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Quick reference medical handouts used by Pediatric offices


Hypothroidism in Children


Hypothyroidism is the condition in which the thyroid is underactive and is producing an insufficient amount of thyroid hormones. Hypothyroidism is the most common thyroid disorder. However, children with the disorder display different symptoms from adults 

  • Infants and small children affected by hypothyroidism may have significant problems with growth and development if it not diagnosed and treated promptly.
  • In older children and young adults, hypothyroidism can cause diverse symptoms due to lack of thyroid hormone, including slowed heart rate, chronic tiredness, inability to tolerate cold, mental fatigue and difficulty in learning, and constipation.

Hypothyroidism can develop at any point in the lifespan. Infants can be born with hypothyroidism, and hypothyroidism can develop in children and adults of any age.

The thyroid is a butterfly-shaped gland located at the base of the neck, just below thr Adam's apple. Although it weighs less than an ounce, the thyroid gland has an enormous effect on your child's health. All aspects of a child's  metabolism,  are regulated by thyroid hormones.

The thyroid gland secretes thyroid hormones, which control the speed at which the body's chemical functions proceed (metabolism). To produce thyroid hormones, the thyroid gland needs iodine, an element contained in many foods. The thyroid gland also produces a hormone called calcitonin, which may be involved in the metabolism of bones

Normal levels of thyroid hormone are vital for proper growth and development.Consequently, hypothyroidism, especially in infants and young children, can lead to serious, sometimes permanent, developmental problems if not detected and treated promptly.

For infants born with hypothyroidism, diagnosis and treatment within the first month or so of life may prevent any irreversible problems with the child's development. On the other hand, if diagnosis or treatment is delayed until after the first two or three months of life, permanent problems with the child's development, most noticeably mental retardation, may be unavoidable.

The older the child when hypothyroidism develops, the less the chances of permanent effects on the child. Consequently, older children who develop hypothyroidism may show many of the symptoms associated with inadequate organ stimulation (such as slowed heart rate, difficulties in thinking and learning, and constipation) but little, if any, permanent abnormality in growth or development.

Symptoms of hypothyroidism In Infants And Young Children

Hypothyroidism that occurs in infancy or early childhood is called cretinism. Babies born with hypothyroidism classically show a number of symptoms in the first weeks to months of life. At birth, many symptoms are subtle, though, and can be missed. They include the following:

  • Puffy face, swollen tongue
  • Hoarse cry Cold extremities, mottled skin
  • Low muscle tone (floppy, no strength)
  • Poor feeding
  • Thick coarse hair that goes low on the forehead
  • Larger-than-normal soft spots on the skull
  • Prolonged newborn jaundice (a yellow discoloration of the skin and the whites of the eyes) Herniated bellybutton
  • Lethargic (lack of energy, sleeps most of the time, appears tired even when awake)
  • Persistent constipation, bloated or full to the touch
  • :Little to no growth
Over time, if untreated, other symptoms typically become apparent in older infants, toddlers, and young children. The most obvious symptoms observed in these youngsters reflect insufficient thyroid hormone for growth and development:
  • Short stature for age and delayed eruption of baby teeth
  • Delays in major developmental milestones
  • Puffy facial features
  • Severe mental retardation
  • Protruding abdomen and umbilical hernia (a soft protrusion around the navel
  • Dry skin and sparse hair

Symptoms In Older Children

When hypothyroidism develops in older children before growth and development are complete, they may have a shorter-than-average height or puberty may be delayed. They also may have symptoms that are more like those found in adults:

  • Slow heart rate

  • Tiredness

  • Inability to tolerate cold

  • Dry, flaky skin

  • Puffiness in the face, especially around the eyes

  • Impaired memory and difficulty in thinking (which may appear as a new learning disability)

  • Emotional depression

  • Drowsiness, even after sleeping through the night

  • Heavy or irregular menstrual periods (in girls at the age of puberty)

  • Constipation

  • TSH - Thyroid Stimulating Hormone is released by the pituary gland that causes the thyroid gland to produce thyroid hormone
  • T4 - a hormone secreted by the thyroid gland which regulates metabolism.
  • T3 - a hormone secreted by the thyroid gland which regulates metabolism; exerts the same biological effects as T4, but is generally more potent and the onset of its effect is more rapid.

