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XVII. ПрогнозА. Обычно через 7—10 сут после рождения состояние ребенка улучшается, а через 3—6 нед заболевание полностью проходит. Однако у 20% детей заболевание длится несколько месяцев или даже лет. Смертность среди новорожденных с тиреотоксикозом составляет в среднем 15—20%, а среди недоношенных с тиреотоксикозом она гораздо выше. Причиной смерти могут быть также сердечная недостаточность и обструкция дыхательных путей. Б. Преждевременное закрытие швов черепа — распространенное позднее осложнение врожденного тиреотоксикоза. Кроме того, у многих детей, перенесших врожденный тиреотоксикоз, наблюдаются неврологические нарушения и нарушения интеллекта. Поздние осложнения возникают даже в тех случаях, когда антитиреоидная терапия была начата вовремя. Следовательно, тиреотоксикоз во внутриутробном и неонатальном периодах нарушает развитие скелета и ЦНС. В. Редкое позднее осложнение врожденного тиреотоксикоза — вторичный гипотиреоз, обусловленный действием избытка тиреоидных гормонов на аденогипофиз в критический период развития ЦНС. Литература 1. Alm J, et al. Congenital hypothyroidism in Sweden. Incidence and age at diagnosis. Acta Paediatr Scand 67:1, 1978. 2. Alves C, et al. Changes in brain maturation detected by magnetic resonance imaging in congenital hypothyroidism. J Pediatr 115:600, 1989. 3. Aronson R, et al. Growth in children with congenital hypothyroidism detected by neonatal screening. J Pediatr 116:33, 1990. 4. Black EG, et al. Serum thyroglobulin in normal and hypothyroid neonates. Clin Endocrinol 16:267, 1982. 5. Bogner U, et al. Cytotoxic antibodies in congenital hypothyroidism. J Clin Endocrinol Metab 68:671, 1989. 6. Boyages SC, et al. A comparative study of neurological and myxedematous endemic cretinism in Western China. J Clin Endocrinol Metab 67:1262, 1988. 7. Brown RS, et al. Maternal thyroid-blocking immunoglobulins in congenital hypothyroidism. J Clin Endocrinol Metab 70:1341, 1990. 8. Brown RS, et al. An apparent cluster of congenital hypopituitarism in central Massachusetts: Magnetic resonance imaging and hormonal studies. J Clin Endocrinol Metab 72:12, 1991. 9. Cheron RG, et al. Neonatal thyroid function after propylthiouracil therapy for maternal Graves disease. N Engl J Med 304:525, 1981. 10. Cimino P, et al. HLA and congenital hypothyroidism (letter). N Engl J Med 303:1177, 1980. 11. Codaccioni JL, et al. Congenital hypothyroidism associated with thyrotropin unresponsiveness and thyroid cell membrane alterations. J Clin Endocrinol Metab 50:932, 1980. 12. Connors MH, Stynes DM. Transient neonatal "athyreosis" resulting from thyrotropin-binding inhibitor immunoglobulins. Pediatrics 78:287, 1986. 13. Daneman D, Howard NJ. Neonatal thyrotoxicosis: Intellectual impairment and craniosynostosis in later years. J Pediatr 97:257, 1980. 14. Davidson KM, et al. Successful in utero treatment of fetal goiter and hypothyroidism. N Engl J Med 324:543, 1991. 15. Delange F, et al. Increased risk of primary hypothyroidism in preterm infants. J Pediatr 105:402, 1984. 16. Dussault JH, et al. Preliminary report on a mass screening program for neonatal hypothyroidism. J Pediatr 86:670, 1974. 17. Farriaux JP, Dhondt JL. Thyroid scanning, ultrasound, and serum thyroglobulin in determining the origin of congenital hypothyroidism (letter). Am J Dis Child 142:1023, 1988. 18. Fisher DA. Second international conference on neonatal thyroid screening: Progress report. J Pediatr 102:653, 1983. 19. Fisher DA, Foley BL. Early treatment of congenital hypothyroidism. Pediatrics 83:785, 1989. 20. Fisher DA. Euthyroid low thyroxine (T4) and triiodothyronine (T3) states in prematures and sick neonates. Pediatr Clin N Am 37:1297, 1990. 21. Fisher DA. Clinical Review 19. Management of congenital hypothyroidism. J Clin Endocrinol Metab 72:523, 1991. 22. Fisher DA. Screening for congenital hypothyroidism. Trends Endocrinol Metab 2:129, 1991. 23. Germak JA, Foley TP, Jr. Longitudinal assessment of L-thyroxine therapy for congenital hypothyroidism. J Pediatr 117:211, 1990. 24. Glorieux J, et al. Follow-up at age 5 and 7 years on mental development in children with hypothyroidism detected by Quebec screening program. J Pediatr 107:913, 1985. 25. Glorieux J, et al. Useful parameters to predict the eventual mental outcome of hypothyroid children. Pediatr Res 24:6, 1988. 26. Hanna CE, et al. Detection of congenital hypopituitary hypothyroidism: Ten years experience in the Northwest Regional Screening 91 Program. J Pediatr 109:959, 1986. 27. Heyerdahl S, et al. Intellectual development in children with congenital hypothyroidism in relation to recommended thyroxine treatment. J Pediatr 118:850, 1991. 