Case Study

Childhood Obesity Obesity is when excess body fat has accumulated to the extent that it may have an adverse effect on health. In order for a child to be medical diagnosed as obese they would need to have a BMI (body mass index), which is a measurement obtained by dividing a person's weight by the square of the person's height, within the 95th percentile.
Unfortunately, this disease has become an epidemic in our world today. The worst part is that it is starting with the children. Nutritional Issues

Iron deficiency: Iron is important when it comes to the formation of healthy new red blood cells. Having a deficiency will give rise to hypothyroidism, symptoms are extreme fatigue, goiter, mental slowing, depression, weight gain, and low basal body temperatures.
Protein deficiency: Protein is important for building and growing tissues and muscles. Some symptoms of a deficiency are developing gallstones, arthritis, muscle deterioration and most importantly heart problems. Some other issues are thinning or brittleness of hair, ridges in nails, edema and weight loss. Edema is concerning especially in obese patients because it is a fluid that can build up in extremities and cause major damage.

Vitamin Deficiencies:

Calcium and Vitamin D deficiency - Calcium and Vitamin D go together as a pair, Vitamin D is also important because it absorbs calcium. Without enough vitamin D, one can’t form enough of the hormone calcitriol. This is known as the active vitamin D. Calcium is needed for our heart, muscles, and nerves to function properly and for blood to clot. Loss of calcium can cause the development of osteoporosis. Osteoporosis is when the bones become brittle and fragile from loss of tissue.

Cobalamin & Folate - Cobalamin is known as Vitamin B12 and folate have a lot to do with a person’s metabolism and there (CNS) Central Nervous System .If a person is lacking both of these vitamins than neuropathy can set in . Neuropathy is commonly found in people who have diabetes. It is an attack on the nervous system that leaves certain parts of the body with no feeling and possibly no circulation.

Hyperthyrotropinemia in obese children :
Hyperthyrotropinemia and obesity are often linked. This is because appetite is stimulated by taking too much thyroid hormone, which makes it a poor weight-loss drug, and higher than normal thyroid levels in the body may have serious negative effects on the cardiovascular system, skeleton and mood.

Case study
Anthropometrics :

Sex : Female.
Age : 8
Height: 4’0" = 121.9 cms .
Weight: 45 kilos
Complains: Constantly dropping things, trouble sleeping
Constipation
Depression
Fatigue or feeling slowed down
Thin, brittle hair or fingernails
Weakness
Tremors in hands
Weight gain (unintentional)
Sleep Apnea

Biochemical Tests

Thyroxin -54[normal: 55 - 144 pmol/lt ]
Triiodothyronine – 26 pmol/l [normal: 0.9 -2.8nmol/l ]
TSH - > undetectable [normal: 0 - 8 mU/l ]
T4 test – 3.0 [normal: 4.5 - 11.2 micrograms/decilitre ]
T3RU test – 36 [normal : 25 – 35 ]
Urine Iodine – 85 mcg/day [normal 90-120 mcg/day]

Clinical Assessment
The levels of biochemical TSH screening, shows that each test is just above the more than normal level, except the thyroid stimulating hormone of the pituitary is undetectable . Also, the slightly above below average level of T4, are all implying towards hypothyroidism in the patient.
The very low levels of urine iodine show that the patient is suffering from iodine deficiency. Primary hyperthyrotropinemia is characterized by a high serum thyrotropin (TSH) concentration and a low serum free thyroxin (T4) concentration. Thus the analysis of the patient is indicative of hyperthyrotropinemia.

Dietary habits
The patient, an inhabitant of the low- income household, has a diet that is severely insufficient in calcium and protein. Her physical appearance suggest a Vitamin D deficiency, due to her dark skin pigmentation, brittle hair and nails and some visual impairment. Along with the physical symptoms, the biochemical test and patients above listed symptoms are positive signs that hyperthyrotropinemia is present. Patient also showing signs of bulging eyes which is another common factor of hyperthyrotropinemia. The patient also takes in food that lacks nutrients, vitamins and minerals in proper quantities.

Drugs for treatment

Methimazole : This is the ONLY antithyroid medication that is available for children in the United States of America. Pediatric dose of methimazole is 0.4-0.7 mg/kg/d, with a lower maintenance dose which is 1/3 to ½ of the starting dose.

Herbal Solutions: Not everyone has hyperthyrotropinemia that doctors deem treatable with medicine; even herbal medicines can work to rescue. Various options like Licorice, Kelp, Maca and Dandelion Root have been found to be helpful in treating hypothyroidism. These remedies help by stimulating thyroxin secretion and increasing metabolism of the body.

Cultural background
The patient comes from a not-so-well to do family, living on the border of the poverty line as such has to struggle for the minimum basic necessities of life, leave alone, nutritious food. Mentally, the patient is overburdened with chores that have become too hard for her to finish up. Economically not better off, with a mother low income typist, as the sole bread winner. Therefore, all of them lack a healthy diet.