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HYPOTHYROIDISM

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Iodine deficiency remains a common cause of hypothyroidism worldwide. In areas of iodine sufficiency, autoimmune disease (Hashimoto’s thyroiditis) and iatrogenic causes (treatment of hyperthyroidism) are most common (Table 376-1).

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Table Graphic Jump Location
TABLE 376-1Causes of Hypothyroidism
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CONGENITAL HYPOTHYROIDISM

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Prevalence
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Hypothyroidism occurs in about 1 in 4000 newborns and neonatal screening is performed in most industrialized countries. It may be transient, especially if the mother has TSH-R blocking antibodies or has received antithyroid drugs, but permanent hypothyroidism occurs in the majority. Neonatal hypothyroidism is due to thyroid gland dysgenesis in 80–85%, to inborn errors of thyroid hormone synthesis in 10–15%, and is TSH-R antibody-mediated in 5% of affected newborns. The developmental abnormalities are twice as common in girls. Mutations that cause congenital hypothyroidism are being increasingly identified, but most remain idiopathic (Table 376-2). Transplacental passage of maternal thyroid hormone occurs before the fetal thyroid gland begins to function and provides partial hormone support to a fetus with congenital hypothyroidism.

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Table Graphic Jump Location
TABLE 376-2Genetic Causes of Congenital Hypothyroidism

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