Thyroid dysfunctions form a major part of the pathology associated with Down's Syndrome (DS), due both to their high prevalence and the repercussions they can have on life quality. That is why routine TSH, T4 and T3 determination must be carried out at regular intervals on all patients with DS. Hypothyroidism is common in DS patients, and replacement therapy with levotiroxine must be started where TSH levels exceeding 10 mcU/mL, low T3 or T4 or high titres of antithyroid antibodies are found, or where there is a need for cardiac surgery. It is advisable to start the treatment at low dosages of levotiroxine (12.5 μg/d) and then adjust it until TSH levels have been normalised. Slight and usually transitory situations of minor subclinical hypothyroidism are common in the first three years of life, and the need for treatment with levotiroxine is to a certain extent disputed. In this respect a recent clinical trial showed an improvement in terms of psychomotor development in a group of patients treated with levotiroxine from the neonatal period. Monitoring in the trial was carried out for 24 months, and the improvement in psychomotor development was estimated at 0.7 months, while allowing for the possibility of magnified differences in subsequent checks. Regarding hyperthyroidism in DS, although it arises in a higher percentage than among the general population, it has a much lower incidence. The most frequent ethiology is toxic diffuse goitre or Graves-Basedow's disease, which is initially treated with synthesis antithyroids (metimazol or carbimazol) and beta-adrenergic blocking agents (propranolol or atenolol). Where the hyperthyroidism persists a definitive treatment must be considered, preferably with radioiodine, given the advantages it offers over surgery (with attendant hospital stay, anaesthesia, etc.).
|Journal||SD Revista Medica Internacional sobre el Sindrome de Down|
|Publication status||Published - 1 Nov 2005|
- Diabetes mellitus
- Low height