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Abnormal thyroid function in paediatric practice
  1. Yee Lin Lee1,2,
  2. Fabian Yap2,
  3. Rashida Farhad Vasanwala2
  1. 1Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
  2. 2Department of Paediatric Endocrinology, KK Women’s and Children’s Hospital, Singapore, Singapore
  1. Correspondence to Dr Yee Lin Lee, Department of Paediatrics, Universiti Putra Malaysia, Malaysia; yeelin{at}upm.edu.my

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Four patients of term gestation were under review following the identification of abnormal thyroid function test (TFT). Patient 1 presented at 2 months of age with prolonged jaundice and cholestatic liver disease. Patient 2 presented at 1 month of age with prolonged jaundice and transaminitis. Both babies were active, thriving and did not have any feeding problems. Patient 3 had respiratory distress with hypotonia at birth and was treated for presumed Group B Streptococcus sepsis during the first week of life. He had soft dysmorphic features of hypertelorism, low set ears and retrognathia, poor suck and oropharyngeal dysphagia. He developed prolonged jaundice with transaminitis at 1 month of age and was developmentally delayed. Patient 4 presented at 19 months of age with faltering growth. Table 1 shows their cord blood thyroid stimulating hormone (TSH) screening and thyroid function trends following their presentation.

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Table 1

Thyroid function trends in these patients

Question 1

What is the most likely diagnosis in these patients?

  1. Primary hypothyroidism with delayed TSH rise.

  2. Central hypothyroidism.

  3. Euthyroid sick syndrome.

  4. Thyroid binding globulin deficiency.

  5. Transient hypothyroxinaemia.

Question 2

How would you manage them during follow-up? (choosing more than one option is …

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