Hypothyroidism In Children: Causes, Symptoms And Treatment

Hypothyroidism In Children

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Childhood is the time to grow, learn, and be robust. But in some cases, it doesn’t happen as certain health issues like hypothyroidism mitigate the development of a child.

Slow growth rate, low metabolism, and increasing fatigue are the signs of hypothyroidism in children.

MomJunction tells you about the importance of the thyroid gland, the causes, and symptoms of hypothyroidism and the ways to control it.

Let’s begin with knowing about the thyroid gland.

What Is The Thyroid Gland And Why Is It Important?

The thyroid gland is an endocrine gland, shaped like a butterfly and located down in the front of the neck, right below the Adam’s apple and along the front of the windpipe.

What Is The Thyroid Gland And Why Is It Important

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The thyroid gland produces two vital hormones called thyroxine (T4) and triiodothyronine (T3) that regulate all the aspects of your child’s growth — functioning of the heart, development of the brain, proper working of the organs and other metabolic activities.

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[ Read: Autoimmune Diseases In Children ]

What is Hypothyroidism?

Hypothyroidism is a condition where the thyroid gland is not able to produce enough hormones to keep the body running optimally.

It results from the under secretion of the hormones, and overproduction of the thyroid stimulating hormone (TSH) from the pituitary gland.

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What Are The Types Of Hypothyroidism?

There are four types of hypothyroidism in children:

1. Congenital hypothyroidism:

The word congenital means something that is present from birth. Congenital hypothyroidism occurs when the thyroid gland is absent, under-developed or abnormally located. This is called dysgenesis (1).

Sometimes, the gland is developed but is incapable of producing thyroid hormones because of an anatomical defect in the gland. These cases are called thyroid dyshormonogenesis.

2. Chronic lymphocytic thyroiditis or Hashimoto’s disease

If the thyroid gland works normally during the initial years of a child’s birth, but later starts dysfunctioning, it is known as acquired hypothyroidism.

Acquired hypothyroidism could be Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis (CLT), which is an autoimmune disorder (2).

In this condition the immune system attacks the thyroid gland, damaging and decreasing the functionality of the gland.

It is more common in girls than boys.

3. Iatrogenic hypothyroidism

Iatrogenic hypothyroidism is another acquired hypothyroidism affecting children in whom the thyroid gland has been excised surgically or eroded medically. The condition is irreversible if the gland is removed, and reversible if the gland has eroded partially due to some medications (3).

4. Central hypothyroidism

Central hypothyroidism (4) occurs due to insufficient stimulation of the thyroid gland (which is otherwise normal) by the thyroid stimulating hormone or TSH. Central hypothyroidism may happen due to:

  • trauma
  • a tumor and its subsequent treatment like a surgery
  • abnormal development of the pituitary gland (the master gland for producing hormones)
  • inheritance

Central hypothyroidism usually comes along with other hormonal deficiencies.

In addition to the above, there is subclinical hypothyroidism or SCH, which is a mild thyroid failure. It can be diagnosed when the TSH levels are a little elevated, but the T4 levels remain normal.

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Causes Of Hypothyroidism

Below are the major causes of hypothyroidism in children (5), (6):

  1. Heredity: A family history of hypothyroidism may make the child vulnerable to the condition.
  1. Deficiency of iodine: Thyroid hormones T3 and T4 have three and four iodine atoms respectively. Therefore, the availability of iodine affects the child’s thyroid functioning. Low levels of iodine make the gland less capable of making the hormones.
  1. Autoimmune disorders: If the child has other autoimmune conditions, wherein the antibodies attack within the body, it could also lead to hypothyroidism.
  1. Thyroiditis: A condition where a viral infection causes the thyroid to swell for a temporary period.
  1. Surgery or treatments: Surgical removal of the thyroid gland done to treat some serious illness like nodules or cancer, or any radiation treatment done to the neck can also lead to the development of hypothyroidism.
  1. Medicines: Certain medicines such as alpha, lithium, amiodarone, aminoglutethimide, thalidomide, sunitinib and sorafenib can be harmful, and prevent the thyroid gland from functioning optimally.
  1. Damage of the pituitary gland: When the pituitary gland is damaged, it cannot signal the brain about the quantity of hormone to produce. Therefore, not enough TSH is made to ensure the functioning of the thyroid.

Hypothyroidism can remain undetected because of the nonspecific symptoms. Therefore, you need to be alert and look out keenly for the symptoms.

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What Are The Signs And Symptoms Of Hypothyroidism?

The symptoms in children vary according to their age. Some of them are (7):

  • Being shorter in height than other children of the same age
  • Have shorter limbs
  • Development of permanent teeth later than normal
  • Puberty beginning later than normal
  • Weight gain
  • Slower mental growth
  • Slow in reactions
  • Coarse skin
  • Slower than normal heart rate
  • Decreased metabolism
  • Increased sensitivity to cold
  • Muscle cramps
  • Hoarse voice
  • Slow speech
  • Enlarged thyroid resembling a goiter-like growth
  • Brittle and coarse hair
  • Puffy facial features
  • Too much fatigue
  • Constipation
  • Poor feeding
  • Sleeping more or less than normal

If you observe several of these symptoms in your child, take them to a doctor for a diagnosis.

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How Is Hypothyroidism Diagnosed?

