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An Infant with Congenital Hypothyroidism and a Disappearing Tumor

Kalina Chavdarova, Viktor Urbanchich, Joana Andonova, Stayko Chavdarov, Georgi Guzgunov

Abstract

Introduction: This is the case of a patient presenting with congenital hypothyroidism combined with undefined tachycardia and probable ganglioneuroblastoma.

Materials and Methods: The patient was a male, born from a third pathological pregnancy in April, 2015, per vias naturales. He was with a birth weight of 2100 g, height - 45 cm, and morphological gestational age 36-37 weeks. There was information about congenital infection transmitted from the mother. The newborn was in damaged general condition with respiratory distress syndrome, but afebrile. The examination determined: tachypnea, dyspnea, general cyanosis, moderate body edema, and hypothermia. The neurological examination showed lack of primitive reflexes and muscle hypotonia. The heart rate was stable and rhythmic. There was no organomegalia.

Results: Blood for congenital screening was taken. The results showed high levels of thyroid-stimulating hormone. A few more blood tests were done. Their results confirmed the suspicions of thyroid disease. 

Also, a chest-ray examination showed suspicion of bilateral bronchopneumonia. A treatment with antibiotics was conducted. A second x-ray was performed. The results were: the shadowed opacities had disappeared, but there was a large thick shadowy formation in the right cardiodiaphragmatic angle, coming from the mediastinum.  

Conclusion: Hormonal therapy was prescribed for the thyroid disease. After a few months the levels of THS (thyroid-stimulating hormone) were back to normal. But an undefined tachycardia appeared.

The formation in the mediastinum was, at first, considered to be ganglioneuroblastoma. After a few more exams it was confirmed that this shadowy formation was the liver. It was migrating because of diaphragmatic weakness but without herniating.


Keywords

congenital hypothyroidism, diaphragmatic weakness


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