A 6-year-old girl is brought to the clinic by her parents who report that she has not grown well since infancy despite adequate nutrition. On examination, she is at the 3rd percentile for height, has a broad, flat nasal bridge, periorbital puffiness, coarse facial features, and delayed speech development. Her skin appears dry and her hair is brittle. Serum TSH is 18.2 mIU/L, free T4 is 0.4 ng/dL (normal 0.8-1.8), and thyroid peroxidase (TPO) antibodies are negative. Newborn screening records from birth are unavailable. Which of the following is the most likely diagnosis?
- A)Acquired autoimmune hypothyroidism (Hashimoto's thyroiditis)
- B)Central hypothyroidism secondary to pituitary hypoplasia
- C)Iodine deficiency hypothyroidism
- D)Congenital hypothyroidism with delayed diagnosisGABARITO
- E)Primary hypothyroidism secondary to thyroid hormone resistance
Explicação
Congenital hypothyroidism (primary thyroidism with elevated TSH and low free T4) presents with growth retardation, developmental delay, coarse facial features, dry skin, and brittle hair when diagnosis is delayed beyond the newborn period. The absence of TPO a... Ver explicação completa e trilha adaptativa →