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LETTER TO THE EDITOR
Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 41-42

Undiagnosed juvenile hypothyroidism and resultant irreversible brain damage: Cannot we do anything?


Department of Medicine, Midnapore Medical College and Hospital, Paschim Medinipur West Bengal, India

Date of Web Publication20-Feb-2017

Correspondence Address:
Partha Pratim Chakraborty
House No.: BE 64, Bidhan Nagar (East), P.O.: Midnapore, Paschim Medinipur - 721 101, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.200565

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How to cite this article:
Chakraborty PP, Biswas SN. Undiagnosed juvenile hypothyroidism and resultant irreversible brain damage: Cannot we do anything?. Thyroid Res Pract 2017;14:41-2

How to cite this URL:
Chakraborty PP, Biswas SN. Undiagnosed juvenile hypothyroidism and resultant irreversible brain damage: Cannot we do anything?. Thyroid Res Pract [serial online] 2017 [cited 2017 Jul 26];14:41-2. Available from: http://www.thetrp.net/text.asp?2017/14/1/41/200565

Sir,

Thyroid disorders, one of the most common endocrine diseases across the globe, affect an estimated 42 million people in India.[1] Untreated hypothyroidism during infancy and childhood is well known to have significant detrimental effects on skeletal growth, sexual maturation, and cognitive ability.[2] Much has been said and done regarding universal screening to diagnose neonatal hypothyroidism which essentially requires resources rather than clinical acumen. Diagnosing juvenile hypothyroidism, on the other hand, requires sound knowledge and clinical skills on part of the treating physicians.

In this letter, we would like to share the stories of three patients (aged 19 years, 25 years, and 28 years) suffering from long-standing undiagnosed juvenile hypothyroidism, encountered in last 2 months, having identical presentations with short stature and severe mental retardation [Figure 1], [Figure 2], [Figure 3]. Clinical examination revealed telltale features of primary hypothyroidism with coarse, dry skin, hoarse voice, and grossly delayed relaxation of ankle jerks. Bone ages were grossly delayed (<10 years) in all of them. Thyroid function tests were suggestive of primary hypothyroidism with negative thyroid autoantibodies. Imaging studies revealed eutopic but atrophic thyroids and epiphyseal dysgenesis.
Figure 1: A 19-year-old girl with short stature, delayed puberty, and coarse dry skin

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Figure 2: A 25-year-old lady with short stature and delayed puberty

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Figure 3: A 28-year-old male with short stature and macroorchidsm

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Developmental milestones remained normal with respect to motor, language, and socio-adaptive skills until the ages of 6, 7, and 6 years, respectively, effectively ruling out the possibility of congenital hypothyroidism. However, motor skills, intellectual abilities and socio-adaptive developments declined progressively with age and they failed to catch up with normal growth. Heralding from the lowest rungs of the society, they had poor access to educational and health-care facilities while seemingly lacking health-related awareness. Treated by quacks/unskilled primary care physicians in the remote areas of the country, they never enjoyed the benefits of comprehensive health-care facilities since birth.

The above cases highlight a major shortcoming in our health-care system where illiteracy, lack of health-related awareness, and shortage of properly trained medical personnel in rural areas often lead to failure in diagnosing a straightforward case of hypothyroidism, the most common treatable cause of impaired intellectual ability and growth in children.

The Public Health Foundation of India and Chellaram Diabetes Institute have recently launched a unique certificate course in “Management of thyroid disorders” aimed at enlightening primary care physicians to address this issue. A similar initiative has been proposed by the Government of West Bengal in recent times to educate the ill-trained quacks, who unfortunately remain the sole health-care providers to majority of people living in remote areas of the state. It is only through proper training we can build capacity among quacks and primary care physicians for diagnosis, management, and referral of thyroid-related illnesses.[3] The exchange of thoughts regarding advances in genetics, laboratory techniques, and therapeutics in thyroid disorders during the ITSCON has remained a prerogative of the privileged few. We as physicians must engage more in serving the rural population and empower the primary care physicians. We believe that the Indian Thyroid Society, in all its capacity, can play an enormous role in reaching out to the remote and underprivileged. Needless to say, it is our compassion that makes us human beings.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab 2011;15 Suppl 2:S78-81.  Back to cited text no. 1
    
2.
Seth A, Maheshwari A. Common endocrine problems in children (hypothyroidism and type 1 diabetes mellitus). Indian J Pediatr 2013;80:681-7.  Back to cited text no. 2
    
3.
Desai MP. Disorders of thyroid gland in India. Indian J Pediatr 1997;64:11-20.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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