Thick lips and big tongue

Introduction The thick lip is mainly characterized by acromegaly, dysplasia, congenital hypothyroidism and other diseases. Acromegaly face: The skull is enlarged, the face is long, the jaw is large and the protrusion is prominent, the ankle is prominent, the eyebrow arch is raised, the ear and nose are enlarged, the lips and tongue are thick, and the teeth are thin and misplaced. Children with congenital hypothyroidism and children with hypothyroidism: Most congenital hypothyroidism is often seen in months or 1-2 years after birth. At this time, thyroxine deficiency is severe and the symptoms are typical.

Cause

Acromegaly, dysentery, congenital hypothyroidism and other diseases.

an examination

Acromegaly face: The skull is enlarged, the face is long, the jaw is large and the protrusion is prominent, the ankle is prominent, the eyebrow arch is raised, the ear and nose are enlarged, the lips and tongue are thick, and the teeth are thin and misplaced. This face is more common in acromegaly.

Mindful illness is caused by congenital factors or local iodine deficiency caused by hypothyroidism or lack of gravitation. Because it affects physical and mental development, it is characterized by short body and sluggish face, so it is called a small disease. Ting disease, short illness. Due to insufficient thyroxine synthesis, the development of the central nervous system is severely affected, and symptoms may occur in the months to years after the baby is born. Abnormal body development is characterized by short stature, short limbs, thin hair, low hearing loss, and mucous edema in the skin. There are also different degrees of delay in mental development, and the face is sluggish. The intelligence (general common sense, comprehension) is significantly lower than that of children of the same age. There are language barriers and special facial features such as small eye cracks, wide eye distance, and thick lips. Auxiliary examination revealed serum T4, thyroid stimulating hormone and elevated serum cholesterol, thyroid absorption of 131 iodine decreased, X-ray examination showed delayed bone age.

Congenital hypothyroidism

Low infants and children: Most congenital hypothyroidism is often seen in months or 1-2 years after birth. At this time, thyroxine deficiency is severe and the symptoms are typical. The severity of symptoms in children is closely related to the degree and duration of thyroxine deficiency.

1 special face: facial swelling, indifferent expression, slow response. The hair is sparse, the lips are thick and thick, the tongue is extended, and the eyelids are edematous.

2 nervous system dysfunction: mental retardation, memory, attention are reduced. Sports developmental disorders, delayed walking, and often accompanied by hearing loss, feeling slow, lethargy, severe cases may have systemic myxedema, coma and so on.

3 growth and development stagnation: short stature, long body, short limbs, the ratio of upper and lower parts is often >1.5, bone development is significantly delayed.

4 low cardiovascular function: pulse is weak, heart sound is low and blunt, heart enlarges, can be associated with pericardial effusion, ECG is low voltage, PR prolonged, conduction block and so on.

5 digestive tract dysfunction: anorexia, bloating, constipation, dry stool, decreased gastric acid, easily misdiagnosed as congenital megacolon.

(a) thyroid function test

1. Determination of serum thyroid hormone: 100% of serum T4 is secreted from the thyroid gland. Since TT4 is affected by serum thyroid binding protein, especially thyroid-binding globulin (TGB), it is FT4, a hypothyroidism patient that truly represents thyroid function. FT4 is often below the normal range.

20% of T3 in serum comes from thyroid secretion, 80% comes from T4 in peripheral transformation, so T3 does not represent the function of thyroid gland well. In patients with hypothyroidism, T4 to T3 is increased under the action of increasing TSH. T3 can be Low, normal or even elevated, TT3 and FT3 have little significance for the diagnosis of hypothyroidism.

2. TSH measurement: TSH and thyroid hormone have a very good negative correlation, and the decrease of T4 and FT4 combined with the increase of TSH is positive for the diagnosis of primary hypothyroidism. When TT4 and FT4 are reduced and TSH is not elevated, the possibility of secondary hypothyroidism should be considered.

