Samenvatting
Background: Hypothyroidism can present atypically making its recognition difficult especially in resource limited settings.
Case presentation and management: Two children presented with atypical features of hypothyroidism with resultant delay in diagnosis. Patient I presented with persistent respiratory distress, facial swelling and recurrent syncopal attacks. Cardiovascular examination was normal except for pulmonary hypertension. He did not respond to conventional supportive therapy and hypothyroidism was discovered much later. Patient II was a seven month old male infant with abdominal swelling, bilateral pitting leg oedema, poor weight gain and delayed developmental milestones. Examination revealed ascites and pericardial effusion. He was being managed for protein energy malnutrition until he was found to have hypothyroidism and was successfully managed with L thyroxin.
Conclusion: A typical presentations of hypothyroidism in resource limited settings can result in delay in diagnosis and treatment which can lead to unnecessary morbidity and mortality. High index of suspicion and expertise are therefore required.
Keywords: hypothyroidism, congenital abnormalities, atypical presentations, thyroid screening
Résumé
Contexte: L’hypothyroïdie peut se présenter de manière atypique donc faisant son identification difficile, surtout dans les pays à ressources limitées. Présentation de cas et gestion: Deux enfants présentaient avec des caractéristiques atypiques de l’hypothyroïdie avec un résultant en retard de diagnostic. Patient I présentais avec détresse respiratoire persistante, gonflement du visage et des attaques syncopales récurrentes. Examen cardiovasculaire était normal sauf pour l’hypertension pulmonaire artérielle. Il n’a pas répondu à une thérapie d’appui conventionnelle et l’hypothyroïdie a été découverte beaucoup plus tard. Patient II était un nourrisson de sexe masculin, âgé de sept mois, avec un gonflement abdominal, enflure d’œdème bilatérale des jambes, pauvre gain de poids et étapes de développement retardés. L’examen a révélé des ascites et effusion péricardique. Il était sous gérance pour malnutrition en protéine énergétique, jusqu’à ce qu’il était constaté d’avoir l’hypothyroïdie et a été géré à succès avec thyroxine L.
Conclusion: Une présentation typique de l’hypothyroïdie dans les lieux avec ressources limitées peut entraîner un retard dans le diagnostic et traitement ce qui peut conduire à la morbidité et mortalité inutile. Haut indice de suspicion et expertise sont donc requis.
Mots-clés: hypothyroïdie, anomalies congénitales, présentations atypiques, dépistage de la thyroid
Correspondence: Dr. Folusho M Balogun, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: folushom@yahoo.com
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