Thyroid Disorders
Pediatric thyroid disorders affect the thyroid gland, which is crucial for regulating metabolism, growth, and development in children . While thyroid disorders are less common in children than adults, they can significantly impact growth, cognitive development, and overall health. Here’s a breakdown of the primary thyroid disorders in children, including their causes, symptoms, diagnosis, and treatments.
Congenital Hypothyroidism (CH)
- Cause: Underdeveloped or absent thyroid gland, or an enzyme deficiency affecting thyroid hormone production. CH is typically present from birth.
- Symptoms: In newborns, symptoms may include jaundice, poor feeding, a large tongue, and hypotonia (low muscle tone). If untreated, it can lead to developmental delays and growth failure.
- Diagnosis: Screening at birth through blood tests to measure thyroid hormone levels (T4 and TSH).
- Treatment: Early initiation of thyroid hormone replacement (levothyroxine) to support normal growth and brain development. Treatment usually continues for life, with regular monitoring.
Acquired Hypothyroidism
- Cause: Autoimmune conditions like Hashimoto's thyroiditis (most common cause), iodine deficiency, or certain medications.
- Symptoms: Fatigue, weight gain, constipation, cold intolerance, slowed growth, delayed puberty, and learning difficulties.
- Diagnosis: Blood tests showing low thyroid hormone levels and elevated TSH. Antibody tests (e.g., anti-thyroid peroxidase) can confirm Hashimoto's.
- Treatment: Levothyroxine therapy to normalize thyroid hormone levels, with regular follow-up to adjust dosages as the child grows.
Hyperthyroidism (Graves' Disease)
- Cause: An autoimmune disorder where antibodies (TSI or thyroid-stimulating immunoglobulins) stimulate the thyroid gland to overproduce hormones.
- Symptoms: Increased appetite, weight loss, nervousness, restlessness, sweating, rapid heartbeat, tremors, and bulging eyes (exophthalmos).
- Diagnosis: High thyroid hormone levels with low TSH, along with elevated levels of thyroid-stimulating antibodies.
- Treatment: Antithyroid medications (e.g., methimazole) to control thyroid hormone production, beta-blockers for symptom relief, and in some cases, radioactive iodine therapy or surgery.
Thyroid Nodules and Thyroid Cancer
- Cause: The cause of thyroid nodules in children is not always clear, but risk factors include radiation exposure and family history. While most nodules are benign, some can be cancerous.
- Symptoms: A noticeable lump in the neck, difficulty swallowing, hoarseness, or swollen lymph nodes.
- Diagnosis: Physical examination, ultrasound of the thyroid, and fine needle aspiration (FNA) biopsy if necessary.
- Treatment: Depending on the biopsy results, treatment may involve surgical removal of the nodule or thyroid, with further treatments if cancer is detected.
Hashimoto’s Thyroiditis
- Cause: An autoimmune disorder where the immune system attacks thyroid tissue, causing chronic inflammation and gradual decline in thyroid function.
- Symptoms: Often asymptomatic in early stages; as hypothyroidism develops, symptoms may include fatigue, weight gain, slowed growth, and cognitive changes.
- Diagnosis: Elevated TSH with low thyroid hormones (T4, T3) and positive thyroid antibodies.
- Treatment: Levothyroxine is prescribed if hypothyroidism develops. Regular monitoring is essential, especially during growth spurts and puberty.
Thyroid Dysgenesis and Dyshormonogenesis
- Cause: Congenital abnormalities in the formation (dysgenesis) or function (dyshormonogenesis) of the thyroid gland, usually due to genetic mutations.
- Symptoms: Symptoms are similar to congenital hypothyroidism, with poor growth and developmental delays if untreated.
- Diagnosis: Newborn screening often detects thyroid hormone deficiency, and additional imaging studies (like ultrasound or scintigraphy) may reveal gland abnormalities.
- Treatment: Lifelong thyroid hormone replacement therapy.
Diagnosis of Thyroid Disorders in Children
- Blood Tests: TSH, Free T4, Total T4, and Total T3 are typically measured to assess thyroid function. High TSH with low T4 suggests hypothyroidism, while low TSH with high T4 indicates hyperthyroidism.
- Antibody Testing: Tests for thyroid antibodies (anti-TPO and anti-thyroglobulin) are useful for autoimmune thyroiditis.
- Ultrasound: Helps visualize thyroid gland size, structure, and presence of nodules.
- Fine Needle Aspiration (FNA): For evaluating suspicious nodules.
Treatment and Management of Pediatric Thyroid Disorders
- Hormone Replacement Therapy: For hypothyroid conditions, levothyroxine is the mainstay, with dose adjustments based on age and weight.
- Antithyroid Medications: For hyperthyroidism, medications like methimazole are used. Beta-blockers can manage symptoms like rapid heart rate.
- Surgery or Radioactive Iodine: May be considered for hyperthyroidism unresponsive to medications or for large nodules and thyroid cancer.
- Regular Monitoring: Children on thyroid treatment require regular monitoring to ensure appropriate growth and development and to adjust dosages.