Neck Swelling in a Newborn with Congenital Goiter
A 6-day-old male baby born to a 21 year old primigravida having normal antenatal course and clinically euthyroid with no past history of thyroid disease and not on any antithyroid medications, with normal thyroid levels in the present pregnancy, delivered by Cesarean section due to delayed progression of labor with birth weight of 2.5 kgs, presented to our hospital with delayed passage of meconium even after 5 days of birth, decreased activity, distension of abdomen, difficulty in latching onto breasts. On admission baby had stable vitals and general examination revealed midline swelling in the neck, which is soft, mobile, noncystic, without inflammatory signs and no bruits was audible. On per abdomen examination, there was soft distension, without hepatosplenomegaly or ascites. Rest of the systemic examination was normal except for the presence of generalised hypotonia.\nInvestigations revealed Hb 15.9 gm%, PCV 49.9, TC 3730, Platelet count 3.4, SBR 15.9/0.79, RBS 150 mg/dl, CRP negative, XR abdomen normal, free T3 <0.04 pg/ml (normal 147.8±50.1 ng/dl), free T4 0.18 ng/dl (normal 2.7±0.6 ng/dl), TSH >40 IU/ml (normal 2.6±1.8 IU/ml), X-ray of knee showing absence of the distal femoral epiphysis [], postnatal ultrasound of thyroid showed diffuse enlargement of thyroid gland. Hearing tests were normal. Further genetic tests were not done due to financial constrains and lack of genetic testing facility.\nA diagnosis of neonatal dysharmonogenitic goiter with hypothyroidism was made. Thyroxin started on 8th day of life at 15 mcg/kg/day and by 15th day decreased in the size of the goiter with regular passage of motions and good cry and activity was noticed. Baby was discharged on 16th day and is under follow-up regularly.