25th centile over eight months while her BMI has risen. She is tired, constipated and her grades have slipped. A firm, bosselated goitre is present. You are the paediatric registrar in clinic.
Opening (must-hit)
"I will confirm the diagnosis with venous TSH and free T4 and anti-TPO antibodies, classify it as overt, subclinical or central, start weight-based levothyroxine for overt primary disease, recheck at six weeks titrating to a normal TSH, and screen for the associated autoimmune conditions — type 1 diabetes, coeliac disease, and in Down or Turner syndrome the annual surveillance that should already be running." [1][3]
References7ShowHide
- [1]Bhattacharyya SS Acquired Hypothyroidism in Children. Indian Journal of Pediatrics, 2023.PMID 37256446
- [2]Rodriguez L, et al. Treatment of hypothyroidism in infants, children and adolescents. Trends in Endocrinology and Metabolism, 2022.PMID 35537910
- [3]Hanley P, Lord K, Bauer AJ Thyroid Disorders in Children and Adolescents: A Review. JAMA Pediatrics, 2016.PMID 27571216
- [4]Diaz A, Lipman Diaz E Hypothyroidism. Pediatrics in Review, 2014.PMID 25086165
- [5]Salerno M, et al. Management of endocrine disease: Subclinical hypothyroidism in children. European Journal of Endocrinology, 2020.PMID 32580145
- [6]Caturegli P, De Remigis A, Rose NR Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmunity Reviews, 2014.PMID 24434360
- [7]Jonklaas J, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid, 2014.PMID 25266247