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HYPOTHYROIDISM AS DIFFERENTIAL DIAGNOSIS IN CHILDREN WITH DOWN’S SYNDROME AND OBSTRUCTIVE SLEEP APNEA – CASE REPORT
Obstructive sleep apnea (OSA) is common in children with Down’s syndrome (DS) due to anatomic abnormalities that results in an airway collapse during sleep time. Hypothyroidism in children mimetizes the clinical situation of a patient with OSA. Thus, the Polysomnography exam, recommended in all children with DS from 4 years old, is essential to allow the differential diagnoses and, therefore, to treat the primary cause of symptoms by improving the quality of life of these patients.
To highlight the differential diagnosis of hypothyroidism in children with Down’s syndrome and Obstructive Sleep Apnea through a case report and literature reviews.
J.I.S, male, Down’s syndrome, four years old, accompanied by his father, complaining of agitated sleep. The father reported that his son often had night sweats and restless sleep. Routinely woke up at night and showed episodes of soliloquy and nocturnal enuresis. Occasionally he felt tired when he woke up, snored lightly, slept during daytime activities and had learning disabilities due to DS. Regarding previous history, he was born with congenital heart disease that was surgically corrected and underwent adenotonsillectomy, but had persistent symptoms even after surgery. Has hypothyroidism, in treatment with Puran (levothyroxine), and hypertension, in use of Captopril.
Polysomnography showed a moderately elevated index of breathing disorders, high index of arousals and normal oxyhemoglobin desaturation, snoring, sleep efficiency, with proportionate sleep stages. The patient was diagnosed with OSA and treated with CPAP. Returned with improved sleep quality and daytime sleepiness.
The child with DS had a classic OSA condition but, at first, was diagnosed with hypothyroidism. Thus, the case becomes relevant once identifies an OSA through polysomnography and discards the differential diagnosis, which has a very similar clinic that makes the early diagnosis harder. Therefore, it is important to know the differential diagnoses of patients with OSA to obtain their early, effective recognition and to optimize results with time to avoid complications and increase the life expectancy of these children.
Down’s syndrome; Obstructive Sleep Apnea; Polysomnography.
Relato de Caso
MARITHZA MAYUMI HATA, ALEXIA DEGASPERIN VOIGT, ANA CAROLINA DE QUADROS, ANA JULIA SILVA RODRIGUES, ANA MARIA FAVARÃO, CAIRO VINICIUS WEBER SANTOS, FERNANDA BAZZANELLA, KARLA MULINARI VICINI, LUANA TURMINA, ANA PAULA INTRA MATSUMOTO