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All Journal JOURNAL LA MEDIHEALTICO Jurnal Impresi Indonesia
Setiadi, Alexander Wignyo
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Malnutrition with Secondary Hypothyroidism in Children: A Case Report and Pathophysiological Review of Patients in One of the Hospitals in Surabaya Puspita, Angela; Setiadi, Alexander Wignyo
Journal La Medihealtico Vol. 6 No. 3 (2025): Journal La Medihealtico
Publisher : Newinera Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37899/journallamedihealtico.v6i3.2115

Abstract

Malnutrition in children remains a global health problem that has a broad impact on growth, development and metabolic balance. One complication that receives less attention is secondary hypothyroidism, a condition that occurs due to metabolic adaptation to prolonged energy deficit. This situation can worsen the patient's prognosis and increase the risk of neurological complications and infections. This case report aims to describe the clinical course of a child with severe malnutrition who experienced secondary hypothyroidism and discuss the pathophysiological mechanisms underlying the link between malnutrition and thyroid dysfunction. Case: A 2 year 1 month old boy with a body weight of 5 kg (< -3 SD) and a height of 69 cm presented with complaints of diarrhea, fever, recurrent cough and episodes of seizures. Laboratory examination showed leukocytosis, increased CRP, and electrolyte disturbances. Evaluation of thyroid function revealed low FT4 levels (0.85 ng/dL) with depressed TSH (0.19 µIU/mL), leading to a diagnosis of secondary hypothyroidism. Metabolic adaptations due to malnutrition lead to decreased production of thyroid binding proteins as well as low TSH secretion in response to metabolic stress. This situation contributes to a slowdown in metabolism and worsens nutritional recovery, as well as increasing the risk of infectious and neurological complications. The literature supports that secondary hypothyroidism in children with malnutrition is reversible with optimal nutritional recovery. A multidisciplinary approach that includes clinical stabilization, electrolyte correction, and monitoring of thyroid function is very important in the management of children with malnutrition and secondary hypothyroidism.
Life-Threatening Pneumonia In A Child With Down Syndrome Challenges In A Rapidly Progressive Respiratory Failure: A Case Report Puspita, Angela; Setiadi, Alexander Wignyo; Elizabeth, Maria
Jurnal Impresi Indonesia Vol. 4 No. 11 (2025): Indonesian Impression Journal (JII)
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/jii.v4i11.7167

Abstract

Children with Down syndrome (DS) demonstrate increased vulnerability to severe respiratory infections due to anatomical, immunological, and physiological vulnerabilities. This case report examines the rapid progression of pneumonia in an 8-year-old child with DS, highlighting critical challenges in managing respiratory failure in this population. Methods: A retrospective case report analysis was conducted at a secondary hospital in Surabaya, Indonesia, involving comprehensive review of medical records, laboratory findings, radiological examinations, and clinical progression of an 8-year-old boy with DS who presented with severe community-acquired pneumonia. Results: The patient presented with a 10-day history of fever, productive cough, and dyspnea. Initial assessment revealed tachypnea (36 breaths/min), hypoxemia (SpO? 89%), and bilateral infiltrates on chest radiography. Despite normal leukocyte count, elevated CRP (24.3 mg/L) and thrombocytosis (589 × 10³/µL) indicated significant inflammation. Management with high-flow nasal cannula oxygenation, empirical antibiotics (ceftriaxone and azithromycin), bronchodilators, and intravenous fluids resulted in clinical improvement within 72 hours, with discharge on the sixth day. Discussion: This case underscores how common respiratory infections can rapidly deteriorate in children with DS due to airway abnormalities, immune dysfunction, and neuromuscular hypotonia. Early recognition of hypoxemia as a warning sign and timely multidisciplinary intervention are crucial to prevent respiratory failure. Preventive strategies including optimized vaccination and caregiver education are essential components of comprehensive care.
Co-Authors Elizabeth, Maria Puspita, Angela