Endemic goiter in a child (Endocrinology)

Deepthi. M., MBBS, MS IN ENT


Medical Case Details:

A 10 year old girl presented with a diffuse thyroid enlargement. She is a resident of an endemic area for goiter and fluorosis. Her thyroid profile shows TSH and T3 levels to be within normal limits, but her T4 levels are marginally high. Does she require treatment? If yes, what would it be?



    Dr. Arvind Guru
    General Surgeon

    Are the levels free or total ? do mention them.
    How significant is the thyroid enlargement ? could it be physiological ?

    11.Jul, 11:08pm

    Dr. Deepthi. M
    ENT Otolaryngologist

    These are free T4 levels which are found elevated.should u consider for anti thyroid drugs ? In view of thyroid enlargement can u leave alone the child without treatment considering physiological.thyroid gland is showing moderate enlargement of size 7×6cm each gland.

    12.Jul, 11:24am

    Dr. Gulati Ranjitsingh Awtarsingh
    Internal Medicine Physician

    These are the physiological changes in a 10yr old girl. No anti-thyroid treatment is required. But do get D3 level done. Give D3 if it is low.

    13.Jul, 12:54pm

    Dr. Madhumati Varma

    It looks like physiology changes of age of age.

    13.Jul, 06:19pm

    Dr. Deepthi. M
    ENT Otolaryngologist

    Kk thank u all

    13.Jul, 09:01pm

    Dr. Arvind Guru
    General Surgeon

    If the child is asymptomatic ( for clinical features of hyperthyroidism - vitals, weight and growth parameters, bowel habits, temperature senstivity, appetite, any other autoimmune diseases etc. ) then the enlargement would be physiological.

    Any USG thyroid ? MNG ? Homogeneous

    I would have appreciated the actual TFT levels rather than high or normal including TPO antibodies, but anyways.

    14.Jul, 11:14am

    Dr. Prabhakar Laxman Jathar

    It is essential to mention all the levels like T4, T3 and mainly TSH. If anti TPO antibodies are tested that also should be stated. If the child is asymptomatic it is better to wait. However, it is mentioned that child comes from the endemic area, so there is a greater possibility of hypothyroidism. What about the child's intelligence and physical growth? There is no mention of that. Thanks.

    15.Aug, 01:11pm

    Dr. Janrao Smit Uttam
    Internal Medicine Physician

    Hi, as per the information given in your query, Thyroid function test should be repeated after 6 to 8 weeks and Thyroid enlargement should be evaluated with the help of local USG THYROID and Thyroid scan.

    26.Aug, 12:44pm

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