Your child’s doctor may recommend blood tests to evaluate the levels of the hormones (8) (9):

  1. Blood tests for thyroid function screening: They measure thyroxine (T4) and TSH levels. Hypothyroidism is detected if the test shows an increased TSH level and a low T4.
  1. Anti-thyroid antibody test: This checks the levels of antibodies released against the thyroid. In the case of autoimmune hypothyroidism, two antibodies, namely anti-thyroperoxidase and anti-thyroglobulin, levels are higher. They serve as indications of the problem.
  1. Ultrasound: Ultrasonic waves image your child’s thyroid gland and the lymph nodes. The thyroid tissue may appear irregular, and some areas might look like a nodule in the gland. This method can also be performed on a newborn for detecting congenital hypothyroidism.
  1. Nuclear medicine scan: This helps to know how your child’s thyroid tissues absorb iodine. For this test your child will be given a small dose of radioactive iodine (I-123 or technetium-99), which is then studied to know the iodine absorption levels. This test is also done to identify the location of thyroid tissues for early detection of congenital hypothyroidism.

Once the tests confirm hypothyroidism, the doctor will begin the treatment process.

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Treatment Of Hypothyroidism In Children

The most common treatment for hypothyroidism is the thyroid replacement pill levothyroxine, which is chemically identical to thyroxine or T4 (10) (11).

Here is the usually recommended dose of the drug:

AgeDose (mcg/kg/day)
1 to 3 years4 to 6
3 to 10 years3 to 5
10 to 16 years2 to 4
  • Levothyroxine is administered once a day, and its maximum response is attained in the second week.
  • The medicine is ideally taken on an empty stomach and at least 30 minutes before a meal.
  • During the medication, do not use soy formula, and iron or calcium supplements, as they decrease the absorption of thyroid hormone.
  • The doctor will monitor the child regularly – every six to 12 months, if the child is older than three years.
  • Since the thyroid is caused by a deficiency of iodine, increase iodine-rich foods and iodine salt in your child’s diet. More on that in the next section.

In rare cases where levothyroxine alone doesn’t work, the doctor might recommend liothyronine (T3) as well (12).

Children with subclinical hypothyroidism do not need a replacement therapy unless the condition matures.

You may supplement the treatment by adding certain foods to the child’s diet and removing some.

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[ Read: Thyroid Cancer In Children ]

Foods To Eat And Foods To Avoid In Hypothyroidism:

Foods your child can eat:

  • Give them fish, eggs, dairy, seaweed and other iodine-rich foods.
  • Use iodized salt instead of regular salt but keep iodine intake within limits.
  • Selenium helps activate thyroid hormones; hence give Brazil nuts, tuna fish, and legumes.
  • Give zinc-rich foods like shellfish, oysters, chicken, and beef as zinc regulates TSH levels in the body (13).

The other foods your child can eat are:

  • Any seafood such as salmon, halibut, shrimps
  • Bananas
  • Oranges
  • Tomatoes
  • Milk
  • Cheese
  • Yogurt
  • Non-caffeinated drinks

Foods your child should avoid:

Foods rich in goitrogenic compounds may interfere with the functioning of the thyroid gland. Some of them are (14):

  • Soy foods like tempeh, tofu
  • Goitrogenic vegetables like cabbage, cauliflower, spinach, and broccoli
  • Red meat
  • Fruits such as peaches, strawberries, sweet potatoes, cassava
  • Nuts such as almonds, peanuts and walnuts
  • Millet
  • Raw Swedes, turnips, and kale
  • Green tea
  • High-calorie food

You need to take every possible care during the treatment because negligence can lead to complications.

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[ Read: Low Blood Pressure In Children ]

What Are The Possible Complications Of Hypothyroidism?

If hypothyroidism goes untreated, it can lead to numerous health complications. Let us go through the most common ones:

  1. Heart diseases: Hypothyroidism poses an increased risk of heart diseases due to the presence of low-density lipoprotein (LDL) cholesterol (bad cholesterol) in high levels (15).

Even mild hypothyroidism with few developed symptoms can lead to an increase in the total cholesterol levels in blood and impair the pumping ability of the heart. Often, hypothyroidism is associated with heart enlargement.

  1. Mental illness: The condition can cause depression, which is often called lower thyroid syndrome (16). If not treated, it may become severe with time. Hypothyroidism can also result in slow cognitive development and low IQ.
  1. Myxedema: The condition happens if hypothyroidism is ignored and untreated for long. Myxedema is rare and its symptoms include intolerance of cold, drowsiness, and lethargy (17).
  1. Peripheral neuropathy: Long-term and untreated hypothyroidism may damage the peripheral nerves of your child. The symptoms include pain, numbness, weak muscles and tingling in the affected areas (18).
  1. Muscle diseases: The child may have muscle weakness, aches and cramps, and stiffness.
  1. Infertility in later life: Low thyroid levels reduce infertility, and cause menstrual disturbances in women. In men, it can lead to erectile problems and abnormalities in sperm motility (19).

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The thyroid is often complex, and the treatment is long-term. It has short-term and long-term repercussions on the overall development of the child. Therefore, if your child has a family history of the condition, look out for the symptoms, and begin the treatment at the earliest. This will help control the damage to the child’s development.

Do you have any experience to share? Let us know in the comment section below.

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