Cretinism face

Introduction The face of cretin: due to hypothyroidism, facial facial features are backward, and severe cases are embryonic. Typical facial features include: large head, short forehead, face; eye cracks are horizontal, eye distance is wide; nose bridge, nose wing hypertrophy, nostril facing forward; lip thick tongue, often mouth-shaped tongue, runny; ear Large, the ear shell is particularly soft, the nasal cartilage is also soft; the hair is sparse, the skin is dry and dull; the expression is sluggish, or a silly or smirk. The etiology of endemic cretinism has been relatively clear and is the result of severe iodine deficiency during embryonic and neonatal periods.

Cause

The etiology of endemic cretinism has been relatively clear and is the result of severe iodine deficiency during embryonic and neonatal periods. In addition to the iodine deficiency theory, there are also people who raise genetic problems, autoimmune problems and goiter problems.

1. Iodine deficiency:

(1) Endemic goiter and Dick disease are prevalent in areas with severe iodine deficiency.

(2) Dick disease often has varying degrees of goiter.

(3) The iodine metabolism of patients with gram disease is basically the same as that of patients with thyroid disease, but the degree of the former is more serious. For example, the urinary iodine is low, the 131I rate of thyroid is "iodine starvation curve", and the thyroid rate of 131I is increased. And serum T4 can be maintained or reduced (the decline in Dick disease is more pronounced). TSH is normal or elevated (the increase in Dick disease is more pronounced), while T3 maintains normal or compensatory elevation.

2. Genetic factors: Dick disease has a tendency to have multiple families, and there are a lot of reports at home and abroad. A history of 208 cases of cretin patients with cretinism was investigated in a ward of Ningwu County, Shanxi Province. Among the family members, 127 (59.9%) had no cretinism, and 3 (1.5%) had cretins. There were 23 cases (10.9%) of mothers with cretinism, 1 case (0.5%) of parents with cretinism, 59 cases (27.6%) of brothers and sisters with cretinism, and a total of cretins among family members. 40.5%. One of the six mothers in the village had mental retardation, and each child had 2 to 3 children with cretinism. However, the above situation cannot be considered that the disease is a hereditary disease, because the congenital factors other than heredity also have similar phenomena in a family.

an examination

Related inspection

Urine iodine iodine iodine test compound iodine test

1. Urine iodine is generally low, and Dick disease is generally found in areas with severe iodine deficiency. The urinary iodine level of residents is usually below 20 g/g creatinine, and the prevalence of thyroid is above 30%. This area is often accompanied by Dick disease. popular.

2. Hormone examination: patients with visceral swelling showed typical hypothyroidism, ie, TT4, FT4, and FT4I decreased; TSH increased; T3 and FT3 decreased, and a small number of patients were normal. Neurological patients vary, generally speaking, lighter than visceral type, TT4, FT4 mostly decreased, a few normal; TSH increased, some normal; FT3, TT3 more normal, some compensatory increase .

3. Iodine absorption rate: The neurogenic cretinism is an iodine starvation curve; while the visceral iodine absorption rate is not obvious, and some even decrease, which does not mean that iodine nutrition is good, but due to thyroid atrophy.

4. Anti-thyroid antibodies: serum anti-microsomal antibody (TMAb), anti-thyroglobulin antibody (TGAb), anti-second glial antibody (TC2-Ab) were negative. However, thyroid growth inhibitory immunoglobulin (TGII) is elevated in visceral cretinism. Tang's examination of Xinjiang visceral cretinism confirmed that 66.7% of patients with visceral type had TGII, and 55.6% of patients also had immunoglobulin (IGF-1 insulin-like growth factor) that inhibits IGF-1. Boyages also found that TGII-positive patients had thyroid atrophy.

Differential diagnosis

Need to be identified with the following symptoms:

Face:

The facial muscles are thin, the eyeballs are prominent, and the gaze is shining with a frightened expression. The eye cracks increase and the eye blinks less, accompanied by the expression of happiness, irritability and irritability. Common in patients with exophthalmia hyperthyroidism. Expressed as a horrified face, it is very horrified by the small sounds of the outside world; the eyeballs are convex, similar to the goldfish eyes; excited, irritated and irritable. This is a typical manifestation of hyperthyroidism.

Liver disease face: liver disease face is more common in patients with chronic hepatitis and cirrhosis, is one of the common clinical manifestations of liver disease patients.

Cacao face: Looking at the face is to look at the expression of the face. Human facial muscles and blood supply are very rich, and twelve pairs of cranial nerves are concentrated here. Healthy people should have a natural expression and a pleasant look. The proportion of organs and organs is moderate and reasonable. When the body is sick, it will be troubled by the pain, especially when the disease develops to a certain extent, some characteristic faces and expressions will appear. Therefore, observing facial facial expressions and expressions will undoubtedly provide important clues for the diagnosis of certain diseases.

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