28. Hollingsworth DR, Alexander NM. Amniotic fluid concentration of iodothyronines and thyrotropin do not reliably predict fetal thyroid status in pregnancies complicated by maternal thyroid disorders or anencephaly. J Clin Endocrinol Metab 57:349, 1983. 29. Hollingsworth DR, Mabry CC. Congenital Graves' disease: Four familial cases with long-term follow-up and perspective. Am J Dis Child 130:148, 1976. 30. Holtzman C, et al. Descriptive epidemiology of missed cases of phenylketonuria and congenital hypothyroidism. Pediatrics 78:553, 1986. 31. Hughes VC, et al. The prevalence of thyroid dysfunction in mentally handicapped inpatients. J Ment Defic Res 26:115, 1982. 32. Ibarrola N, et al. Effect of neonatal hypothyroidism on myelin protein gene expression. Abstracts of 19th Annual Meeting of the European Thyroid Association. Ann Endocrinol 52:35, 1991. 33. Klein AH, et al. Improved prognosis in congenital hypothyroidism treated before age three months. J Pediatr 81:912, 1972. 34. Klein RZ, et al. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol 35:41, 1991. 35. Kohno H, et al. Pituitary cretinism in two sisters. Arch Dis Child 55:725, 1980. 36. LaFranchi SH. Hypothyroidism, congenital and acquired. In SA Kaplan (ed), Clinical Pediatric and Adolescent Endocrinology. Philadelphia: Saunders, 1982. P. 87. 37. LaFranchi SH, et al. Neonatal hypothyroidism detected by the Northwest Regional Screening Program. Pediatrics 63:180, 1979. 38. LaFranchi SH, et al. Screening program for congenital hypothyroidism with specimen collection at two time periods: Results of the Northwest Regional Screening Program. Pediatrics 76:734, 1985. 39. Landau H, et al. Amniotic fluid, 3,3'-5'-triiodothyronine in the detection of congenital hypothyroidism. J Clin Endocrinol Metab 50:799, 1980. 40. Larsen PR, et al. Immunoassay of human TSH using dried blood samples. J Clin Endocrinol Metab 42:987, 1976. 41. MacFaul R, Grant DB. Early detection of congenital hypothyroidism. Arch Dis Child 52:87, 1977. 42. McLean RH, et al. Hypothyroidism in the congenital nephrotic syndrome. J Pediatr 101:72, 1982. 43. Mandel SH, et al. Diminished thyroid-stimulating hormone secretion associated with neonatal thyrotoxicosis. J Pediatr 109:662, 1986. 44. Matsuura N, et al. Familial neonatal transient hypothyroidism due to maternal TSH-binding inhibitor immunoglobulin. N Engl J Med 303:738, 1980. 45. Miyai K, et al. Increased frequency of HLA-AW24 in congenital hypothyroidism in Japan (letter). N Engl J Med 303:226, 1980. 46. Montoro M, et al. Successful outcome of pregnancy in women with hypothyroidism. Ann Intern Med 94:31, 1981. 47. Muir A, et al. Thyroid scanning, ultrasound, and serum thyroglobulin in determining the origin of congenital hypothyroidism. Am J Dis Child 142:214, 1988. 48. New England Congenital Hypothyroidism Collaborative. Characteristics of infantile hypothyroidism discovered on neonatal screening. J Pediatr 104:539, 1984. 49. 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Maturation of the secretion of thyroid hormone and thyroid-stimulating hormone in the fetus. N Engl J Med 324:532, 1991. 63. Vanderschueren-Lodeweyck M, et al. Sensorineural hearing loss in sporadic congenital hypothyroidism. Arch Dis Child 58:419, 1983. 64. Vulsma T, et al. Maternal-fetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect or thyroid agenesis. N Engl J Med 321:13, 1989. 65. Weichsel ME, Jr. Thyroid hormone replacement therapy in the perinatal period: Neurological considerations. J Pediatr 92:1035, 1978. 66. Zakarija M, McKenzie JM. Pregnancy-associated changes in the thyroid-stimulating antibody of Graves' disease and the relationship to neonatal hypothyroidism. J Clin Endocrinol Metab 57:1036, 1983. 67. Zakarija M, et al. Transient neonatal hypothyroidism: Characterization of maternal antibodies to the thyrotropin receptor. J Clin Endocrinol Metab 70:1239, 1990. Глава 32. Болезни щитовидной железы у детей Н. Лавин Зоб Зоб — это видимое увеличение щитовидной железы. Зоб возникает при разных заболеваниях щитовидной железы и может сопровождаться клиническими проявлениями гипотиреоза либо тиреотоксикоза; нередко симптомы дисфункции щитовидной железы отсутствуют (эутиреоз). Таким образом, наличие зоба само по себе не позволяет установить причину заболевания. У большинства детей с зобом имеется эутиреоз. Частота зоба у детей составляет 4—5% и увеличивается с возрастом. У девочек зоб встречается чаще, чем у мальчиков (во всех возрастных группах). Существует несколько классификаций зоба; одна из них приведена в табл. 32.1. Дата добавления: 2015-02-05 | Просмотры: 1070 | Нарушение авторских прав |