The diagnosis of hypothyroidism in a typical clinic is not difficult. In doubtful cases, a therapeutic test can help the recognition of the disease – the patient’s response to a specific treatment. Patients with hypothyroidism are very sensitive to thyroidin and even respond to small doses. With a daily intake of 30-180 mg of thyroidin after 3 to 4 weeks, a decrease in body weight due to the release of excess interstitial fluid, a marked decrease in blood cholesterol, an increased excretion of creatinine in the urine, the disappearance of a grayish-pale skin color, an increase in body temperature and activity of the child . Taking thyroidin for two months or more has a positive effect on accelerating bone growth and development, and improving ossification. A decrease in plasma cholesterol during treatment can serve as a relative diagnostic sign.
Differential diagnosis of hypothyroidism
The differential diagnosis is carried out with chondrodystrophy, rickets, cretinism, Down’s disease, pituitary dwarfism, gargoyleism.
The prognosis of the disease depends on the timeliness of treatment: started at the age of one year and later in 40% of cases is ineffective, the intellectual coefficient of sick children remains below 50%; begun up to six months allows half the patients to achieve an intellectual coefficient of 90% or more (M. A. Zhukovsky).
Of great importance is replacement therapy. The results of treatment largely depend on the duration of the disease, the degree of hypofunction of the thyroid gland, the patient’s age at the beginning of treatment, and the rationality of replacement therapy. Substitution therapy is carried out with a dried thyroid drug – thyroidin (inside after eating, preferably in 2 divided doses). The dose is determined individually, taking into account the degree of thyroid deficiency, the tolerance of the drug, as well as under the control of SBI and BEI. In all cases, treatment, regardless of the age of the child, begins with small doses and gradually increases them to individually necessary. For young children, the initial dose of thyroidin can be 15 to 20 mg / day. If improvement does not occur, the dose is increased every 7-10 days by 10-15 mg until the euthyroid state is reached. Practice shows that a dose of thyroidin of 45-60 mg / day is sufficient for a child under the age of one year with a pronounced form of hypothyroidism. Children aged 1-3 years begin treatment with 30-40 ml / day and gradually increase to 45-150 mg, sometimes up to 180 mg; for children under 5 years of age, the estimated therapeutic dose of thyroidin is an average of 200 mg / day (E.P. Tikhonova, 1973). When the effect is achieved, when the growth ends, the symptoms of hypothyroidism decrease or disappear, treatment should be continued with maintenance doses with a gradual decrease. Monitoring of treatment should be carried out systematically, at least once a month. Signs of an overdose of the drug: increased irritability, tachycardia, arterial hypertension. In severe forms of hypothyroidism, thyroidin and triiodothyronine hydrochloride are combined. The introduction of both thyroid hormones into the body is more physiological and effective (V. R. Klyachko). Vitamin therapy (retinol, ascorbic acid, pyridoxine, cyanocobalamin, etc.), the appointment of heart remedies and small doses of diuretics, good nutrition, adequate exposure to fresh air, physiotherapy exercises, and pedagogical education are essential in the complex treatment of thyroid insufficiency. In post-infectious hypothalamic-pituitary insufficiency with the development of secondary hypothyroidism, anti-inflammatory therapy is indicated.