A 2-month-old infant presented to the clinic with a history of prolonged jaundice, constipation, large tongue, and mottled dry skin. There is a positive family history of autoimmun... A 2-month-old infant presented to the clinic with a history of prolonged jaundice, constipation, large tongue, and mottled dry skin. There is a positive family history of autoimmune disease. Given the lab results showing abnormal thyroid hormone levels (high TSH, low T4 and T3), which of the following is the most appropriate step in management? A. Oral thyroxine for 1 month B. Life-long thyroxine replacement C. Repeat the blood test after 1 month D. Prednisolone replacement for 6 weeks.
Understand the Problem
The question describes a 2-month-old infant presenting with symptoms and lab results indicative of hypothyroidism. The key features are prolonged jaundice, constipation, large tongue, mottled dry skin, and a positive family history of autoimmune disease. Critically, the lab results show significantly elevated thyroid-stimulating hormone (TSH) and low thyroxine (T4) and triiodothyronine (T3) levels. We need to determine the most appropriate next step in the management of this infant. The elevated TSH indicates primary hypothyroidism, meaning the thyroid gland is not producing enough thyroid hormone.
Answer
Life-long thyroxine replacement.
Given the infant's symptoms (prolonged jaundice, constipation, large tongue, mottled dry skin), positive family history of autoimmune disease, and lab results (high TSH, low T4 and T3), the most appropriate step in management is B. Life-long thyroxine replacement.
Answer for screen readers
Given the infant's symptoms (prolonged jaundice, constipation, large tongue, mottled dry skin), positive family history of autoimmune disease, and lab results (high TSH, low T4 and T3), the most appropriate step in management is B. Life-long thyroxine replacement.
More Information
The combination of clinical signs and abnormal thyroid function tests (high TSH, low T4 and T3) strongly suggests congenital hypothyroidism. Prompt initiation of thyroid hormone replacement is crucial to prevent neurodevelopmental impairment.
Tips
A common mistake is to repeat the blood test before starting treatment as any delay can have negative consequences on the baby's development. Prednisolone is used for autoimmune conditions that affect the adrenal glands.
Sources
- Congenital Hypothyroidism - StatPearls - NCBI Bookshelf - ncbi.nlm.nih.gov
- Congenital Hypothyroidism - Medscape Reference - emedicine.medscape.com
- Hypothyroidism in Infants and Children - Pediatrics - MSD Manuals - msdmanuals.com
AI-generated content may contain errors. Please verify critical information
