CLINICAL CASE OF DIFFUSE TOXIC GOITER IN THREE YEARS OLD CHILD
About the author:
Tsvirenko S. M., Fastovets M. M., Pokhylko V. I., Kaliuzhka O. O., Cherevko I. G.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The problem of thyroid pathology (thyroid gland) of children and adolescents in Ukraine has been urgent for a long time. The high frequency of thyroid disease is explained by many reasons, including genetic predisposition, high prevalence of iodine deficiency, high technogenic load, eating disorders and social factors. Diseases of the thyroid gland make up 14% of all endocrine diseases in children. According to literature data, pediatric patients account 1–6% of all cases of diffuse toxic goiter. The peak of the disease is observed in puberty, but diffuse toxic goiter can occur also in newborns. The disease is 6–8 times more often occurs in girls than in boys. Characteristic clinical manifestations of the manifestation of diffuse toxic goiter in children are diffuse thyroid hypertrophy (diffuse goiter) and manifestations of thyrotoxicosis associated with hyperproduction of thyroid hormones. The article presents our clinical observation of the case of the first detected diffuse toxic goiter in a child of 3 years of age. The child was hospitalized with complaints of pain in the area of the heart, heart palpitations, fatigue, which arose after acute respiratory infection. It was established a diagnosis of secondary cardiomyopathy, a course of treatment was conducted. In two months after the discharge, the mother of the child applied for medical assistance with complaints that during the last two weeks, the child had irritability, aggressiveness, fatigability, sweating, increased appetite, and accelerated heartbeat. ZAK, biochemical analysis of blood, electrolyte blood composition, ZAC, EchoKS were without significant changes. Thyroid panel was: TTG – 0.009 μM/ml, free T4> 7.77 ng/dl, ATPO – 10.57 IU/ml. The ECG recorded sinus tachycardia up to 162 beats/min, aberrant conduction along the right stalk of the Gisson bundle, reduced processes of repolarization in the myocardium of the posterior wall of the left ventricle. The ultrasound of the thyroid gland showed that its total volume was increased to 6.5 cm³, the contours were clear and smooth, the capsule was not sealed, the echostructure of the parenchyma was homogeneous. Ophthalmologist: the anterior chambers were not changed, the discs of the optic nerve were in the norm, the vessels were normal, orthophore. Cardiologist: nonparoxysmal sinus tachycardia, CH0, secondary cardiomyopathy against the background of diffuse toxic goiter. Based on the clinical symptoms, the dynamics of the disease, and the results of additional methods of examination, a clinical diagnosis was established: «Diffuse toxic goiter of the second stage, severe form. Secondary cardiomyopathy. Heightenedness». Tyreostatic, β-adrenoblocking, sedative, hepatoprotective, metabolic therapy led to normalization of pulse, the disappearance of clinical manifestations of thyrotoxicosis, positive dynamics of the processes of repolarization of the posterior wall of the left ventricle. In satisfactory condition, the child was discharged from the hospital. Against the background of the treatment we observed normalization of the pulse, the disappearance of clinical manifestations of thyrotoxicosis, ECG showed positive dynamics of the processes of repolarization of the posterior wall of the left ventricle. The clinical picture of diffuse toxic goiter in young children is not always clearly defined, which leads to difficulties in the diagnosis of the disease. Given the fact that early thyrotoxicosis is a fairly rare disease, the clinical case of diffuse toxic goiter in our 3-year-old child with a lack of eye symptoms of thyrotoxicosis demonstrates the need for caution of general practitioners and pediatricians regarding the onset of thyrotoxicosis in young children when detected accelerated physical development, pathology of the cardiovascular system, accompanied by a stable tachycardia, in them.
diffuse toxic goiter, thyrotoxicosis, children of early age.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (152), 2019 year, 209-213 pages, index UDK 616.441-008.61-053.4-456.03