Pediatric Thyroid Disorders
Your thyroid gland is a butterfly-shaped gland located at the base of your neck, just above your collarbone. It is one of your endocrine glands, which means its job is to produce hormones. Thyroid hormones control your body’s metabolism, including how fast you burn calories and how fast your heart beats. They also help regulate your body’s calcium levels.
Thyroid disease may occur when the thyroid gland produces too much thyroid hormone (hyperthyroidism) or too little thyroid hormone (hypothyroidism). It can also be a result of an autoimmune disorder, cancer or non-cancerous growths on the thyroid gland. They have metabolic consequences, but more importantly, they may affect the development of the brain, skeleton and other tissues.
Disorders of the thyroid gland are among the most common endocrine disorders affecting children occuring in 37 of 1,000 school-aged children in the United States. Thyroid problems in children may include:
- Congenital hypothyroidism (present at birth) - This occurs when the thyroid gland doesn’t develop or function while the baby is still in the womb. Because it may affect one baby out of every 3,000, it is something all babies are checked for during routine newborn screening.
Most have few or no symptoms because their thyroid hormone levels are just a little below normal. Infants with more severe forms often have a specific appearance that includes a dull look, puffy face and a thick protruding tongue.
- The child may also have:
- Acquired hypothyroidism (also known as Hashimoto's thyroiditis) -This condition often shows up in late childhood or in the teens. It is thought to be a result of the body mistaking the thyroid for an invader. The immune system then attacks the gland, as it would anything that is seen as a threat.
Symptoms are often very subtle and have a very slow onset. Thus, it may be some time before a diagnosis is made. Symptoms include:
- An inability to exercise for the amount of time or level that they should be able to given their age (exercise intolerance)
- Droopy eyelids
- Dry and thickened skin
- Dull expression on face
- Eyebrows that thin or fall out
- Increased menstrual flow or cramping after puberty
- Muscle cramping
- Puffiness or swelling around the face
- Sensitivity to cold
- Slow pulse
- Slow speech
- Slowed reaction times
- Swelling at the front of neck because of an enlarged thyroid gland (goiter)
- Thinning, coarse, dry hair
- Voice that is always hoarse
- Weight gain that is not related to eating more
Tests and Diagnosis
Blood tests are used to find out how well the thyroid is functioning. They do so by measuring thyroid stimulating hormone (TSH) or levels of specific thyroid hormones. Your child’s doctor may test for certain antibodies to the thyroid if they think the immune system might be attacking it. X-rays and other radiologic tests look at how well the thyroid is working or look for abnormalities in the gland itself.
Tests used to make a diagnosis include:
- Blood tests for circulating hormones
- Radioactive iodine uptake
- Thyroid scans
- Thyroid-stimulating hormone test
For most with uncomplicated hypothyroidism, hormone replacement therapy will be the only treatment required. A manmade version of T4 will be given to try and mimic normal function as closely as possible. Blood tests will be taken at intervals to make sure your child’s hormone levels are not too high or too low.
For hyperthyroidism, the treatment will depend on what is causing the extra production of hormone. For many, an antithyroid medication that blocks the thyroid’s production of hormones will be tried first.
Since there are high levels of relapse even with successful drug regimens, your child’s doctor might suggest other methods that permanently prevent hormone production. The thyroid uses iodine as a main building block for making hormones. When a child is given radioactive iodine, cells are damaged or killed. Iodine is harmless to other cells in the body, which limits side effects.
Surgery may be considered for children with hyperthyroidism who don’t respond to medication, have bad side effects or are allergic to it, or in cases where the gland has gotten too large. It also is used when cancer has been confirmed.