In pediatric practice it is important to look for hypothyroidism whenever
there is some suspicion, especially in infants. As a matter of policy we
look for organic causes in all infants presenting with constipation during
infancy and we do thyroid profile (T3, T4, and TSH) in them. In our study
population there were 11 cases of infants (up to 12 months of age) but
none of them were found to have hypothyroidism [1]. Due to the newborn
screening program in the West, North American Society for Pediatric
Gastroenterology, Hepatology and Nutrition (NASPGHAN) practice guideline
[2] has not stressed on screening for hypothyroidism among infants with
constipation. However, in India, we must investigate all infants with
chronic constipation for hypothyroidism as the neonatal screening program
is not in practice. Regarding older children with refractory constipation,
yes if a child has other features to suggest hypothyroidism then the child
should be investigated for hypothyroidism. None of our cases among
non-responders/difficult responders to medical therapy had hypothyroidism.
References
1. Khanna V, Poddar U, Yachha SK. Etiology and clinical
spectrum of constipation in Indian children. Indian Pediatr.
2010;47:1025-30.
2. Baker SS, Liptak GS, Colletti RB, Croffie JM,
DiLorenzo C, Ector W, et al. Clinical practice guideline.
Evaluation and treatment of constipation in infants and children:
Recommendations of the North American Society for Pediatric
Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr.
2006;43:e1-e13.
|