Children often develop problems with their thyroid gland, a small, butterfly-shaped organ located at the base of the neck. This gland produces hormones instrumental in regulating metabolism, the process of converting food into energy. In children, these hormones are especially important because they govern normal physical growth, neurological development, and the maturation of various organ systems. An imbalance can affect nearly every cell and function, making early detection of dysfunction critical.
Types of Pediatric Thyroid Conditions
The most common thyroid issues in children involve an imbalance in hormone production, categorized as either hypothyroidism (underactive) or hyperthyroidism (overactive). Hypothyroidism, an insufficient production of thyroid hormone, is the most frequently diagnosed condition in pediatric patients. This deficiency can be present from birth (congenital) or develop later (acquired).
Congenital hypothyroidism occurs when the gland does not develop or function correctly during fetal development. Acquired hypothyroidism is primarily caused by Hashimoto’s thyroiditis, an autoimmune disorder where the immune system attacks the thyroid tissue, leading to chronic inflammation and declining hormone output.
Conversely, hyperthyroidism occurs when the thyroid produces too much hormone. Most cases are caused by Graves’ disease, an autoimmune condition where antibodies overstimulate the thyroid. Less common are structural issues like a goiter (gland enlargement) or thyroid nodules (lumps), which are rare but carry a higher risk of being cancerous in children.
Recognizing the Signs in Children
Symptoms of thyroid dysfunction in children interfere directly with growth and development. Hypothyroidism causes a metabolic slowdown, leading to a noticeable decrease in growth rate and potentially short stature if untreated. Children may exhibit fatigue, sluggishness, difficulties with concentration, and poor school performance.
Physical signs of an underactive thyroid include dry, coarse skin, hair loss, feeling cold, and chronic constipation. Any weight gain is usually modest and secondary to stalled linear growth. In adolescents, hypothyroidism can also delay puberty or cause irregular, heavy menstrual periods in girls.
Hyperthyroidism, or an overactive thyroid, presents as an acceleration of bodily functions, often mistaken for anxiety or hyperactivity. Children may experience unexplained, rapid weight loss despite an increased appetite. They frequently report heat intolerance, excessive sweating, and a rapid or irregular heartbeat.
Behaviorally, a child with hyperthyroidism can be irritable, emotionally volatile, and demonstrate poor focus. In some cases, the eyes may appear prominent or bulging, a sign associated with Graves’ disease. Although initial growth may accelerate due to the metabolic speed-up, bones may mature too quickly, ultimately leading to a shorter adult height.
Diagnosis and Management
Detection of pediatric thyroid issues begins immediately after birth with routine newborn screening for congenital hypothyroidism. If a problem is suspected later, diagnosis is confirmed using blood tests that measure hormone levels. These tests specifically check Thyroid-Stimulating Hormone (TSH) from the pituitary gland, and the thyroid hormones T4 (thyroxine) and T3 (triiodothyronine).
For hypothyroidism, a high TSH level paired with low T4 indicates the thyroid is underperforming. The standard treatment is a daily dose of synthetic levothyroxine, which replaces the missing hormone. Regular monitoring of TSH and T4 levels is required to ensure the child receives the correct dosage, which must be adjusted as they grow.
In hyperthyroidism, blood work usually shows a suppressed TSH level with high T4 and T3 concentrations. Initial management involves anti-thyroid medication, such as methimazole, which blocks the thyroid from producing excessive hormone. For severe symptoms like rapid heart rate, a temporary beta-blocker prescription may provide immediate relief.
If anti-thyroid medication is ineffective or causes adverse reactions, definitive treatments are considered. These options include radioactive iodine ablation, which destroys overactive thyroid cells, or surgery (thyroidectomy) to remove the gland. Both permanent interventions result in hypothyroidism, necessitating lifelong treatment with levothyroxine.