How Is Hypothyroidism Diagnosed?

In the United States, Canada, and much of the Western world, newborns are routinely screened for thyroid hormone deficiency. Infants with abnormal screening tests receive follow-up evaluation for hypothyroidism. Such testing commonly leads to the correct diagnosis within the first four weeks of age, and treatment can begin immediately.

Diagnosis later in childhood is usually based on information from blood tests, which check levels of thyroid hormones T4, T3, and TSH, among other related substances. Abnormally low levels of T4 and T3 indicate hypothyroidism is present.

  • If TSH is present at a higher-than-normal level, the abnormality is within the thyroid gland. It is not responding properly to TSH.
  • If TSH is low, the abnormality is within the brain or pituitary gland. The pituitary is not releasing TSH despite levels of thyroid hormone low enough that it should do so

Among babies with hypothyroidism, roughly 95% or more of cases represent problems in the thyroid gland. In less than 5% of cases, the abnormality is found in the brain or in the pituitary gland, the small gland at the base of the brain, almost always the pituitary gland.

This is the same for hypothyroidism that develops in older children and young adults, although the exact causes of hypothyroidism are different for the different age groups.

Causes Of Hypothyroidism In Newborns

Hypothyroidism present from birth is called congenital hypothyroidism. In North America, CH is found in roughly 1 in every 4,000 newborns. Congenital hypothyroidism used to be a major cause of mental retardation. Development of the brain, as well as normal growth of the child, is dependent upon normal levels of thyroid hormone. Congenital hypothyroidism results in permanent hypothyroidism and require life-long treatment, and these account for about 90% of all newborns with CH:

  • Abnormal thyroid gland development includes babies born without a thyroid gland and those whose thyroid is not functioning (roughly 80% to 85% of cases).
  • Abnormal thyroid hormone production is much less common (roughly 10% to 15% of cases). It is often inherited.
  • Abnormal development of the brain or pituitary gland is the least common cause of permanent CH (fewer than 5% of cases).

 

Causes Of Hypothyroidism That Develops During Childhood

Hypothyroidism that develops during childhood has a number of causes. In general, the older the child, the more likely it is that the cause will be similar to the causes of hypothyroidism in adults.

Causes of hypothyroidism that develops during childhood include:

  • Late appearance of a congenital problem - A congenital problem is a problem with which a baby is born. But sometimes these problems may only become apparent later, after the newborn period. These children may have small or poorly formed thyroid glands that could not meet the demands of the growing child.
  • Inhibition of thyroid hormone production in the thyroid gland- Inability to produce enough thyroid hormone may reflect poor function of an apparently normal thyroid gland. This can be caused by too little iodine in the diet or a drug taken for a non-thyroid condition inhibits the production of thyroid hormone. 
  • Permanent thyroid cell loss as a consequence of a medical treatment Autoimmune disease -
  • Autoimmune disorders are the most common cause of thyroid problems- in these conditions, the normal ummune system mistakenly directs an immune "attack" against is own healthy cells. Specifically, the immune system makes antibodies (or attack proteins) that can affect the function of the thyroid. In Hashimoto's thyroiditis, the antibodies directly attack and destroy thyroid cells.

What Is The Treatment For Hypothyroidism?

No matter what form of hypothyroidism a child develops, the treatment is always the same. It involves prescription thyroid replacement hormone treatment, in pill form, This will supply the body with the thyroid hormone that isn't being produced and released by the thyroid gland. Synthetic (artificially produced) thyroid hormone (T4) is manufactured in a wide range of strengths so that dosage can be individually tailored for each child.

It is important that an experienced physician oversee treatment, because the body's need for thyroid hormone varies over the course of childhood and puberty. A child will usually be started on a daily dose of thyroid hormone, have it adjusted until a healthy level of hormone in the blood is reached, and then be monitored with regular blood tests.

Almost all children with hypothyroidism will require thyroid hormone replacement therapy for the rest of their lives. 

posted 01-12-06

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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