3. Thyroid-induced I131 rate: Because the severity of the disease in patients with hypothyroidism is different, the early and late stages of the disease are different, the thyroid rate of I131 is different, and can be low or normal or elevated, so the thyroid rate of I131 is diagnosed with hypothyroidism. Pointless.

4. TSH test and TRH test: The differential diagnosis of primary hypothyroidism and secondary hypothyroidism is facilitated by the presence of a highly sensitive TSH assay kit. The current differential diagnosis of primary and secondary hypothyroidism The TRH test is rarely performed.

5. Determination of thyroid autoantibodies: Determination of serum thyroid autoantibodies is helpful for understanding the cause of hypothyroidism, but it is not a necessary condition for the diagnosis of hypothyroidism, because some patients with chronic lymphatic thyroiditis can have negative antibodies and normal thyroid function.

6. Others: Deficiency of thyroid hormone, causing cholesterol decomposition <cholesterol synthesis, serum cholesterol in patients with hypothyroidism can be increased, triglyceride, low-density lipoprotein cholesterol and apolipoprotein are elevated, while high-density lipoprotein is not significantly changed.

Some serum enzymes in patients with hypothyroidism include elevated creatinine phosphokinase and lactate dehydrogenase, elevated blood uric acid, decreased urinary 17-ketosteroids and urinary 17-hydroxycorticosteroids. These laboratory tests cannot be used as diagnostic criteria. For comparison before and after treatment.

Differential diagnosis

1. thythyroid sick syndrome with normal thyroid function

Some acute or chronic non-thyroid diseases have low metabolic manifestations and low sympathetic response. For example, cold, fatigue, edema, anorexia, constipation, etc., serum T3 and / or T4 is low, easily misdiagnosed as hypothyroidism. Low T3 is called low T3 syndrome, and severe cases can also show low T4, called low T4 syndrome. The decline of serum T3 and T4 is a protective measure of the body. Artificially adding thyroid hormone preparation to increase the metabolic rate of the body will inevitably aggravate the condition of the primary disease.

2. Chronic nephritis

Hypothyroidism patients with pale sodium retention showed pale skin, edema, anemia, high blood pressure and elevated blood cholesterol. Patients with chronic renal insufficiency in nephritis often show abnormalities in thyroid hormone determination, mainly in serum T3, but TSH is normal. Serum TSH was significantly elevated in patients with hypothyroidism.

Anemia

About 25% to 30% of patients with hypothyroidism show anemia, and the causes of anemia are various. Patients with hypothyroidism are more common in women, often with more menstrual flow, longer menstrual period, leading to excessive blood loss, loss of appetite, undernutrition and stomach acid. The lack of more serious anemia. The thyroid hormone in the primary hypothyroidism is low, and the TSH is elevated. The differential diagnosis is not difficult.

4. Serous effusion

Hypothyroidism occurs in serous effusion due to slow lymphatic reflux, increased capillary permeability, lymphocyte secretion of highly hydrophilic mucin and mucopolysaccharide, causing ascites, pericardial effusion, pleural effusion and joint cavity Fluid.

5. Idiopathic edema

The fibroblasts of patients with hypothyroidism secrete hyaluronic acid and mucopolysaccharide, which are hydrophilic, block lymphatic vessels, cause mucinous edema, and most of them show non-concave edema, which is misdiagnosed as idiopathic edema.

6. Pituitary tumor

In patients with long-term hypothyroidism, especially in children, the pituitary gland can be enlarged and sometimes misdiagnosed as pituitary tumors. The primary hypothyroidism decreased blood T4, the pituitary TSH cells proliferated and hypertrophied, and the sella increased. Some female patients had mild elevation of prolactin due to menstrual disorders and lactation, and were misdiagnosed as pituitary prolactin secretory tumor. Some patients with hypothyroidism due to swelling of the hands and feet, thick lips, hoarseness, increased hand and foot, and increased saddle, will be misdiagnosed as pituitary growth hormone secretory tumor, thyroid hormone determination can be differential diagnosis.

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