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2018, Número 1

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Rev Mex Pediatr 2018; 85 (1)


Actualización en hipotiroidismo congénito: etiología, cuadro clínico, diagnóstico y tratamiento. Segunda parte

Rivera-Hernández A, Huerta-Martínez H, Centeno-Navarrete Y, Zurita-Cruz JN

Idioma: Español
Referencias bibliográficas: 41
Paginas: 34-40
Archivo PDF: 250.23 Kb.


RESUMEN

En esta segunda parte se abordarán los aspectos del hipotiroidismo congénito (HC): su etiología, cuadro clínico, diagnóstico, tratamiento y seguimiento. El HC se clasifica, por su base genética, en esporádico y hereditario. La causa más común del HC esporádico es la disgenesia tiroidea y en el caso del HC hereditario es la dishormonogénesis, debido a mutaciones en genes que codifican para proteínas involucradas en la síntesis de hormonas tiroideas (HT). El diagnóstico de HC en México tiene dos etapas, la primera a través del tamiz neonatal con determinación de la hormona estimulante de la tiroides (TSH), ya que 95% de los RN son asintomáticos; si es positivo (TSH › 10 µU/mL), entonces en la segunda etapa deben determinarse TSH y HT para confirmar o descartar el diagnóstico. Otros estudios complementarios como la tiroglobulina, el gammagrama y el ultrasonido de tiroides son útiles para determinar la etiología, pero no necesarios para iniciar tratamiento con levotiroxina, el cual debe iniciarse dentro de las primeras dos semanas de vida para evitar secuelas neurológicas. En general, el tratamiento con levotiroxina es de por vida, pero a los tres años de edad es conveniente revaluar el diagnóstico de HC, puesto que hasta 35% de los casos son transitorios. El seguimiento es multidisciplinario y debe incluir pediatras, endocrinólogos y expertos en medicina de rehabilitación.


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