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Pediatric Thyroid Disease

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Summary

Disorders of the thyroid gland are among the most common endocrine disorders affecting children. They have metabolic consequences, but more importantly, they may affect the development of the brain, skeleton and other tissues.

Types

Thyroid nodules

A thyroid nodule is an abnormal growth of thyroid cells forming a lump inside the thyroid gland. These benign masses are usually soft and compressible and are found during a routine examination.

The prevalence of pediatric benign thyroid nodules ranges from 0.2-3% and patients usually respond to thyroxine treatment. However, benign nodules carry a high risk of becoming malignant. A physician will therefore recommend a fine-needle aspiration (FNA) biopsy.

Thyroid Carcinoma (Cancer)

Pediatric thyroid cancer is not uncommon. Radiation exposure from bone marrow transplantation therapy or treatment for Hodgkin's disease remains a significant risk factor. Many patients have a family history of thyroid cancer and iodine insufficiency also can be a precursor.

Treatment

Treatment for thyroid malignancy is most usually surgery. A thyroid lobectomy is followed by radioactive therapy. Although pediatric thyroid cancer is usually caught at an advanced stage, it has an excellent prognosis, with long-term survival rates of over 95%.

Hypothyroidism

Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This occurs in 1 of every 3,500 births.

Congenital Hypothyroidism

Congenital hypothyroidism is evident by a goiter at birth, or with the gradual development of symptoms over the first few months of life. If untreated in early infancy, it results in growth failure and has a serious impact on the development of the central nervous system.

Neonatal patients are treated with thyroid hormone replacement therapy until they are 2 to eliminate potential cognitive deficits.

Acquired Hypothyroidism

Acquired hypothyroidism is caused by an autoimmune disorder called chronic lymphocytic thyroiditis (CLT). It is usually caused by thyroid disease (primary hypothyroidism) or hypothalamic-pituitary disease (central hypothyroidism).The chronic manifestation of this disorder is known as Hashimoto’s thyroiditis.

Pediatric Hyperthyroidism

Hyperthyroidism is an extremely rare condition in infants and children, and the vast majority of cases are caused by an autoimmune disorder known as Graves' disease. It can also be caused by a non-immune viral infection. It is usually treated with anti-thyroid medication and in more extreme cases, with radioactive iodine ablation or a thyroidectomy.

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